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MLR

The medical loss ratio rule requires insurers to spend a set share of premium on care and quality, 80 percent in the small-group and individual markets and 85 percent for large groups, or rebate the difference.

What is the medical loss ratio (MLR), and why did I get a rebate check?

June 28, 2026June 28, 2026 by HealthInsuranceFAQs

The ACA’s medical loss ratio rule requires insurers to spend at least 80% of premiums (85% for large groups) on medical care rather than overhead and profit. If they spend too little, they must send the difference back as a rebate, which is why you might get a check.

Categories Costs & Affordability Tags MLR

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