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MLR final rule: Insurers must disclose healthcare spending

Even if insurers meet the medical-loss ratio (MLR) threshold, they will still have to explain to consumers how their premium dollars are spent under the final MLR rule released Dec. 2 by the Department of Health & Human Services (HHS).

The final rule requires insurers to send their customers a notice about the MLR--regardless of whether they meet the 80 to 85 percent threshold. The notice must disclose the MLR amount and how it improved because of health reform, according to HHS.

When insurers don't meet the MLR requirements and must issue rebates, the final rule requires they explain to customers how much money they're getting back and how the MLR compared to the Congressional standard.

HHS also is phasing out special allowances for "mini-med" plans that offer limited benefits to individuals or small groups by slowly tightening standards for those plans. By 2014, mini-meds will have to meet almost the same requirements as comprehensive policies, reports Kaiser Health News.

Another change in the final MLR rule is that fees paid to brokers and agents won't count as medical care.

To learn more:
- read the MLR final rule (.pdf) and related fact sheet
- see The Hill's Healthwatch article
- check out the Kaiser Health News article

Related Articles:
State regulators call for 'immediate actions' to fix MLR

New MLR rule requires payers to cut overhead costs
Insurers lose battle as NAIC approves tough MLR rules
MLR causing premium drops, broker fee cuts

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