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Medical Loss Ratio rebate exposure - The issue - Ernst & Young - Global

Medical Loss Ratio rebate exposure

The issue

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Insurers need to take steps now to understand their MLR rebate exposure, and then take action soon to improve their MLR position and avoid or minimize rebate payouts, which will begin in 2012.

Minimum MLRs

  • Large group (101 enrollees or more) — 85% of premium revenue
  • Small group (1 to 100 enrollees) — 80% of premium revenue
  • Individual — 80% of premium revenue
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