Before the medical loss ratio rule came into effect, insurers could accumulate a reserve from low-claim years to pay for the claims in high-claim years.
"Liars figure, and figures lie." When I was a kid, I remember seeing this on a plaque in the clubhouse of a golf course I worked at. Now, as an adult in the health care industry, these words really ring true.
Medical loss ratio, a part of the health care reform, requires insurers to spend a specified percentage (80% for small groups and 85% for large groups) of total premiums on medical costs and expenses that improve health care quality. If these requirements aren't reached, the insurers must issue rebates to their customers.
Complete your profile to continue reading and get FREE access to BenefitsPRO, part of your ALM digital membership.
Your access to unlimited BenefitsPRO content isn’t changing.
Once you are an ALM digital member, you’ll receive:
- Breaking benefits news and analysis, on-site and via our newsletters and custom alerts
- Educational webcasts, white papers, and ebooks from industry thought leaders
- Critical converage of the property casualty insurance and financial advisory markets on our other ALM sites, PropertyCasualty360 and ThinkAdvisor
Already have an account? Sign In Now
© 2025 ALM Global, LLC, All Rights Reserved. Request academic re-use from www.copyright.com. All other uses, submit a request to [email protected]. For more information visit Asset & Logo Licensing.
