Feds post MLR calculator form

By Allison Bell

May 02, 2014 at 01:31 PM

Share & Print

The Center for Consumer Information & Insurance Oversight has published a spreadsheet form health insurers are supposed to use to report 2013 revenue and costs to the federal government.

The Patient Protection and Affordable Care Act medical loss ratio provisions require health insurers to spend 85 percent of large-group plan revenue and 80 percent of individual and small-group plan revenue on health care and quality improvement.

Insurers that fail to meet the PPACA MLR standards are supposed to use rebates or methods to make up the difference.

Insurers began filing PPACA MLR reports in 2012, for the 2011 plan year. The upcoming cycle of MLR reports will be the third insurers have filed.

One major difference is that PPACA calls for three risk-management programs — a reinsurance program, a risk corridors program and a risk-adjustment program — to protect eligible health insurers against catastrophic claims, overall poor performance, and high-risk patients starting this year.

The Centers for Medicare & Medicaid Services — CCIIO's parent — has said it will use the MLR form data to run the risk corridor program and another form to run the reinsurance and risk-adjustment programs.

See also: