The Centers for Medicaid & Medicare Services (\u201cCMS\u201d) recently released a final rule establishing the new medical loss ratio requirements under the Affordable Care Act (\u201cACA\u201d). Under the ACA, individual and small group market insurers are required to spend at least 80 percent of premium dollars on medical care and quality improvement, and large group market insurers must spend at least 85 percent of premium dollars on the same services. The final rule describes the technical process for calculating medical loss ratio and also provides details on insurers\u2019 annual medical loss ratio reporting requirements, as well as the ACA\u2019s requirement that insurers grant rebates to consumers in the event the insurer fails to meet the required medical loss ratio.<\/p>\n
Read the full text of the rule here<\/a>, or HHS\u2019 fact sheet on the ACA\u2019s changes to medical loss ratios here<\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":" The Centers for Medicaid & Medicare Services (\u201cCMS\u201d) recently released a final rule establishing the new medical loss ratio requirements under the Affordable Care Act (\u201cACA\u201d). Under the ACA, individual and small group market insurers are required to spend at least 80 percent of premium dollars on medical care and quality improvement, and large group … <\/p>\n