45 CFR 158.210

§ 158.210 Minimum medical loss ratio.

United States · 45 CFR — Public Welfare · Status: effective

Cite this

Citation: 45 CFR 158.210, § 158.210 Minimum medical loss ratio, United States, version 1 as recorded 2026-07-09, yourstate.us, https://yourstate.us/provision/217862
Permanent ID: ys:prov:217862@1
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Full text

Subject to the provisions of § 158.211 of this subpart: (a) Large group market. For all policies issued in the large group market in a State during the MLR reporting year, an issuer must provide a rebate to enrollees if the issuer has an MLR of less than 85 percent, as determined in accordance with this part. (b) Small group market. For all policies issued in the small group market in a State during the MLR reporting year, an issuer must provide a rebate to enrollees if the issuer has an MLR of less than 80 percent, as determined in accordance with this part. (c) Individual market. For all policies issued in the individual market in a State during the MLR reporting year, an issuer must provide a rebate to enrollees if the issuer has an MLR of less than 80 percent, as determined in accordance with this part. (d) Adjustment by the Secretary. If the Secretary has adjusted the percentage that issuers in the individual market in a specific State must meet, then the adjusted percentage determined by the Secretary in accordance with § 158.301 of this part et seq. must be substituted for 80 percent in paragraph (c) of this section.

Legislative history

This is a federal regulation, adopted through agency rulemaking under the Administrative Procedure Act — not enacted by a recorded vote of Congress.