Here is the Code of Federal Regulations (CFR) on MLR – Medical  Loss Ratio.  Part 158
For an introduction see our sister web pages.

 

PART 158—ISSUER USE OF PREMIUM REVENUE: REPORTING AND REBATE REQUIREMENTS

Proposed Rules CMS 9930 P 10.27.2017

Contents

§158.101   Basis and scope.
§158.102   Applicability.
§158.103   Definitions.

Subpart B—Calculating and Providing the Rebate

§158.210   Minimum medical loss ratio.
§158.211   Requirement in States with a higher medical loss ratio.
§158.220   Aggregation of data in calculating an issuer’s medical loss ratio.
§158.221   Formula for calculating an issuer’s medical loss ratio.
§158.230   Credibility adjustment.
§158.231   Life-years used to determine credible experience.
§158.232   Calculating the credibility adjustment.
§158.240   Rebating premium if the applicable medical loss ratio standard is not met.
§158.241   Form of rebate.
§158.242   Recipients of rebates.
§158.243   De minimis rebates.
§158.244   Unclaimed rebates.
§158.250   Notice of rebates.
§158.251   Notice of MLR information.
§158.260   Reporting of rebates.
§158.270   Effect of rebate payments on solvency.

 

 

Regulations

Guidance

  • December 17, 2010 OCIIO Technical Guidance: Process for a State to Submit a Request for Adjustment to the Medical Loss Ratio Standard of PHS Act Section 2718 (PDF – 35 KB)
  • April 26, 2011 CCIIO Technical Guidance: Submission of 2011 Quarterly Reports of MLR Data by Issuers of “Mini-med” and Expatriate Plans (PDF – 26 KB)
  • May 13, 2011 CCIIO Technical Guidance: Questions and Answers Regarding the Medical Loss Ratio Interim Final Rule (PDF – 75 KB)
  • May 19, 2011 CCIIO Technical Guidance: Deadline for Submission of 2011 First Quarter MLR Data by Issuers of “Mini-med” and Expatriate Plans (PDF – 26 KB)
  • July 18, 2011 CCIIO Technical Guidance: Questions and Answers Regarding the Medical Loss Ratio Interim Final Rule (PDF – 66 KB)
  • February 10, 2012 CCIIO Technical Guidance: Questions and Answers Regarding the Medical Loss Ratio Interim Final Rule (PDF – 94 KB)
  • March 30, 2012 Memo to Insurance Companies: Medical Loss Ratio Annual Reporting Procedures (PDF – 96 KB)
  • April 20, 2012 CCIIO Technical Guidance: Questions and Answers Regarding the Medical Loss Ratio Regulation (PDF – 101 KB)
  • May 15, 2012 Memo to Insurance Companies: Guidance for Medical Loss Ratio Annual Reporting Form (PDF – 66 KB) Memo to Insurance Companies: Guidance for Medical Loss Ratio Notices of Rebates (PDF – 67 KB)
  • May 24, 2012 CCIIO Technical Guidance: Questions and Answers Regarding the Medical Loss Ratio Reporting Form (PDF – 91 KB)
  • May 30, 2012 CCIIO Technical Guidance: Questions and Answers Regarding the Medical Loss Ratio Reporting Requirements (PDF – 83 KB)
  • July 17, 2012 CCIIO Technical Guidance: Questions and Answers Regarding the Medical Loss Ratio Reporting and Rebate Requirements (PDF – 69 KB)
  • March 29, 2013 Memo to Insurance Companies: Guidance for 2012 Medical Loss Ratio Annual Reporting Form (PDF –119 KB) Memo to Insurance Companies: Announcement Regarding Training for 2012 Medical Loss Ratio Reporting Period (PDF – 125 KB)
  • April 5, 2013 CCIIO Technical Guidance: Questions and Answers Regarding the MLR Reporting and Rebate Requirements (PDF – 139 KB)
  • May 30, 2013 CCIIO Technical Guidance: Question and Answer Regarding the Requirement that Issuers of Certain Health Insurance Coverage Sold as Fixed Indemnity Insurance Submit an Annual Medical Loss Ratio (MLR) Report to the Secretary (PDF – 89 KB)
  • July 2, 2013 CCIIO Technical Guidance Questions and Answers Regarding the Medical Loss Ratio Reporting and Rebate Requirements [PDF, 109KB]
  • December 30, 2013 CCIIO Technical Guidance (CCIIO 2013—0004): Question and Answer Regarding the Medical Loss Ratio Reporting and Rebate Requirements [PDF, 120KB]

Technical Links


Regulations:

Guidance:

 

 

UnitedHealth to rebate $3.5 million to California small businesses

Nearly 4,400 small businesses in California will share in $3.5 million in rebates from insurance giant UnitedHealth Group

about $98 each for nearly 36,000 small-business employees and dependents

Other companies are expected to disclose the size of their customer rebates later this week and send out money by Aug. 1.

Under the federal and state laws, insurers must spend at least 80% of premiums collected on medical care for individual and small-group policies, which cover businesses with 50 or fewer workers

it’s up to employers to decide how they share those savings under the federal law. Some employers may split the rebate money based on the percentage workers contribute to their annual premiums or they could reduce next year’s premium by a similar amount.

but the rules don’t address the larger issue of rising medical costs.

“Rebates are one way to adjust the price of insurance,” Johnston said, “but the bigger issues are containing cost and extending coverage.”

latimes.com

Sibling Pages

 

 

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