9/10/2023
California
Delve into the latest Medical Loss Ratio (MLR) numbers for the reporting year 2022.
The MLR is a metric that determines the efficiency of health insurance providers in managing healthcare costs. It represents the proportion of premium revenue insurers spend on medical care and healthcare quality improvement.
In this article, we give the updated MLR figures for 2022 from the major California carriers. For an overview on MLR data, please read this report from the State of California's Department of Managed Health Care.
The MLR is a metric that determines the efficiency of health insurance providers in managing healthcare costs. It represents the proportion of premium revenue insurers spend on medical care and healthcare quality improvement.
In this article, we give the updated MLR figures for 2022 from the major California carriers. For an overview on MLR data, please read this report from the State of California's Department of Managed Health Care.
| Carrier MLR Report* |
| Aetna report |
| Anthem Blue Cross report |
| UnitedHealthcare report |
*We will continually add carriers' reports as they are provided to us.
Rebates for MLR Thresholds
It's important to note that the Affordable Care Act requires insurance carriers to provide rebates to employer groups if their MLR falls below certain thresholds. These rebates are designed to ensure that a significant portion of premium dollars is used for actual healthcare expenses.
Employer groups that receive these rebates have several options for utilizing them.
They can choose:
- Premium reduction: Employers can use the rebates to reduce the premium costs for their employees in the following plan year.
- Administrative costs: Employers can also allocate the rebates to offset administrative costs related to managing their healthcare plans.
- Enhanced benefits: Another option is to reinvest the rebates into the healthcare benefits offered to employees, such as expanding coverage, lowering deductibles, or adding new wellness programs.