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Understanding Medical Loss Ratio
Under the health care reform law, health insurance companies have to spend at least 80 percent (for individual and small group) or 85 percent (for large group) of their policy premiums in a given state on claims. If their medical loss ratio (claims over premiums) is less than the required percentage, the difference has to be paid to enrollees and group policyholders. The payment is in proportion to their contribution to the cost of coverage.
For the 2011 reporting year, plans covering expatriates have a different formula for calculating the medical loss ratio. This is due to their higher administrative costs.
To learn more, watch our webinar about changes to medical loss ratio or see our timeline.
What's Your Role in Reform?
We've prepared information about health care reform just for you.
Employers and organizationsBrokers and consultantsHealth care professionalsIndividuals and familiesTools for Managing Reform
Our health care reform tools make it easy for you to manage and track health insurance reform.
Read a reform overviewDiscover our reform timelineView the state exchange mapRead Reform TodayKey Health Care Reform Rules
Health insurance reform changes how we all operate.
State insurance exchangesEmployer insurance rulesIndividual mandate in reformQuestions about Reform?
Read answers to frequently asked questions about health care reform.

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