Georgians For a Healthy Future

Final Ruling on Medical Loss Ratio Standards Heeds Consumer Input and Sets a Reasonable Standard

Thanks to your support and advocacy, Georgia consumers will experience better value in their health insurance plans and will receive rebates if their insurance companies cannot meet these reasonable standards of value.

The U.S. Department of Health and Human Services (HHS) issued a compromise decision this afternoon allowing new health insurance standards, known as medical loss ratio rules, to be phased in between now and 2013 in Georgia. These new standards will provide increased transparency and value for health care consumers.

Back in September, we sent an alert asking you to add your voice to our effort in support of the new standards, which require insurance companies to provide more information to consumers about how their premium dollars are being spent AND to provide rebates to consumers if they don’t spend a reasonable portion of premiums (80 percent) on medical care and quality improvement activities as compared to profits, administration, and marketing. This effort was in response to the Georgia Department of Insurance’s request to lower the standard for Georgia insurance companies.
Today, HHS determined that the Georgia Department of Insurance’s request exceeded the adjustment necessary to prevent a destabilizing effect on the market and would have unnecessarily denied consumers some of the benefits of the new provision.  As a result, Georgia insurance companies will be required to meet a 70 percent standard in 2011 and a 75 percent standard in 2012 before fully implementing the 80 percent standard in 2013. The public comments that Georgians for a Healthy Future, Georgia Watch, and 15 additional Georgia organizations submitted were referenced throughout the decision.
Our voices made a difference! While the decision didn’t go as far as health care consumer advocates would have liked, HHS made a balanced decision that carefully considered the needs of health care consumers.
Thank you for your continued advocacy on behalf of Georgia’s health care consumers.  To read more about the MLR adjustment process in Georgia, click here.