Preventing Unwarranted Exceptions to the Affordable Care Act’s Medical Loss Ratio (MLR) Requirements

Starting in 2011, the Affordable Care Act requires insurers to spend a specific share of premium dollars on medical care, as opposed to administration, marketing, and profits. If insurers don’t meet these requirements, they must refund the excess to policyholders in the form of rebates. These standards are known as medical loss ratio (MLR) requirements.

States that seek MLR adjustments for their individual markets must follow a specific public process, which presents several opportunities for advocacy.

This fact sheet includes a list of questions advocates can ask regulators if their state seeks an MLR adjustment, and advocates can adapt these questions for their states.