The Affordable Care Act allows the Secretary to adjust the Medical Loss Ratio standard for a state if it is determined that meeting the 80% MLR standard may destabilize the individual market. In order to qualify for this adjustment, a state must demonstrate that requiring insurers in its individual market to meet the 80% MLR has a likelihood of destabilizing the individual market and result in fewer choices for consumers.
This HHS Bulletin describes the method and format states must use in order to apply for an MLR adjustment. Applications must be submitted by email to MLRAdjustments@hhs.gov
A state’s request for an adjustment to the MLR standard is a public document. The Secretary invites public comment regarding a state’s request. However, public comments must be submitted within 10 calendar days of HHS posting a state's complete request online to guarantee consideration. The public comment period is designed to give all interested parties full opportunity to present relevant information to the Secretary, which will be considered in making a timely determination on whether an adjustment to the statutory MLR standard is justified for the state applicant’s individual market.
This page contains state applications for an adjustment to the MLR standard for the individual market. When an application is deemed complete, the web page will be updated to reflect the deadline for public comment on the state’s application. To guarantee consideration, public comments must be submitted electronically by midnight on the 10th calendar day after the posting of a complete state request.
To submit a comment regarding a State's adjustment application, please email MLRAdjustments@hhs.gov . Please include the relevant state applicant in the email subject line.
State Requests for MLR Adjustment: