Medical Loss Ratio FAQs
Answers to frequently asked questions about the medical loss ratio.
What is the federal government’s medical loss ratio (MLR) standard for health care spending and how does HMSA compare? >>
| Group Size |
MLR Requirement |
HMSA Performance |
| Large employer groups |
85 percent of dues spent on care |
90.5 percent |
| Small businesses |
80 percent of dues spent on care |
87.5 percent |
| Individual Plans |
80 percent of dues spent on care |
92.2 percent |
What does it mean to surpass the MLR requirements? >>
It means we spent the vast majority of dues on health care for our members. We have done this for nearly 75 years.
Some health plans on the Mainland are giving their members rebates because of MLR. Will HMSA issue rebates? >>
No. By providing excellent value to our members, we outperformed the MLR requirement. Only health plans that failed to meet this standard are required to give rebates.
This information is based on HMSA’s review of the national health care reform
legislation. This overview is intended for educational purposes and should not be
used as tax, legal, or compliance advice. Interpretations of the legislation vary
and some reform regulations differ for particular members enrolled in certain groups.
HMSA will continue to present and update information related to national health
care reform as additional guidance becomes available.
