Insurance commissioners weigh medical loss ratio definitions

A new draft document outlines some of the outstanding issues state insurance commissioners need to resolve concerning the medical loss ratio.

The National Association of Insurance Commissioners begins its annual meeting in Seattle this week, and one of its highest-profile tasks will be defining what should count as medical care and what shouldn't.

The 20-page document outlines outstanding questions, including:

• Should incurred claims and earned premiums used in the calculation of Medical Loss Ratio for rebate calculations be on a net of reinsurance basis?

• Should the experience for a multi-state employer be included in the policy issue state or apportioned among the states with enrollees?

• Should new business with less than 12 months of experience be excluded from the MLR calculation?

• Should the change in reserves for future contingent benefits and lawsuits be included in the definition of incurred claims?

• How should rebates be handled if they don't meet minimum thresholds?

• Which enrollees are eligible for rebates in the case of averaged experience years?

The draft is accessible at