The MLR, part of the Patient Protection and Affordable Care Act, requires health insurers spend at least 80 percent (for individual and small group markets) or 85 percent (for large group markets) of premiums on medical care instead of profit, marketing and other administrative costs.
The final rule does not require insurers to include information about the current or prior year MLR, and the mandated notice will direct policyholders to the HHS website for specific information on all health insurers’ MLRs.
CMS officials said the final rule should expand transparency for consumers on how their premium dollars are used and provide an incentive for health insurers to maximize their premiums on improving healthcare and promote greater efficiency.
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HHS Ramps Up Medical Loss Ratio Efforts
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