Delaware Request for an Adjustment of the Medical Loss Ratio Standard

The Affordable Care Act allows the Secretary to adjust the Medical Loss Ratio (MLR) standard for a state if it is determined that meeting the 80 percent Medical Loss Ratio standard may destabilize the individual market.  In order to qualify for this adjustment, a state must demonstrate that requiring insurers in its individual market to meet the 80 percent MLR has a likelihood of destabilizing the individual market and could result in fewer choices for consumers. This page contains materials related to this state’s application for an adjustment to the MLR standard for the individual market.   .

State: Delaware

Application Status: HHS determination issued

Application Determination:

• HHS Determination on Delaware MLR Adjustment Request (PDF - 97 KB)
• Fact Sheet (Posted on 9/9/2011)

Application Materials:

Persons using assistive technology may not be able to fully access information in this file. For assistance, please email MLRAdjustments@hhs.gov.

1. MLR Adjustment Request (PDF – 1.81 MB)
   This document contains Delaware’s request to adjust the MLR standard to 65 percent, 70 percent, and 75 percent in 2011, 2012, and 2013, respectively (received by HHS on 05/12/11).
2. Stakeholder Letters (PDF – 1.38 MB)
   This file contains letters from various stakeholders to the Delaware Department of Insurance regarding Delaware’s request for adjustment to the MLR standard (received by HHS on 05/12/11).
3. Consolidated Data on Delaware Individual Market (XLS – 22 KB)
   This document contains financial data for the consolidated Delaware individual market (received by HHS on 05/12/11).
4. HHS Request for Additional Information (PDF – 48 KB)
   This document is a May 26, 2011 letter from the Acting Director of the Office of Oversight to Delaware requesting additional information in order for Delaware’s application to be deemed complete.
5. HHS Follow Up Letter (PDF – 51 KB)
   This document is a May 26, 2011 letter from the Acting Director of the Office of Oversight to Delaware requesting additional information regarding Delaware’s application, which is separate and distinct from the request for information for completeness.
6. Delaware Response to HHS Request for Additional Information (PDF – 114 KB)
   This document is a letter from Delaware to the Acting Director of the Office of Oversight with responses to CCIIO’s May 26, 2011 letter requesting additional information (received by HHS on 06/09/11).
7. Delaware Response to HHS Follow-Up Letter (PDF – 114 KB)
   This document is a letter from Delaware to the Acting Director of the Office of Oversight with responses to CCIIO’s May 26, 2011 letter requesting additional information (received by HHS on 06/09/11).
8. Enrollees and Premium Information (XLS – 11 KB)
   This file contains information on number of enrollees and premiums earned by issuer and by product type in the Delaware individual market (received by HHS on 06/09/11).
9. Financial Information by Issuer (XLS – 11 KB)
   This file contains financial information on three issuers in the Delaware individual market (received by HHS on 06/09/11).
10. Aetna 2010 Supplemental Health Care Exhibit filing (received by HHS on 06/09/11).
    Part 1
    Part 1 Other Indicators
    Part 2
    Part 3A
    Part 3B
11. BCBSD 2010 Supplemental Health Care Exhibit filing (received by HHS on 06/09/11).
    Part 1
    Part 1 Other Indicators
    Part 2
    Part 3A
    Part 3B
12. Freedom 2010 Supplemental Health Care Exhibit filing (received by HHS on 06/09/11).
    Part 1
    Part 1 Other Indicators
    Part 2
    Part 3A
    Part 3B
13. Golden Rule 2010 Supplemental Health Care Exhibit filing (received by HHS on 06/09/11).
    Part 1
    Part 1 Other Indicators
    Part 2
    Part 3A
    Part 3B
14. John Alden 2010 Supplemental Health Care Exhibit filing (received by HHS on 06/09/11).
    Part 1
    Part 1 Other Indicators
    Part 2
    Part 3A
    Part 3B
15. Time 2010 Supplemental Health Care Exhibit filing (received by HHS on 06/09/11).
    Part 1
    Part 1 Other Indicators
    Part 2
    Part 3A
    Part 3B
16. Public Comments (PDF – 86 KB)
    This file contains public comments regarding Delaware’s request for an adjustment to the MLR standard, forwarded to HHS by Delaware as part of Delaware’s responses to CCIIO’s May 26, 2011 letter requesting additional information (received by HHS on July 1, 2011).
17. HHS Letter Deeming Delaware's Application Complete (PDF – 48 KB)
    This document is a July 11, 2011 letter from the Acting Director of the Office of Oversight to Delaware deeming Delaware’s application complete and indicating the start of the HHS review period.
18. HHS Letter to Delaware Extending the 30 Day Review Period for an Additional 30 Days (PDF – 47 KB)
    This document is an August 9, 2011 letter from the Acting Director of the Office of Oversight to Delaware exercising the Secretary’s discretion to extend the 30-day review period for an additional 30 days. 

Public Comments:

1. Consumer Public Comments (PDF – 120 KB)
   This file contains 15 public comments, from Delaware consumers and the Delaware Alliance of Health Care Reform, regarding Delaware’s request for an adjustment to the MLR standard (received by HHS between 05/26/11 and 07/21/11).
2.  NAHU Public Comment (PDF – 218 KB)
   This file is a public comment from the National Association of Health Underwriters regarding Delaware’s request for an adjustment to the MLR standard (received by HHS on 07/16/11).