medical loss ratio


Also found in: Acronyms.

medical loss ratio

Managed care
The percentage of revenues received by a for-profit health plan that are actually be spent on healthcare; the ratio between the cost to deliver medical care and the amount of money that was taken in by a plan.

Insurance companies often have a medical loss ratio of 92 percent or more; tightly managed HMOs may have medical loss ratios of 75 percent to 80 percent, although the overhead (or administrative cost ratio) is concomitantly higher. The MLR depends on the amount of money brought in as well as the cost of delivering care; thus, if the rates are too low the ratio may be high, even though the actual cost of delivering care is not excpetionally high itself.
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The senators bipartisan legislation would exclude from the medical loss ratio any compensation earned by independent agents and brokers who serve the individual and small group markets.
That was down from a combined medical loss ratio of 103 percent for the comparable period in 2015.
Of three companies that offered plans on Arkansas' health insurance exchange, Centene was the only one that owed rebates based on its medical loss ratio for 2014, the Northwest Arkansas Democrat-Gazette reported.
But in the end, policymakers compromised by including incentives to strengthen states' health insurance rate review programs and by establishing a federal medical loss ratio requirement.
Health Care Reform's Commercial Minimum Medical Loss Ratio.
costs exceed the minimum medical loss ratio of total premium dollars.
On PPACA, the medical loss ratio, which mandates how much medical carriers must spend on patient health care, has led to cuts in producer commissions.
The researchers have included state-by-state data showing that the ratio of medical losses to revenue at the PCIP plans is at least twice as high and, in some cases, 8 times as high, as the medical loss ratios at the comparable state "risk pool" plans.
Outlier values occurred for the medical loss ratio and operating margin ratios; therefore, these ratio values were adjusted to their respective 95th percentile and 5th percentile values.
The State of Florida continues to carry the banner of health insurance agents on the medical loss ratio (MLR) issue, asking federal health regulators to review its decision not to make adjustments to the rule, as it has in some smaller states.
At that point, insurers would be required to meet the 80/20 medical loss ratio requirement established by health reform.
The average medical loss ratio (medical costs as a percentage of premium revenues) declined to 82.

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