Affordable Care Act (ACA) Medical Loss Ratio Rule Issued
On December 1, 2010, the Department of Health and Human Services (HHS) is publishing an interim final rule with comment period implementing ACA medical loss ratio requirements. Under the rule, beginning in 2011, insurance companies in the individual and small group markets must spend at least 80% of the premium dollars they collect on medical care and quality improvement activities, and insurance companies in the large group market must spend at least 85% of premium dollars on medical care and quality improvement activities. Insurance companies that do not meet the medical loss ratio standard will be required to provide rebates to their consumers beginning in 2012. The rule also requires insurance companies to publicly report how they spend premium dollars, beginning in 2011. For background information, see the HHS website. Comments on the rule will be accepted until January 31, 2011.
