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Diane Publishing Books
Private Health Insurance: Early Effects of Medical Loss Ratio Requirements and Rebates on Insurers and Enrollees
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John E. Dicken (au)
Private insurers are required to meet minimum Patient Protection and Affordable Care Act (PPACA) medical loss ratio (MLR) standards äóî expressed as the percent of premium dollars spent on patient care and related activities äóî and beginning in 2011 they must pay rebates back to enrollees and policyholders who paid premiums if they do not meet these standards. This report reviewed the effects of the PPACA MLR requirements on insurers and enrollees and how rebates would change if agent and broker payments were excluded from the MLR formula. It examines (1) the extent to which insurers met the PPACA MLR standards, and how much they spent on the MLR components of claims, quality improvement activities, and non-claims costs; (2) the amount of rebates insurers paid and how this amount would have changed with agents' and brokers' commissions and fees excluded from the MLR; and (3) the perspectives of insurers on the effects of the MLR requirements on their business practices. Tables and figures. This is a print on demand report.
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