NC Seeks Adjustment to Medical Loss Ratio Without Physician Input

State Insurance Commissioner Wayne Goodwin announced Tuesday that the state had requested an adjustment to the applicable medical loss ratio (MLR) standard for individual comprehensive health insurers in North Carolina. Starting this year, the Patient Protection and Affordable Care Act requires insurance companies to spend at least 80 percent of premium dollars on medical care and health care quality improvement, instead of administrative costs. States may request adjustments to the standard if it’s determined that the 80 percent MLR requirement might destabilize the individual insurance market in the state.

Commissioner Goodwin says NC DOI requested the adjustment after consulting with insurers, agents and brokers, consumer advocates and DOI technical experts; however, no physicians were consulted in the process.

According to a statement released by NC DOI, North Carolina requested that the 80 percent MLR requirement be adjusted to 72 percent in 2011, 74 percent in 2012, and 76 percent in 2013. Comprehensive health insurers issuing policies to individuals in the state would have to meet the 80 percent MLR stand in 2014.

Click here to read the MLR adjustment request and view accompanying exhibits. These exhibits include the MLR for each insurer selling coverage in North Carolina.

See related article:

Focus on Health System Reform – The Medical Loss Ratio, 6-4-10, NCMS Bulletin


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