News & Updates
Health Net met or exceeded the MLR standards for Individual, Small Group plans, and Large Group plans in all regions.
Health Net filed 2015 MLR results with CMS in July and August 2016.
The federal Affordable Care Act (ACA) requires health carriers to maintain an MLR of at least 80 percent for Individual and Small Group plans and 85 percent for Large Group plans. The MLR is the percentage of premium dollars a health plan spends on physician, hospital, and other medical services and activities that improve health care quality, including wellness programs.
This requirement is referred to as the “Medical Loss Ratio” standard or the “80/20” or “85/15” rule. If those standards are not met, the company must refund part of the premium. The MLR rule was created to provide more transparency and accountability around health care costs.
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