This issue brief explains medical loss ratio (MLR), also known as the 80/20 rule, and makes policy recommendations aimed at ensuring that consumers achieve the value they deserve. MLR rules 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.