Members of the National Association of Insurance Commissioners today voted to approve a medical loss ratio blanks proposal.
The NAIC, Kansas City, Mo., will post the approved blank form Wednesday, officials say.
A blank is the form an insurer uses to submit financial data to state insurance regulators.
The federal Affordable Care Act, the legislative package that includes the Patient Protection and Affordable Care Act (PPACA), will require the minimum medical loss ratio (MLR), or percentage of premium revenue spent on health care and quality improvement efforts, to be 80% for individual and small group health coverage and 85% for large group coverage.
The NAIC is creating a supplemental health care exhibit that insurers can use to supply the MLR information needed to verify compliance with the minimum MLR requirements.
Insurers that fail to meet the MLR requirements are supposed to compensate customers by sending them rebates.
Insurers will have to report spending on categories such as “expenses for health improvements other than health information technology,” “health information technology expenses related to health improvement,” and “deductible fraud and abuse detection recovery expenses” for individual business, small group business, large group business, government business, “other health business,” and “other business (excluded by statute).”
Some categories of expenses will be included in the MLR calculations, and others will be reported separately but left out of the official calculations.