Sunday, December 2, 2012

Finding an Insurer’s Medical Loss Ratio (MLR)

Finding an Insurer’s Medical Loss Ratio (MLR)

As stated in a previous post, the Patient Protection Affordability and Care Act (PPACA) requires that an insurance company meet a Medical Loss Ratio.  The Medical Loss Ratio requires that 80% to 85% of patients’ premium dollars go towards medical treatments and healthcare improvements.  At the time of my previous post, I was unable to point you in the direction of where the government publicly made that information available.  I have that information now.

How to find it?

1)  Go to  Click on “Get Help Using Insurance”.

2)  On the next page, click on “Your Insurance Company & Costs of Coverage”

3)  Look for the part of the screen where it allows you to “Find Basic Information About Your Insurance Company”

4)  Enter the state and insurer’s name that you want to find out about.  Click MLR.  Then click search.

For the purpose of an example, I chose my state Pennsylvania, and a major insurer in the state, Independence Blue Cross.

5)  You will find your Medical Loss Ratio and a calculated Average Rebate on the bottom of this next page.

In this example using Independence Blue Cross, the insurers MLR of 96.3% was greater than both the 80% threshold for the Individual Market and 85% for the Large Group Market.  Therefore, they have met the MLR Standard and no rebate is required.

I hope this information has been helpful.  I would like to thank Blake Hutson from LinkedIn for helping me locate this information.  He provided me with the direct link:

And remember all of you Human Resources professionals:  Be Human... Be a Resource...  Be a Resource for Humans.

Disclaimer:  The views expressed in this post are by the author Trevor Stasik, and do not necessarily reflect the views of any employer or any other organization. Please note, this information is based on my understanding and is only to be used for informational and educational purposes.  Do not take what I am writing as advice.  Seek your own legal counsel and/or see a tax accountant before making business or personal decisions.  The author of this post makes no representations as to the accuracy or completeness of any information on this site or found by following any link on this site. The owner will not be liable for any errors or omissions in this information nor for the availability of this information. The owner will not be liable for any losses, injuries, or damages from the display or use of this information.

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