Medical Loss Ratio Rebates — 5 Tips For ERISA Sponsors

Law360, New York (September 18, 2013, 6:13 PM EDT) -- The Affordable Care Act’s medical loss ratio (MLR) rule requires health insurance companies (but not self-insured plans) in the group or individual market to provide an annual rebate to enrollees if the insurer’s MLR falls below a certain minimum level.

Generally, this means that health insurance companies in the individual and small-group markets must spend at least 80 percent of the premium dollars they collect on medical care and quality improvement activities, and health insurance companies in the large-group market must spend at least 85 percent...
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