Many insurance companies spend a substantial portion of consumers’ premium dollars on administrative costs and profits, including executive salaries, overhead, and marketing.
The Affordable Care Act requires health insurance issuers to submit data on the proportion of premium revenues spent on clinical services and quality improvement, also known as the Medical Loss Ratio (MLR). It also requires them to issue rebates to enrollees if this percentage does not meet minimum standards. The Affordable Care Act requires insurance companies to spend at least 80% or 85% of premium dollars on medical care, with the rate review provisions imposing tighter limits on health insurance rate increases. If an issuer fails to meet the applicable MLR standard in any given year, as of 2012, the issuer is required to provide a rebate to its customers.
November 1, 2019
Enhanced Direct Enrollment Approved Partners (Updated)
August 15, 2019
Quality Rating Information Bulletin for Plan Year 2020
April 18, 2019
CMS-9926-F: Final HHS Notice of Benefit and Payment Parameters for 2020
Final 2020 Letter to Issuers on Federally-facilitated Exchanges
Key Dates for Calendar Year 2019: QHP Certification in the FFEs; Rate Review; Risk Adjustment
February 28, 2019
Section 1332 Pass-through Funding Tools and Resources