Medical loss ratio means a formula that measures the ratio of MCO spending on medical and related benefits compared to revenue, to ensure that MCOs are spending a sufficient amount of their premium revenue on medical expenses and other high-impact initiatives.
Medical loss ratio or “MLR” means the percentage of capitation payments that is used to pay medical or dental expenses.
Medical loss ratio means direct losses incurred and direct losses paid for all preferred provider benefit plans issued by an insurer, divided by direct premiums earned for all preferred provider benefit plans issued by that insurer. This amount may not include home office and overhead costs, advertising costs, network development costs, commissions and other acquisition costs, taxes, capital costs, administrative costs, utilization review costs, or claims processing costs.
Examples of Medical loss ratio in a sentence
To facilitate accurate measurement of the pharmacy component of the Medical Loss Ratio (MLR) the CONTRACTOR shall provide Claim-level pharmacy reimbursement detail, reflecting the amount paid by the Pharmacy Benefit Manager (PBM) to the pharmacy Provider, per Section 7 of this contract.
More Definitions of Medical loss ratio
Medical loss ratio has the definition set forth in Annex 6 – Current Year and Consolidated Medical Loss Ratio Formulas.
Medical loss ratio means the ratio of expected incurred benefits
Medical loss ratio means the measurement of the share of Enrollee premiums that the Contractor spends on medical claims, as opposed to other non-claims expenses such as administration or profits. Additional clarification can be found in the Congressional Research Service report dated August 26, 2014, found here: xxxx://xxx.xxx/sgp/crs/misc/R42735.pdf
Medical loss ratio or “MLR” used without specific reference to Federal MLR or Oregon MLR means either Federal MLR or Oregon MLR.
Medical loss ratio. (MLR) means the amount the Medical Spend divided by total capitation payments made to the Contractor annually.
Medical loss ratio. The MLR is calculated separately for Blue Cross and Blue Shield’s small and large group markets. You acknowledge and agree that Blue Cross and Blue Shield will categorize your group as small or large based on the information you provide to Blue Cross and Blue Shield in the Patient Protection and Affordable Care Act MLR Calculation Employer Group Size Survey form. Blue Cross and Blue Shield will also use this information when determining whether your group will be eligible for MLR premium rebates in the event that premium rebates are required to be issued.
Medical loss ratio and “MLR” each means the proportion of premium revenues (net of taxes) spent on incurred claims, including Provider Stabilization Payments, quality health improvements, and fraud prevention activities.