# 45 C.F.R. § 158.230 (2026): Credibility adjustment

> Federal · Regulations · In force

URL: https://www.frixlaw.com/law-library/statutes/CFR_T45_P158_S158_230

## Section

- **Citation:** 45 C.F.R. § 158.230 (2026)
- **Heading:** Credibility adjustment
- **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 / § 158.230: § 158.230   Credibility adjustment.

## Text

(a)
General rule.
An issuer may add to the MLR calculated under § 158.221(a) of this subpart the credibility adjustment specified by § 158.232 of this section, if such MLR is based on partially credible experience as defined in paragraph (c)(2) of this section. An issuer may not apply the credibility adjustment if the issuer's experience is fully credible, as defined in paragraph (c)(1) of this section, or non-credible, as defined in paragraph (c)(3) of this section.
(b)
Life-years.
The credibility of an issuer's experience is based upon the number of life-years covered by the issuer. Life-years means the total number of months of coverage for enrollees whose premiums and claims experience is included in the report to the Secretary required by § 158.110 of this part, divided by 12.
(c)
Credible experience.
(1) An MLR calculated under § 158.221(a) through (c) of this subpart is fully credible if it is based on the experience of 75,000 or more life-years.
(2) An MLR calculated under § 158.221(a) through (c) of this subpart is partially credible if it is based on the experience of at least 1,000 life-years and fewer than 75,000 life-years.
(3) An MLR calculated under § 158.221(a) through (c) of this subpart is non-credible if it is based on the experience of less than 1,000 life-years.
(d) If an issuer's MLR is non-credible, it is presumed to meet or exceed the minimum percentage required by § 158.210 or § 158.211 of this subpart.

## 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_230. Check the current official text before relying on it. Not legal advice.