# TDI Commissioner's Bulletin B-0018-11: DATA CALL REGARDING MEDICAL LOSS RATIO (MLR) STANDARDS FOR INDIVIDUAL, ASSOCIATION, AND SMALL EMPLOYER MARKETS PURSUANT TO 45 C.F.R. PART 158, SUBPART C > Texas · Agency guidance · In force URL: https://www.frixlaw.com/law-library/statutes/TX_INS_B_0018_11 ## Section - **Citation:** TDI Commissioner's Bulletin B-0018-11 - **Heading:** DATA CALL REGARDING MEDICAL LOSS RATIO (MLR) STANDARDS FOR INDIVIDUAL, ASSOCIATION, AND SMALL EMPLOYER MARKETS PURSUANT TO 45 C.F.R. PART 158, SUBPART C - **Jurisdiction:** Texas - **Kind:** Agency guidance - **Status:** In force - **Text as of:** August 14, 2026 - **Source:** Compiled text - **Location:** Texas Department of Insurance Commissioner's Bulletins / DATA CALL REGARDING MEDICAL LOSS RATIO (MLR) STANDARDS FOR INDIVIDUAL, ASSOCIATION, AND SMALL EMPLOYER MARKETS PURSUANT TO 45 C.F.R. PART 158, SUBPART C ## Text Home Bulletins 2011 Bulletins B-0018-11 April 20, 2011 To: ALL INSURANCE COMPANIES LICENSED TO WRITE HEALTH COVERAGE IN THE STATE OF TEXAS AND ALL HEALTH MAINTENANCE ORGANIZATIONS (HMOs) Re: DATA CALL REGARDING MEDICAL LOSS RATIO (MLR) STANDARDS FOR INDIVIDUAL, ASSOCIATION, AND SMALL EMPLOYER MARKETS PURSUANT TO 45 C.F.R. PART 158, SUBPART C The purpose of the attached data call is to collect data from insurance companies and HMOs that provide health coverage subject to the requirements of the Patient Protection and Affordable Care Act in the individual and small group markets. The data collected will enable the Texas Department of Insurance (Department) to determine whether to request an adjustment to the MLR standard pursuant to the United States Department of Health and Human Services (HHS) regulations located at 45 C.F.R. 158, §§158.301-158.350. To comply with rebate requirements, §2718 of the Public Health Service Act (codified at 42 U.S.C. §300gg-18) requires health insurance issuers in the individual and small group market to spend at least 80 percent of each premium dollar on reimbursement for clinical services or for activities that improve health care quality. Pursuant to §2718, the HHS Secretary has adopted regulations that permit a state insurance commissioner to request an adjustment to the MLR requirement in regard to individual coverage for up to three years. Such a request must be supported by information about how the insurance market is organized and functions in the state and an assessment of how best to address any risk of destabilization through an adjustment of the MLR standard. The information obtained will enable the Department to evaluate the impact of the MLR and assess whether an adjustment is appropriate ual coverage for up to three years. Such a request must be supported by information about how the insurance market is organized and functions in the state and an assessment of how best to address any risk of destabilization through an adjustment of the MLR standard. The information obtained will enable the Department to evaluate the impact of the MLR and assess whether an adjustment is appropriate. Although the federal regulation only addresses a potential request for adjustment for the individual market, the Department is interested in any impact the MLR requirement may have on the small group market and has determined that information concerning this market is also relevant to a possible proposal for adjustment. In addition, the Department believes the MLR adjustment should incorporate a broader phase-in on a national level, and thus, is collecting nationwide data through this data call. This MLR Adjustment Data Call is issued subject to the provisions of §38.001 of the Texas Insurance Code and pursuant to 45 C.F.R. 158, §§158.301-158.350. For the period of January 1, 2010 through December 31, 2010, Texas requests the data as outlined in the attached data call. Insurance companies and HMOs should access the data entry form and instructions from the Department's website at www.tdi.state.tx.us/health/datacall.html and described as "Data for Potential MLR Adjustments". The deadline for submitting the requested information is May 4, 2011. The Department appreciates the assistance of the insurance and HMO industry. If you have any questions concerning the information presented in this bulletin, please contact LIFEHEALTH@tdi.state.tx.us . Mike Geeslin Commissioner of Insurance For more information, contact: LifeHealth@tdi.texas.gov Last updated: 7/15/2025 ## Nearby sections - [TDI Commissioner's Bulletin B-0001-00 Amendment to Commissioner's Bulletin No. B-0044-98](https://www.frixlaw.com/law-library/statutes/TX_INS_B_0001_00.md) - [TDI Commissioner's Bulletin B-0001-03 2002 Policy Count Exhibit (Inactive as of 6/2/03)](https://www.frixlaw.com/law-library/statutes/TX_INS_B_0001_03.md) - [TDI Commissioner's Bulletin B-0001-05 2004 Policy Count Exhibit](https://www.frixlaw.com/law-library/statutes/TX_INS_B_0001_05.md) - [TDI Commissioner's Bulletin B-0001-06 2005 Policy Count Exhibit](https://www.frixlaw.com/law-library/statutes/TX_INS_B_0001_06.md) - [TDI Commissioner's Bulletin B-0001-08 2007 Policy Count Exhibit](https://www.frixlaw.com/law-library/statutes/TX_INS_B_0001_08.md) - [TDI Commissioner's Bulletin B-0001-16 CALL FOR FOURTH QUARTER EXPERIENCE – 2015 CALL FOR FOURTH QUARTER EXPERIENCE – 2015 WORKERS' COMPENSATION DEDUCTIBLE PLANS](https://www.frixlaw.com/law-library/statutes/TX_INS_B_0001_16.md) - [TDI Commissioner's Bulletin B-0001-18 TRANSITION TO FEDERAL EXTERNAL REVIEW PROCESS](https://www.frixlaw.com/law-library/statutes/TX_INS_B_0001_18.md) - [TDI Commissioner's Bulletin B-0001-19 Revised workers' compensation classification relativities – instructions on making rate filings](https://www.frixlaw.com/law-library/statutes/TX_INS_B_0001_19.md) - [TDI Commissioner's Bulletin B-0001-20 Title Insurance Underwriters Data Call](https://www.frixlaw.com/law-library/statutes/TX_INS_B_0001_20.md) - [TDI Commissioner's Bulletin B-0001-22 Revised NCCI advisory loss costs and the Catastrophe (Other Than Certified Acts of Terrorism) Provision—instructions on making rate filings](https://www.frixlaw.com/law-library/statutes/TX_INS_B_0001_22.md) - [TDI Commissioner's Bulletin B-0001-25 Calendar year 2024 Texas title insurance agent data call](https://www.frixlaw.com/law-library/statutes/TX_INS_B_0001_25.md) - [TDI Commissioner's Bulletin B-0002-01 Regarding Weather-Related Events Occurring on 124/24/00-12/31/00](https://www.frixlaw.com/law-library/statutes/TX_INS_B_0002_01.md) - [TDI Commissioner's Bulletin B-0002-02 The Use of Electronic Signatures and Records in Connection with Marketing and Selling Insurance and Related Products or Engaging in Other Business Regulated by the Texas Department of Insurance.](https://www.frixlaw.com/law-library/statutes/TX_INS_B_0002_02.md) - [TDI Commissioner's Bulletin B-0002-03 Adoption of Proposed Amendments to the Texas Commercial Lines Statistical Plan](https://www.frixlaw.com/law-library/statutes/TX_INS_B_0002_03.md) --- Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/TX_INS_B_0018_11. 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