Medical Loss Ratio (MLR) and Rate Review

The Affordable Care Act includes features that promote transparency and hold insurers accountable for how they spend your premium dollars and rate increases. “Medical Loss Ratio” and “Rate Review” are two features of the health care law that are in place and making a difference for consumers.

  • Medical Loss Ratio: Insurers      must, in general, spend 80% or 85% of the premium dollars they take in on      health care costs and health care improvement activities. If they do not,      they must provide refunds to policy holders.
  • Rate Review: Health insurance companies      must tell consumers when they want to increase insurance rates for      individual or small group policies by an average of 10% or more. Learn      more about Rate Reviews. has created a search tool to find a basic profile of your insurance company or information about Medical Loss Ratio (MLR) and Rate Reviews. Medical Loss Ratio (MLR) and Rate Reviews Carrier Profiles



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The information provided is for informational purposes only and does not constitute legal advice. The information above contains only a summary of the applicable legal provisions and does not purport to cover every aspect of any particular law, regulation or requirement. Depending on the specific facts of any situation, there may be additional or different requirements. This is to be used only as a guide and not as a definitive description of your compliance obligations.