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Medical Loss Ratio

Florida 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: Florida

Application Status: HHS Determination Issued

Application Determination:

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 Cover Letter (PDF – 68 KB)
    This document is a cover letter to the State of Florida’s request for adjustment to the MLR standard (received by HHS by 03/11/11).
  2. MLR Adjustment Request (PDF – 807 KB)
    This document contains Florida’s request to adjust the MLR standard to 65 percent for insurers and 70 percent for HMOs for the years 2011 through 2013 (received by HHS by 03/11/11).
  3. Financial Information by Issuer (XLS – 26 KB)
    This file contains financial information on issuers in the Florida individual market (received by HHS on 03/11/11).
  4. Preferred Medical Plan Rates (XLS – 360 KB)
    This file contains rate information for Preferred Medical Plan products (received by HHS on 03/11/11).
  5. Aetna Health Rates (PDF – 58 KB)
    This file contains rate information for Aetna Health products (received by HHS on 03/11/11).
  6. Aetna Life Rates (PDF – 69 KB)
    This file contains rate information for Aetna Life products (received by HHS on 03/11/11).
  7. AvMed Health Rates (XLS – 435 KB)
    This file contains rate information for AvMed Health products (received by HHS on 03/11/11).
  8. BCBS of Florida Rates (XLS - 106)
    This file contains rate information for Blue Cross Blue Shield of Florida products (received by HHS on 03/11/11).
  9. Connecticut General Life Rates – Part 1 (XLS – 43 KB)
    This file is part 1 of 3 documents containing rate information for Connecticut General Life products (received by HHS on 03/11/11).
  10. Connecticut General Life Rates – Part 2 (XLS – 110 KB)
    This file is part 2 of 3 documents containing rate information for Connecticut General Life products (received by HHS on 03/11/11).
  11. Connecticut General Life Rates – Part 3 (XLS – 110 KB)
    This file is part 3 of 3 documents containing rate information for Connecticut General Life products (received by HHS on 03/11/11).
  12. CoventryOne Rates – Part 1 (XLS – 632 KB)
    This file is part 1 of 2 documents containing rate information for CoventryOne products (received by HHS on 03/11/11).
  13. CoventryOne Rates – Part 2 (XLS – 240 KB)
    This file is part 2 of 2 documents containing rate information for CoventryOne products (received by HHS on 03/11/11).
  14. Vista (Coventry) Rates – Part 1 (XLS – 399 KB)
    This file is part 1 of 2 documents containing rate information for Vista products (received by HHS on 03/11/11).
  15. Vista (Coventry) Rates – Part 2 (XLS – 193 KB)
    This file is part 2 of 2 documents containing rate information for Vista products (received by HHS on 03/11/11).
  16. Health Options Rates (XLS – 46 KB)
    This file contains rate information for Health Options products (received by HHS on 03/11/11).
  17. Public Evidentiary Hearing Transcript (PDF-- 511 KB)
    This document is the official transcript of the September 24, 2010 public evidentiary hearing on MLR conducted by the Florida Office of Insurance Regulation and the Florida Health Insurance Advisory Board (received by HHS on 03/11/11).
  18. HHS Request for Additional Information (PDF – 33 KB)
    This document is an April 4, 2011 letter from the Acting Director of the Office of Oversight to Florida requesting additional information in order for Florida’s application to be deemed complete.
  19. HHS Follow-up Letter (PDF – 31 KB)
    This document is an April 4, 2011 letter from the Acting Director of the Office of Oversight to Florida requesting additional information regarding Florida’s application, and is separate and distinct from requests for information to complete Florida’s application.
  20. Florida Extension Request  (PDF – 59 KB)
    This document is an April 6, 2011 letter from Florida to the Acting Director of the Office of Oversight requesting a three week extension to submit its response to CCIIO’s April 4, 2011 letters (received by HHS on 04/06/11).
  21. HHS Extension Grant Letter (PDF – 22 KB)
    This document in an April 7, 2011 letter from the Acting Director of the Office of Oversight to Florida granting Florida’s request for an extension.
  22. Florida Responses to HHS Request for Additional Information and Follow-up Letter (PDF – 75 KB)
    This document is a June 28, 2011 letter from Florida to the Acting Director of the Office of Oversight with responses to CCIIO's April 4, 2011 letters requesting additional information (received by HHS on 06/28/11).
  23. Financial Information by Issuer – Revised (XLS – 41 KB)
    This file contains updated financial information on issuers in the Florida individual market (received by HHS on 06/28/11).
  24. Attachment B-1: Premium and Enrollee Information (XLS – 13 KB)
    This file contains enrollee, product type, premium, and market share information by issuer (received by HHS on 06/28/11).
  25. Attachment E: Company Name Match (XLS – 11 KB)
    This file matches the alphabetical letter identifiers with company names for certain issuers (received by HHS on 06/28/11).
  26. Attachment F: Estimated Rebates (XLS – 12 KB)
    This file contains issuers’ estimated 2011-2013 rebates under Florida’s proposed adjustment to the 80 percent MLR standard (received by HHS on 06/28/11).
  27. Attachment G: New Entrants (XLS – 10 KB)
    This file contains financial information for four of the seven issuers that have entered the Florida individual health insurance market since 2008 (received by HHS on 06/28/11).
  28. Attachment H: Assumptions (XLS – 24 KB)
    This file contains assumptions underlying issuers’ estimates of MLRs and rebates, issuers’ estimated 2011-2013 rebates under Florida’s proposed adjustment to the 80 percent MLR standard, and enrollment by product for certain issuers (received by HHS on 06/28/11).
  29. Product Data by Issuer – Part 1 (ZIP – 2,671 KB)
    This file contains policy benefit, rate, and enrollment data for issuers A through H (received by HHS on 06/28/11).   The zip file contains a number of individual excel workbooks and pdf files.  Policy benefit files specify plan name and type, covered benefits, and benefit and cost sharing levels for representative individual plans offered by the issuer.  Rate workbooks specify rates for age/gender/smoking status/geographic region combinations for the individual plans offered by the issuer.  Enrollment workbooks contain enrollment broken down by plan for the individual plans offered by the issuer. Please contact MLRAdjustments@hhs.gov if you are unable to open the zip file.
  30. Product Data by Issuer – Part 2 (ZIP – 8,756 KB)
    This file contains policy benefit, rate, and enrollment data for issuers I through T (received by HHS on 06/28/11).   The zip file contains a number of individual excel workbooks and pdf files.  Policy benefit files specify plan name and type, covered benefits, and benefit and cost sharing levels for representative individual plans offered by the issuer.  Rate workbooks specify rates for age/gender/smoking status/geographic region combinations for the individual plans offered by the issuer.  Enrollment workbooks contain enrollment broken down by plan for the individual plans offered by the issuer. Please contact MLRAdjustments@hhs.gov if you are unable to open the zip file.
  31. HHS Second Follow-up Letter (PDF – 870 KB)
    This document is a July 20, 2011 letter from the Acting Director of the Office of Oversight to Florida requesting additional information and clarifications regarding the information Florida submitted on June 28, 2011.
  32. Florida Notice of the Timeframe for Response (PDF – 53 KB)
    This document is a July 21, 2011 letter from Florida to the Acting Director of the Office of Oversight notifying CCIIO that Florida will require more than seven days to submit its response to CCIIO’s July 20, 2011 letter (received by HHS on 07/21/11).
  33. Florida Response to HHS Second Follow-up Letter  (PDF – 67 KB)
    This document is a September 2, 2011 letter from Florida to the Acting Director of the Office of Oversight with responses to CCIIO's July 20, 2011 letter requesting additional information (received by HHS on 09/02/11).
  34. Financial Information by Issuer – Revised  (XLS – 42 KB)
    This file contains updated financial information on issuers in the Florida individual market (received by HHS on 09/02/11).
  35. Issuer Withdrawal Notices  (PDF – 196 KB)
    This file contains notices of withdrawal from the Florida individual market by Citrus Health Care, Guarantee Trust Life, Guardian, and National Health (received by HHS on 09/02/11).
  36. Attachment F: Estimated Rebates – Issuer Clarifications  (PDF – 12 MB)
    This file contains several issuers’ explanations for the inconsistencies between their estimated MLRs and  their estimated 2011-2013 rebates under Florida’s proposed adjustments to the 80 percent MLR standard (received by HHS on 09/02/11).
  37. 2010 Supplemental Health Care Exhibits – Part 1  (PDF – 2.9 MB)
    This file contains the 2010 Supplemental Health Care Exhibits for Florida Health; Humana; and Medica (received by HHS on 09/02/11).
  38. 2010 Supplemental Health Care Exhibits – Part 2  (PDF – 6.4 MB)
    This file contains the 2010 Supplemental Health Care Exhibits for BCBS of FL; CGLIC; Coventry; Aetna Health; AvMed; Health Options; Preferred Medical (received by HHS on 09/02/11).
  39. 2010 Supplemental Health Care Exhibits – Part 3  (PDF – 6.4 MB)
    This file contains the 2010 Supplemental Health Care Exhibits for Aetna Life; American Republic; Celtic; Freedom; Golden Rule; Humana; John Alden; MEGA; Mid-West; Time; World (received by HHS on 09/02/11).
  40. HHS Letter Deeming Florida's Application Complete  (PDF – 57 KB)
    This document is an October 17, 2011 letter from the Acting Director of the Office of Oversight to Florida deeming Florida’s application complete and indicating the start of the HHS review period.
  41. HHS Letter to Florida Extending the 30 Day Review Period for an Additional 30 days  (PDF – 54 KB)
    This document is a November 16, 2011 letter from the Acting Director of the Office of Oversight to Florida exercising the Secretary’s discretion to extend the 30-day review period for an additional 30 days.
  42. American Enterprise Group Letter  (PDF – 201 KB)
    This document is an October 20, 2011 letter from the American Enterprise Group to Florida notifying Florida that American Republic and World are withdrawing from all individually underwritten comprehensive major medical insurance markets (received by HHS on 12/08/11).
  43. Florida Request for Reconsideration  (PDF – 126 KB)
    This document is a December 30, 2011 letter from Florida to the Director of the Center for Consumer Information and Insurance Oversight requesting reconsideration of the HHS determination (received by HHS on 12/30/11).
  44. Additional Information from Florida Regarding Its Request for Reconsideration  (PDF – 3.1 MB)
    This document is a January 6, 2012 letter from Florida to the Director of the Center for Consumer Information and Insurance Oversight providing additional information Florida would like HHS to consider in making a determination on Florida’s reconsideration request (received by HHS on 1/06/12).

Public Comments

  1. Consumer Public Comment (PDF – 95 KB)
    This file contains a comment from a Florida consumer regarding Florida’s request for an adjustment to the MLR standard (received by HHS on 9/7/2011).
  2. Consumer Watchdog Public Comment  (PDF – 147 KB)
    This file is a public comment from Consumer Watchdog regarding Florida’s request for an adjustment to the MLR standard (received by HHS on 10/25/11).
  3. Health Care for America Now Public Comment  (PDF – 282 KB)
    This file is a public comment from Health Care for America Now regarding Florida’s request for an adjustment to the MLR standard (received by HHS on 10/26/11).
  4. Consumers Union Public Comment  (PDF – 58 KB)
    This file is a public comment from Consumers Union regarding Florida’s request for an adjustment to the MLR standard (received by HHS on 10/27/11).
  5. Florida Consumer Groups Public Comment  (PDF – 401 KB)
    This file is a public comment from 20 consumer and patient advocacy organizations regarding Florida’s request for an adjustment to the MLR standard (received by HHS on 10/27/11).
  6. Florida Consumers Petition  (PDF – 152 KB)
    This file is a petition by Florida consumers requesting that HHS deny Florida’s request for an adjustment to the MLR standard (received by HHS on 10/27/11).
  7. Agent Reconsideration Request Comments  (ZIP – 844 KB)
    This file contains emails and letters from 26 agents regarding Florida’s request for reconsideration.  The zip file contains 15 individual Word and PDF files.  Please contact MLRAdjustments@cms.hhs.gov if you are unable to open the zip file.  (received by HHS between 1/12/12 and 1/16/12).
  8. Florida Consumer Groups Reconsideration Request Comment  (PDF – 243 KB)
    This file is a comment from Florida CHAIN and Florida Center for Fiscal and Economic Policy regarding Florida’s request for reconsideration (received by HHS on 1/16/12).
  9. Health Care for America Now Reconsideration Request Comment  (PDF – 135 KB)
    This file is a comment from Health Care for America Now regarding Florida’s request for reconsideration (received by HHS on 1/17/12).