ME-Maine Request for Medical Loss Ratio Waiver

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On March 8, Maine became the first state to be granted a waiver from the medical loss ratio (MLR) requirement of the Affordable Care Act (ACA).  The ACA requires that carriers covering large employers spend at least 85 percent of premiums paid on claims or quality improvements, and carriers covering small group and individual insurers spend 80 percent, or refund the difference to policyholders, beginning in 2012. However, the ACA gave the Kathleen Sebelius, Secretary of Health and Human Services (HHS), the authority to waive the requirement if states can demonstrate that fulfilling it would destabilize the individual market. On December 1, 2010, HHS published an interim final rule, giving states the opportunity to apply for waivers.

In a letter to Maine’s Superintendent of Insurance, Mila Kofman, HHS outlined the terms of the MLR waiver and HHS’s reasons for approving the state’s request. Maine will receive an adjustment to the MLR rule for three years, and continue to use its current standard for the individual market— 65 percent.  However, in 2013 the state will need to submit 2012 data showing the need for a continued adjustment to the MLR standard.

To View the Request Click Here.

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Date: Mar 2011