§ 158.210 Minimum medical loss ratio.
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Title 45 CFR: Public Welfare › Part 158: ISSUER USE OF PREMIUM REVENUE: REPORTING AND REBATE REQUIREMENTS › Subpart B: Calculating and Providing the Rebate › § 158.210: § 158.210 Minimum medical loss ratio.
Text
Subject to the provisions of § 158.211 of this subpart:
(a)
Large group market.
For all policies issued in the large group market in a State during the MLR reporting year, an issuer must provide a rebate to enrollees if the issuer has an MLR of less than 85 percent, as determined in accordance with this part.
(b)
Small group market.
For all policies issued in the small group market in a State during the MLR reporting year, an issuer must provide a rebate to enrollees if the issuer has an MLR of less than 80 percent, as determined in accordance with this part.
(c)
Individual market.
For all policies issued in the individual market in a State during the MLR reporting year, an issuer must provide a rebate to enrollees if the issuer has an MLR of less than 80 percent, as determined in accordance with this part.
(d)
Adjustment by the Secretary.
If the Secretary has adjusted the percentage that issuers in the individual market in a specific State must meet, then the adjusted percentage determined by the Secretary in accordance with § 158.301 of this part
et seq.
must be substituted for 80 percent in paragraph (c) of this section.
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