Medical loss ratio
From Healthcarepedia
What is a medical loss ratio?
A medical loss ratio is the percentage of health insurance premiums a health insurance company spends on health care services for health plan members.
The Affordable Care Act, requires that large group plans spend 85% of premiums on clinical services and other activities for the quality of care for health plan members. Small group and individual market plans must devote 80% of premiums to these purposes.
