45 CFR 158.211
§ 158.211 Requirement in States with a higher medical loss ratio.
United States · 45 CFR — Public Welfare · Status: effective
Cite this
- Citation
- 45 CFR 158.211, § 158.211 Requirement in States with a higher medical loss ratio, United States, version 1 as recorded 2026-07-09, yourstate.us, https://yourstate.us/provision/217863
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Full text
(a) State option to set higher minimum loss ratio. For coverage offered in a State whose law provides that issuers in the State must meet a higher MLR than that set forth in § 158.210, the State's higher percentage must be substituted for the percentage stated in § 158.210. If a State requires the small group market and individual market to be merged and also sets a higher MLR standard for the merged market, the State's higher percentage must be substituted for the percentage stated in § 158.210 for both the small group and individual markets.
(b) Considerations in setting a higher minimum loss ratio. In adopting a higher minimum loss ratio than that set forth in § 158.210, a State must seek to ensure adequate participation by health insurance issuers, competition in the health insurance market in the State, and value for consumers so that premiums are used for clinical services and quality improvements.
Legislative history
This is a federal regulation, adopted through agency rulemaking under the Administrative Procedure Act — not enacted by a recorded vote of Congress.