Indiana Insurance Commissioner Stephen W. Robertson issues Bulletin 185 on Medical Loss Ratio Requirements in the Small Group Market
Nov 2, 2011
The Indiana Department of Insurance Commissioner Stephen W. Robertson has issued Bulletin 185 pertaining to Medical Loss Ratio Requirements in the Small Group Market.
This Bulletin is directed to all insurers writing group policies of accident and sickness insurance, as defined by IC 27-8-5-1, and all health maintenance organizations, as defined by IC 27-13-1-19 (collectively, Health Insurers). The Affordable Health Care Act (“ACA”) added new section 2718 to the Public Health Service Act (“PHSA”) requiring health insurance issuers offering coverage in the small group market to provide an annual rebate to each enrollee under such coverage if the ratio of the amount of premium revenue expended by the issuer on costs attributable to reimbursement for clinical services provided to enrollees for such coverage and activities that improve health care quality to the total amount of premium revenue (with certain exclusions) for the plan year (the “Medical Loss Ratio”) in less than 80 percent, or such higher percentage as a state determines by regulation. The ACA medical loss ratio rules apply as of the first plan or policy year on or after January 1, 2011. This Bulletin is intended to provide guidelines for implementing these new medical loss ratio requirements in the small group market in Indiana.
Click on the embedded hyperlink to view the attached document, which details the provisions of the Medical Loss Ratio Requirements in the Small Group Market.
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