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 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

• Medical loss ratio shall be as defined by the Office of the Insurance Commissioner (OIC) in RCW 48.43.049 with the additional inclusion of any quality incentive payments made directly to Participating Providers prior to the end of the year.

• A – C No Material Change D - Medical loss ratio rebates required pursuant to the Public Health Service Act.

• 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).

• In many states, the initial launch of managed care generates a rash of provider complaints for this reason.✓ Medical loss ratio – Per federal rules, MCOs should not retain more than 15 percent of capitation rates dollars for administrative expenses.

• Or maybe the Performance Standard should be beefed up and include elements such as resident involvement?’ – Tenant participant.

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 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 means direct losses incurred