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Medical Loss Ratio

Georgia 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.

A state’s request for an adjustment to the MLR standard is a public document. The Secretary invites public comment regarding a state’s request. Public comments must be submitted electronically by midnight on the 10th calendar day after the posting of a complete state request in order to guarantee consideration. When the application is deemed complete, the webpage will be updated to reflect the deadline for public comment on the state’s application.

To submit a comment regarding this adjustment application, please email MLRAdjustments@hhs.gov. Please include Georgia in the email subject line.

State: Georgia

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 (PDF – 1.26 MB)
    This document contains Georgia’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 03/17/11).
  2. Supporting Data by Issuer (XLS – 47 KB)
    This document contains enrollee, premium, market share, and financial data by issuer in the Georgia individual market (received by HHS on 03/17/11).
  3. HHS Request for Additional Information (PDF – 30 KB)
    This document is an April 4, 2011 letter from the Acting Director of the Office of Oversight to Georgia requesting additional information in order for Georgia’s application to be deemed complete.
  4. HHS Follow-up Letter (PDF – 32 KB)
    This document is an April 18, 2011 letter from the Acting Director of the Office of Oversight to Georgia requesting additional information regarding Georgia’s application, which is separate and distinct from the request for information for completeness.
  5. Georgia Notice of the Timeframe for Responses (PDF – 66 KB)
    This document is a letter from Georgia to the Acting Director of the Office of Oversight, notifying CCIIO that Georgia will submit responses to CCIIO’s April 4 and 18, 2011 letters by May 18, 2011 (received by HHS on 04/29/11).
  6. Georgia Responses to HHS Request for Additional Information and Follow-up Letter (PDF – 303 KB)
    This document is a letter from Georgia to the Acting Director of the Office of Oversight with responses to CCIIO’s April 4 and 18, 2011 letters requesting additional information (received by HHS on 05/18/11).
  7. Supporting Data by Issuer – Revised (XLS – 47 KB)
    This file contains updated enrollee, premium, market share, and financial data by issuer, as well as calculation assumptions, and Part 1 of the Supplemental Health Care Exhibits for issuers in the Georgia individual market (received by HHS on 05/18/11).
  8. Product Data by Issuer – Part 1 (ZIP – 3,733 KB)
    This file contains policy benefit, rate, and enrollment data for issuers 1-4, 6, and 8 (received by HHS on 05/18/11).   The zip file contains a number of individual excel workbooks.  Policy benefit workbooks specify plan name and type, covered benefits, and benefit and cost sharing levels for each individual plan offered by the issuer.  Rate workbooks specify rates for age/gender/smoking status/geographic region combinations for each individual plan offered by the issuer.  Enrollment workbooks contain enrollment broken down by plan for each individual plan offered by the issuer. Please contact MLRAdjustments@hhs.gov if you are unable to open the zip file.
  9. Product Data by Issuer – Part 2 (ZIP – 2,088 KB)
    This file contains policy benefit, rate, and enrollment data for issuers 9-11, 14-17, and 19 (received by HHS on 05/18/11).  The zip file contains a number of individual excel workbooks and one pdf.  Policy benefit workbooks specify plan name and type, covered benefits, and benefit and cost sharing levels for each individual plan offered by the issuer.  Rate workbooks specify rates for age/gender/smoking status/geographic region combinations for each individual plan offered by the issuer.  Enrollment workbooks contain enrollment broken down by plan for each individual plan offered by the issuer. Please contact MLRAdjustments@hhs.gov if you are unable to open the zip file.
  10. Product Data by Issuer – Part 3 (ZIP – 8,224 KB)
    This file contains policy benefit, rate, and enrollment data for issuers 5, 12, 13, and 18 (received by HHS on 05/20/11).  The zip file contains a large number of individual excel workbooks.  Policy benefit workbooks specify plan name and type, covered benefits, and benefit and cost sharing levels for each individual plan offered by the issuer.  Rate workbooks specify rates for age/gender/smoking status/geographic region combinations for each individual plan offered by the issuer.  Enrollment workbooks contain enrollment broken down by plan for each individual plan offered by the issuer. Please contact MLRAdjustments@hhs.gov if you are unable to open the zip file.
  11. Product Data by Issuer – Enrollment for Issuer 11 (PDF – 126 KB)
    This file contains enrollment data by product for issuer 11 (received by HHS on 05/20/11).
  12. Product Data by Issuer – Enrollment for Issuer 19  (PDF – 59 KB)
    This file contains enrollment data by product for issuer 19 (received by HHS on 05/20/11).
  13. Commission Rates Chart (PDF – 148 KB)
    This file contains commission rates for several issuers in the Georgia health insurance market (received by HHS on 06/13/11).
  14. Georgia Association of Health Underwriters Letter (PDF – 81 KB)
    This document is a December 14, 2010 letter from the Georgia Association of Health Underwriters to Georgia requesting that Georgia seek an adjustment to the MLR standard (received by HHS on 06/13/11).
  15. HHS Second Follow-up Letter (PDF – 67 KB)
    This document is a July 1, 2011 letter from the Acting Director of the Office of Oversight to Georgia requesting additional information and clarifications regarding the information Georgia submitted on May 18, 2011.
  16. Georgia Extension Request (PDF – 44 KB)
    This document is a letter from Georgia to the Acting Director of the Office of Oversight, requesting a one week extension to submit its responses to CCIIO’s July 1, 2011 letter (received by HHS on 07/07/11).
  17. HHS Extension Grant Letter (PDF – 48 KB)
    This document in a July 8, 2011 letter from the Acting Director of the Office of Oversight to Georgia granting Georgia’s request for an extension.
  18. Georgia Response to HHS Second Follow-up Letter (PDF – 272 KB)
    This document is a letter from Georgia to the Acting Director of the Office of Oversight with responses to CCIIO’s July 1, 2011 letter requesting additional information (received by HHS on 07/15/11).
  19. Supporting Data by Issuer – Revised (XLS – 60 KB)
    This file contains enrollee, premium, market share, and financial data by issuer, as well as calculation assumptions, and data from Part 1 of the Supplemental Health Care Exhibits for issuers in the Georgia individual market, revised to include information for five additional issuers (received by HHS on 07/15/11).
  20. Commission Rates Chart – Updated (PDF – 148 KB)
    This file contains commission rates for several issuers in the Georgia health insurance market, updated to show applicable years (received by HHS on 07/15/11).
  21. Georgia Response to HHS Second Follow-up Letter – Addendum 1 (PDF – 133 KB)
    This document is a letter from Georgia to the Acting Director of the Office of Oversight with corrections and amendments to Georgia’s July 15, 2011 letter (received by HHS on 07/21/11).
  22. Georgia Response to HHS Second Follow-up Letter – Addendum 2 (PDF – 58 KB)
    This document is a letter from Georgia to the Acting Director of the Office of Oversight with amendments to Georgia’s July 21, 2011 letter (received by HHS on 07/28/11).
  23. HHS Letter Deeming Georgia's Application Complete  (PDF – 124 KB)
    This document is a September 9, 2011 letter from the Acting Director of the Office of Oversight to Georgia deeming Georgia’s application complete and indicating the start of the HHS review period.
  24. Georgia Response to Additional Question in HHS Letter Deeming Georgia’s Application Complete (PDF – 80 KB)
    This document is a letter from Georgia to the Acting Director of the Office of Oversight with responses to follow-up question in CCIIO’s September 9, 2011 letter (received by HHS on 09/14/11).
  25. HHS Letter to Georgia Extending the 30 Day Review Period for an Additional 30 days  (PDF – 48 KB)
    This document is an October 7, 2011 letter from the Acting Director of the Office of Oversight to Georgia exercising the Secretary’s discretion to extend the 30-day review period for an additional 30 days.

Public Comments:

  1. Georgia Consumer Organizations Public Comment (PDF – 132 KB)
    This file is a public comment from the Georgians for a Healthy Future, Georgia Watch, and the 15 additional organizations regarding Georgia’s request for an adjustment to the MLR standard (received by HHS on 09/16/11).
  2. Georgia Consumer Organizations Public Comment Attachment – NAHU Commissions Data  (XLS – 50 KB)This file contains data on commission rates in Georgia complied by the National Association of Health Underwriters and submitted with the Georgia consumer organizations public comment regarding Georgia’s request for an adjustment to the MLR standard (received by HHS on 09/16/11).