Reports suggest that the interpretation of medical-loss ratio on the part of federal regulators can influence the participants ranging from industry major UnitedHealth Group Inc. to the specialized Companies, including American National Insurance Co. Also, the plans can come as real trouble for some, as it can make some of the players pay millions in rebates, and some can even be eliminated out of the market.
The medical-loss ratio is the amount that premiums insurers will pay for medical care against administrative costs. Under the proposed law, the insurers must use at least 80% of the premiums from individuals and small businesses, so that medical care and profit-taking can be paid and also an 85% of premium from larger employers is mandated.
Health insurers are not fully aware of the whole scenario and they are waiting for the regulators to present a complete picture of telling them that how the Companies should account for the numbers, like whether or not they can average the MLRs of their subsidiaries.
Meanwhile, the National Association of Insurance Commissioners is expected to make suggestions to the Department of Health and Human Services regarding this issue by the end of this month. Former is the group of state regulators, which was earlier charged with drafting the rules.
Sandy Praeger, Head of the Health-Insurance Committee at the regulators' group and the Kansas insurance commissioner also said that the matter was of immense importance for the Companies.