Starting next year, the U.S. Department of Health and Human Services will require insurance companies to spend 80 to 85 percent of premiums on direct care for patients.
The department is moving ahead with implementing health care reform measures slated to begin in January, despite newly elected Republicans’ pledge to repeal the law.
The medical loss ratio, or the amount of money insurance companies spend on actual care, is intended to give consumers more value for their money, according to Kathleen Sebelius, HHS secretary.
The law is anticipated to affect 74.8 million people in states with low medical loss ratio requirements. In Colorado, the state legislature required a medical loss ratio of 85 percent beginning in 2008.
People in other states, however will be eligible for rebates worth up to $1.4 billion, according to HHS. The average rebate will total $164.
Other provisions affecting the insurance market include: Requiring companies to report total earned premiums, reimbursements for clinical services, spending to improve quality and all administrative expenses.
Current Colorado law does not require disclosures of non-claim expenses or dollars spent to improve quality.