CHA News Article

California Medical Loss Ratio Resources Released
Data include median MLR, number of insurers owing a rebate, average rebate per enrollee, and more

The California HealthCare Foundation (CHCF) has released California medical loss ratio (MLR) resources including a reference guide and two fact sheets about the MLR. Data encompass MLR summaries for California’s individual, small group and large group insurance markets, as well as MLR standards; median MLR; number of insurers owing a rebate; average rebate per enrollee; premium spending on medical claims and sales expenses; commercial market size, by premiums and enrollment; and premiums per member per month.

About the MLR
The Affordable Care Act (ACA) requires health insurance issuers to submit data on the proportion of premium revenues spent on clinical services and quality improvement, also known as the MLR. The ACA also requires them to issue rebates to enrollees if this percentage does not meet minimum standards. Insurance companies are required to spend at least 80 percent (individual and small group markets) or 85 percent (large group markets) of premium dollars on medical care, with the review provisions imposing tighter limits on health insurance rate increases. Since 2011, the Department of Health and Human Services has enforced minimum MLR standards.

To view the CHCF resources, visit the CHCF website. More information about the MLR is available at www.cms.gov/CCIIO/Resources/Data-Resources/mlr.html.

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