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Bang for the Buck: Medical Loss Ratio Rules

Beginning in 2012, Georgia consumers who purchase individual health insurance policies will have access to more information about how their premium dollars are being spent AND will be eligible for rebates if their insurance company fails to provide sufficient value for the premium dollar.


These new standards, known as medical loss ratio (MLR) rules, are part of the Affordable Care Act and are designed to spur insurance companies to operate more transparently and to ensure that consumers get the most value for their premium dollars. Consumers will receive rebates if their insurance company fails to spend at least 80 percent of collected premiums on medical care or quality improvement activities, as compared to profits, administration, and marketing. It is estimated that Georgia consumers will receive approximately $42 million in rebates over the next three years.


The Georgia Department of Insurance, however, has made a request to the U.S. Department of Health and Human Services for an adjustment to these new standards, which would effectively weaken them. If the adjustment is approved, the rebates would be substantially reduced and Georgia consumers would lose out on an estimated $34 million in rebates they are slated to receive.


The MLR rules are exciting news for Georgia consumers, but they are at risk of being weakened. We need your voice to keep them strong and to ensure that Georgia consumers get the most value from their insurance plans. Here is what you can do:


1)     Learn more about this issue by downloading our new issue brief, hot off the press from Georgians for a Healthy Future and Georgia Watch.


2)     Take action on behalf of your organization: Georgians for a Healthy Future and Georgia Watch have teamed up to file public comments that explain why these standards are good for Georgia consumers and should go through as planned, and we’re asking you to add your voice to this effort. If your organization would like to sign onto these public comments, please e-mail us by 12pm Friday and we will add you to the growing list of groups asking that the request for an adjustment be denied.


3)     Take action as an individual consumer: If you are an individual consumer and would like to make your voice heard, please contact us and we can walk you through how to file comments as an   individual.



Thank you for your advocacy, and please let us know if we can answer any questions or provide additional resources on this important issue. Please share this information with friends, family and colleagues so we can ensure that Georgia consumers get the most value for their health insurance premium dollar.



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