Process for a State to submit a Request for Adjustment to Individual Market MLR Standard

CCIIO issues technical guidance on the process for a state to submit a request for adjustment to the individual market medical loss ratio standard.

Document Excerpt

Section 2718 of the Public Health Service Act (PHS Act), as added by the Patient Protection and Affordable Care Act (PPACA), requires health insurance issuers (issuers) to submit a report to the Secretary concerning their medical loss ratio (MLR) and requires them to issue a rebate to enrollees if the issuer’s MLR is less than the applicable MLR standard established in section 2718(b). This Bulletin sets forth the address and format by which a State must submit its request to the Secretary for an adjustment to the individual market MLR standard under 45 CFR §158.301, et. seq.


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