# 45 C.F.R. § 158.231 (2026): Life-years used to determine credible experience

> Federal · Regulations · In force

URL: https://www.frixlaw.com/law-library/statutes/CFR_T45_P158_S158_231

## Section

- **Citation:** 45 C.F.R. § 158.231 (2026)
- **Heading:** Life-years used to determine credible experience
- **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 / § 158.231: § 158.231   Life-years used to determine credible experience.

## Text

(a) The life-years used to determine the credibility of an issuer's experience are the life-years for the MLR reporting year plus the life-years for the two prior MLR reporting years. If a State requires the small group market and individual market to be merged, then life-years used to determine credibility must be the life-years from the small group market and the individual market for the MLR reporting year plus the life-years from the small group market and the individual market for the two prior MLR reporting years.
(b) For the 2011 MLR reporting year, the life-years used to determine credibility are the life-years for the 2011 MLR reporting year only.
(c) For the 2012 MLR reporting year-
(1) If an issuer's experience for the 2012 MLR reporting year is fully credible, the life-years used to determine credibility are the life-years for the 2012 MLR reporting year only;
(2) If an issuer's experience for the 2012 MLR reporting year only is partially credible or non-credible, the life-years used to determine credibility are the life-years for the 2011 MLR reporting year plus the life-years for the 2012 MLR reporting year.
(d) For the 2013 MLR reporting year for the student market only, the life-years used to determine credibility are the life-years for the 2013 MLR reporting year only.
(e) For the 2014 MLR reporting year for the student market only—
(1) If an issuer's experience for the 2014 MLR reporting year is fully credible, the life-years used to determine credibility are the life-years for the 2014 MLR reporting year only;
(2) If an issuer's experience for the 2014 MLR reporting year only is partially credible or non-credible, the life-years used to determine credibility are the life-years for the 2013 MLR reporting year plus the life-years for the 2014 MLR reporting year.
[75 FR 74921, Dec. 1, 2010, as amended at 75 FR 82279, Dec. 30, 2010; 77 FR 16469, Mar. 21, 2012; 79 FR 30353, 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_231. Check the current official text before relying on it. Not legal advice.