Medical loss ratio definition

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 the ratio of expected incurred benefits

Examples of Medical loss ratio in a sentence

• Medical loss ratio rebates required pursuant to the Public Health Service Act.

• The STATE also reserves the right to review value- based purchasing or other reimbursement occurring outside of encounter reimbursement and may adjust reported claim costs accordingly.Nothing in this section shall prohibit the MCO from making payments under bona fide value- based agreements evidenced by executed contracts, with providers or entities related to the MCO for the purposes described in 42 CFR §438.8 (titled Medical loss ratio (MLR) standards).

• The last, 49.8, occurs in the poetic blessing (so its vocabulary usage is atypical and statistically less important) and speaks of the brothers bowing to Judah (in prediction of the Davidic monarchy).

• Retrospectively Rated Contracts & Contracts Subject to Redetermination A – C No Material Change D - Medical loss ratio rebates required pursuant to the Public Health Service Act.

• Medical loss ratio regulations require that health insurers spend a minimum percentage of their premium revenues on medical expenses.

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 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.

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 means direct losses incurred

Medical loss ratio or “MLR” means the accounting guidance and procedures which describe the definitions of premiums, Quality Improvements, Claims, taxes and fees. The general definition of MLR is the ratio of Claims plus Quality Improvements to premiums less taxes and fees. The minimum MLR requirement threshold is 85% for large groups under the ACA.

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.

Medical loss ratio or "MLR" means the minimum percentage of all premium funds collected by an insurer for dental insurance plans each year that must be spent on actual patient care rather than overhead costs, administration, and other expenses, as compared to the total revenue collected from that plan’s premiums.