Skip Navigation
Centers for Medicare & Medicaid Services

CCIIO Home > Programs and Initiatives > Health Insurance Market Reforms > Medical Loss Ratio

Programs and Initiatives

Resources

Updates

About Us

Steve Larsen 
Director of the Center for Consumer Information and Insurance Oversight 

Prior to being named the Director of the Center for Consumer Information and Insurance Oversight, Steve Larsen served as Director of the Division of Insurance Oversight in OCIIO. Biography →

CCIIO Organizational Changes

The Office of Consumer Information and Insurance Oversight (OCIIO) is now the Center for Consumer Information and Insurance Oversight (CCIIO), a part of the Centers for Medicare & Medicaid Services (CMS). This change lets us improve operations, working better and smarter by sharing resources and expertise.

Looking for consumer information? Go to www.healthcare.gov.

Indiana 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: Indiana

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 – 5.35 MB)
    This document contains Indiana’s request to adjust the MLR standard to 65 percent, 68.75 percent, 72.5 percent, 76.25 percent, and 80 percent for in 2011, 2012, 2013, 2014, and 2015, respectively (received by HHS on 05/13/11).
  2. Summary of Estimated Rebates (PDF – 36 KB)
    This document contains a summary of the potential estimated rebates to be paid by Indiana issuers (received by HHS on 05/13/11).
  3. Estimated Rebates by Issuer (PDF – 165 KB)
    This document contains an estimate of the potential rebate to be paid by each Indiana issuer that has filed a Supplemental Health Care Exhibit (received by HHS on 05/13/11).
  4. HHS Request for Additional Information (PDF –  58 KB)
    This document is a June 14, 2011 letter from the Acting Director of the Office of Oversight to Indiana requesting additional information in order for Indiana's application to be deemed complete.
  5. HHS Follow-Up Letter (PDF –  62 KB)
    This document is a June 14, 2011 letter from the Acting Director of the Office of Oversight to Indiana requesting additional information and clarifications regarding Indiana’s application, which is separate and distinct from the request for information needed for Indiana’s application to be complete. 
  6. Indiana Response to HHS Request for Additional Information (PDF –  2.1 MB)
    This document is a letter from Indiana to the Acting Director of the Office of Oversight with responses to CCIIO’s June 14, 2011 letter requesting additional information (received by HHS on 07/26/11).
  7. Indiana Response to HHS Request for Additional Information (PDF –  2.2 MB)
    This document is a letter from Indiana to the Acting Director of the Office of Oversight with responses to CCIIO’s June 14, 2011 letter requesting additional information (received by HHS on 08/10/11).
  8. Exhibit A: Enrollment and Market Share  (XLS – 44 KB)
    This document contains enrollee, premium, market share, and MLR estimates for all issuers in the Indiana individual market (received by HHS on 08/10/11).
  9. Exhibit B: Estimated Rebates (XLS – 37 KB)
    This document contains enrollment and MLR and rebate estimates for all issuers in the Indiana individual market (received by HHS on 08/10/11).
  10. Exhibit C: Financial Information by Issuer  (XLS – 31 KB)
    This document contains enrollment, MLR and rebate estimates, and financial data for issuers with at least 1,000 enrollees in the Indiana individual market (received by HHS on 08/10/11).
  11. Exhibit D: Estimated Rebates (XLS – 46 KB)
    This document contains enrollment, MLR and rebate estimates, and financial data for all issuers in the Indiana individual market (received by HHS on 08/10/11).
  12. 2010 Supplemental Health Care Exhibits – The following files contain data from the 2010 Supplemental Health Care Exhibit for certain issuers in the Indiana individual market (received by HHS on 08/10/11 and 08/19/11
  13. HHS Letter Deeming Indiana's Application Complete  (PDF –  49 KB)
    This document is a September 28, 2011 letter from the Acting Director of the Office of Oversight to Indiana deeming Indiana’s application complete and indicating the start of the HHS review period.
  14. HHS Letter to Indiana Extending the 30 Day Review Period for an Additional 30 days (PDF – 67 KB)
    This document is an October 28, 2011 letter from the Acting Director of the Office of Oversight to Indiana exercising the Secretary’s discretion to extend the 30-day review period for an additional 30 days.
  15. American Enterprise Group Letter  (PDF – 4.9 MB)
    This document is an October 20, 2011 letter from the American Enterprise Group to Indiana notifying Indiana that American Republic and World are withdrawing from all individually underwritten comprehensive major medical insurance markets (received by HHS on 11/17/11).
  16. American Enterprise Group Letter Exhibit A  (PDF – 756 KB)
    This document is a sample notice of discontinuation of coverage by American Republic, sent by American Enterprise Group to Indiana  (received by HHS on 11/17/11).
  17. American Enterprise Group Letter Exhibit B  (PDF – 820 KB)
    This document is a sample notice of discontinuation of coverage by American Republic, sent by American Enterprise Group to Indiana  (received by HHS on 11/17/11).
  18. Indiana Request for Reconsideration  (PDF – 55 KB)
    This document is a December 9, 2011 email from Indiana to HHS requesting reconsideration of the HHS determination and requesting a verbal discussion of Indiana’s issues (received by HHS on 12/09/11).
  19. HHS Response to Indiana Preliminary Request for Reconsideration  (PDF – 58 KB)
    This document is a December 9, 2011 email from the Acting Director of the Office of Oversight to Indiana requesting that Indiana submit all information it would like HHS to consider in writing, as required by the MLR regulation.
  20. Additional Information from Indiana Regarding Its Request for Reconsideration  (PDF – 1.5 MB)
    This document is a letter from Indiana to the Director of the Center for Consumer Information and Insurance Oversight providing the information Indiana would like HHS to consider in making a determination on Indiana’s reconsideration request (received by HHS on 12/16/11).

Public Comments:

  1. Consumer Watchdog Public Comment  (PDF – 209 KB)
    This file is a public comment from Consumer Watchdog regarding Indiana’s request for an adjustment to the MLR standard (received by HHS on 10/08/11).
  2. Robert Stone Public Comment  (PDF – 70 KB)
    This file is a public comment from Robert Stone, Director of Hoosiers for a Commonsense Health Plan regarding Indiana’s request for an adjustment to the MLR standard (received by HHS on 10/10/11).
  3. Health Care for America Now Public Comment  (PDF – 213 KB)
    This file is a public comment from Health Care for America Now regarding Indiana’s request for an adjustment to the MLR standard (received by HHS on 10/12/11).
  4. Joyce Michelin Public Comment  (PDF – 67 KB)
    This file is a public comment from Joyce Michelin regarding Indiana’s request for an adjustment to the MLR standard (received by HHS on 10/23/11).