# 45 C.F.R. § 158.211 (2026): Requirement in States with a higher medical loss ratio

> Federal · Regulations · In force

URL: https://www.frixlaw.com/law-library/statutes/CFR_T45_P158_S158_211

## Section

- **Citation:** 45 C.F.R. § 158.211 (2026)
- **Heading:** Requirement in States with a higher 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 / § 158.211: § 158.211   Requirement in States with a higher medical loss ratio.

## Text

(a)
State option to set higher minimum loss ratio.
For coverage offered in a State whose law provides that issuers in the State must meet a higher MLR than that set forth in § 158.210, the State's higher percentage must be substituted for the percentage stated in § 158.210. If a State requires the small group market and individual market to be merged and also sets a higher MLR standard for the merged market, the State's higher percentage must be substituted for the percentage stated in § 158.210 for both the small group and individual markets.
(b)
Considerations in setting a higher minimum loss ratio.
In adopting a higher minimum loss ratio than that set forth in § 158.210, a State must seek to ensure adequate participation by health insurance issuers, competition in the health insurance market in the State, and value for consumers so that premiums are used for clinical services and quality improvements.
[75 FR 74921, Dec. 1, 2010, as amended at 79 FR 30352, May 27, 2014]

## 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_211. Check the current official text before relying on it. Not legal advice.