# 45 C.F.R. § 158.210 (2026): Minimum medical loss ratio

> Federal · Regulations · In force

URL: https://www.frixlaw.com/law-library/statutes/CFR_T45_P158_S158_210

## Section

- **Citation:** 45 C.F.R. § 158.210 (2026)
- **Heading:** Minimum medical loss ratio
- **Jurisdiction:** Federal
- **Kind:** Regulations
- **Status:** In force
- **Text as of:** August 14, 2026
- **Source:** Compiled text
- **Location:** 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.

## Nearby sections

- [45 C.F.R. § 158.210 (2026) § 158.210   Minimum medical loss ratio.](https://www.frixlaw.com/law-library/statutes/CFR_T45_P158_S158_210.md)
- [45 C.F.R. § 158.211 (2026) § 158.211   Requirement in States with a higher medical loss ratio.](https://www.frixlaw.com/law-library/statutes/CFR_T45_P158_S158_211.md)
- [45 C.F.R. § 158.220 (2026) § 158.220   Aggregation of data in calculating an issuer's medical loss ratio.](https://www.frixlaw.com/law-library/statutes/CFR_T45_P158_S158_220.md)
- [45 C.F.R. § 158.221 (2026) § 158.221   Formula for calculating an issuer's medical loss ratio.](https://www.frixlaw.com/law-library/statutes/CFR_T45_P158_S158_221.md)
- [45 C.F.R. § 158.230 (2026) § 158.230   Credibility adjustment.](https://www.frixlaw.com/law-library/statutes/CFR_T45_P158_S158_230.md)
- [45 C.F.R. § 158.231 (2026) § 158.231   Life-years used to determine credible experience.](https://www.frixlaw.com/law-library/statutes/CFR_T45_P158_S158_231.md)
- [45 C.F.R. § 158.232 (2026) § 158.232   Calculating the credibility adjustment.](https://www.frixlaw.com/law-library/statutes/CFR_T45_P158_S158_232.md)
- [45 C.F.R. § 158.240 (2026) § 158.240   Rebating premium if the applicable medical loss ratio standard is not met.](https://www.frixlaw.com/law-library/statutes/CFR_T45_P158_S158_240.md)
- [45 C.F.R. § 158.241 (2026) § 158.241   Form of rebate.](https://www.frixlaw.com/law-library/statutes/CFR_T45_P158_S158_241.md)
- [45 C.F.R. § 158.242 (2026) § 158.242   Recipients of rebates.](https://www.frixlaw.com/law-library/statutes/CFR_T45_P158_S158_242.md)
- [45 C.F.R. § 158.244 (2026) § 158.244   Unclaimed rebates.](https://www.frixlaw.com/law-library/statutes/CFR_T45_P158_S158_244.md)
- [45 C.F.R. § 158.250 (2026) § 158.250   Notice of rebates.](https://www.frixlaw.com/law-library/statutes/CFR_T45_P158_S158_250.md)
- [45 C.F.R. § 158.251 (2026) § 158.251   Notice of MLR information.](https://www.frixlaw.com/law-library/statutes/CFR_T45_P158_S158_251.md)
- [45 C.F.R. § 158.260 (2026) § 158.260   Reporting of rebates.](https://www.frixlaw.com/law-library/statutes/CFR_T45_P158_S158_260.md)

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Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/CFR_T45_P158_S158_210. Check the current official text before relying on it. Not legal advice.