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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 →

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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.

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Medical Loss Ratio

Kentucky 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: Kentucky

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
    This document contains Kentucky’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 02/16/11).
  2. Enrollees, Premium, and Market Share Information
    This file contains information on number of enrollees, premiums earned, and individual market share by issuer in the Kentucky individual market (received by HHS on 02/16/11).
  3. Financial Information by Issuer
    This file contains financial information on three issuers in the Kentucky individual market (received by HHS on 02/16/11).
  4. Dale Hyers Opinion
    This file contains the expert opinion of Dale Hyers, a consultant to the Kentucky Department of Insurance, regarding the implementation of the 80 percent MLR standard in Kentucky’s individual market (received by HHS on 02/16/11).
  5. American Academy of Actuaries Letter
    This file is an April 28, 2010 letter from the American Academy of Actuaries Medical Loss Ratio Regulation Work Group to the NAIC regarding potential disruption of individual markets (received by HHS on 02/16/11).
  6. Issues Regarding Minimum Loss Ratios
    This file is a February 2010 issue document regarding minimum loss ratios written by the American Academy of Actuaries (received by HHS on 02/16/11).
  7. Rate Filing Requirements
    This file describes Kentucky’s health benefit plan rate filing requirements (received by HHS on 02/16/11).
  8. Commissioner’s Rate Filing Approval Authority
    This file describes the Kentucky Commissioner’s authority to approve or disapprove rate filings (received by HHS on 02/16/11).
  9. Renewal or Continuation Requirements
    This file describes Kentucky’s renewal or continuation requirements for health benefit plans (received by HHS on 02/16/11).
  10. Premium Rate Guidelines
    This file describes the premium rate guidelines for individual, small group, and association plans in Kentucky (received by HHS on 02/16/11).
  11. Kentucky Access Premiums
    This file describes how premium rates under the Kentucky Access program are established (received by HHS on 02/16/11).
  12. Kentucky Access Eligibility
    This file describes how eligibility for the Kentucky Access program is determined (received by HHS on 02/16/11).
  13. History of Kentucky Health Insurance Market
    This file describes the history of Kentucky’s accident and health insurance market since 1990 (received by HHS on 02/16/11).
  14. Kentucky Health Insurance Market Report – Part 1
    This file contains part 1 of 3 of the Kentucky Department of Insurance’s 1997 Market Report on Health Insurance (received by HHS on 02/16/11).
  15. Kentucky Health Insurance Market Report – Part 2
    This file contains part 2 of 3 of the Kentucky Department of Insurance’s 1997 Market Report on Health Insurance (received by HHS on 02/16/11).
  16. Kentucky Health Insurance Market Report– Part 3
    This file contains part 3 of 3 of the Kentucky Department of Insurance’s 1997 Market Report on Health Insurance (received by HHS on 02/16/11).
  17. Enrollees, Premium, and Market Share Information – Revised (XLS – 16 KB)
    This file contains updated information on number of enrollees, premiums earned, and individual market share by issuer in the Kentucky individual market (received by HHS on 03/08/11).
  18. HHS Request for Additional Information (PDF – 49 KB)
    This document is a March 24, 2011 letter from the Acting Deputy Director of CCIIO to Kentucky requesting additional information in order for Kentucky’s application to be deemed complete.
  19. HHS Follow-up Letter (PDF – 53 KB)
    This document is a March 24, 2011 letter from the Acting Deputy Director of CCIIO to Kentucky requesting additional information regarding Kentucky’s application, which is separate and distinct from the request for information for completeness.
  20. Kentucky Response to HHS Follow-up Letter (PDF – 68 KB)
    This document is a letter from Kentucky to the Acting Deputy Director of CCIIO with responses to CCIIO’s March 24, 2011 letter requesting additional information (received by HHS on 04/07/11).
  21. MEGA’s Notice of Discontinuance of Sales (PDF -  49 KB)
    This document is an October 12, 2010 letter from MEGA to Kentucky stating that MEGA has ceased sales of individual health plans in Kentucky, but will continue to renew existing plans (received by HHS on 04/07/11).
  22. Physicians Mutual’s Certification of No Marketing Activity (PDF – 47 KB)
    This document is an October 14, 2010 letter from Physicians Mutual to Kentucky certifying that Physicians Mutual has not sold individual health plans in Kentucky since 2005, but will continue to renew its sole existing plan (received by HHS on 04/07/11).
  23. Assurant’s Response to Kentucky’s Individual Market Survey (PDF – 93 KB)
    This document is a December 16, 2010 response by Time to Kentucky’s request for information (received by HHS on 04/07/11).
  24. KRS 304.17A-260 (PDF – 107 KB)
    This document is a Kentucky statute offering amnesty to issuers wishing to re-enter the market prior to the five year moratorium (received by HHS on 04/07/11).
  25. Kentucky Access Funding and Enrollment Levels (XLS – 16 KB)
    This file contains the 2008-2010 funding and enrollment levels for Kentucky’s State high risk pool (received by HHS on 04/07/11).
  26. Market Shares 2006-2009 (XLS – 19 KB)
    This file contains 2006-2009 market shares for the top four issues in the individual market (received by HHS on 04/07/11).
  27. Re-entry Information by Issuer (XLS - 17 KB)
    This file contains 2003-2009 enrollment data for issuers that have re-entered the market after a withdrawal (received by HHS on 04/07/11).
  28. Kentucky Response to HHS Request for Additional Information (PDF – 66 KB)
    This document is a letter from Kentucky to the Acting Deputy Director of CCIIO with responses to CCIIO’s March 24, 2011 letter requesting additional information (received by HHS on 05/16/11).
  29. Enrollees, Premium, and Market Share Information – Revised (XLS – 24 KB)
    This file contains updated information on number of enrollees, premiums earned, and individual market share by issuer in the Kentucky individual market (received by HHS on 05/16/11).
  30. Financial Information by Issuer – Revised (XLS – 17 KB)
    This file contains updated financial information on five issuers in the Kentucky individual market (received by HHS on 05/16/11).
  31. Kentucky Access Budget (XLS – 16 KB)
    This file contains the 2010-2011 budget for Kentucky’s State high risk pool (received by HHS on 05/16/11).
  32. HHS Letter Deeming Kentucky’s Application Complete (PDF – 52 KB)
    This document is a May 31, 2011 letter from the Acting Director of the Office of Oversight to Kentucky deeming Kentucky’s application complete, requesting additional information regarding Kentucky’s May 16, 2011 responses, and indicating the start of the HHS review period.
  33. Kentucky Extension Request (PDF - 71 KB)
    This document is a June 14, 2011 email from Kentucky to the Acting Director of the Office of Oversight requesting that HHS delay acting or deciding upon Kentucky’s application until after July 1, 2011, when Kentucky anticipates providing additional information to support Kentucky’s application. (received by HHS on 06/14/11).
  34. HHS Letter Granting Kentucky’s Extension Request (PDF - 43 KB)
    This document is a June 24, 2011 letter from the Acting Director of the Office of Oversight to Kentucky granting Kentucky’s request that HHS delay issuing a determination pending submission of additional information by Kentucky.
  35. Kentucky Supplemental Information 1 (PDF – 102 KB)
    This document is a letter from Kentucky to the Acting Director of the Office of Oversight with additional information to support Kentucky’s application (received by HHS on 07/01/11).
  36. Kentucky Supplemental Information 2 (PDF – 289 KB)
    This file contains a May 19, 2011 letter from Aetna to Kentucky notifying Kentucky that Aetna intends to withdraw from the Kentucky individual and small group markets, and a July 7, 2011 letter from Kentucky to Aetna approving Aetna’s request to withdraw and setting forth conditions for Aetna’s withdrawal (received by HHS on 07/08/11).
  37. HHS Letter Deeming Kentucky's Application Complete (PDF – 48 KB)
    This document is a July 11, 2011 letter from the Acting Director of the Office of Oversight to Kentucky deeming Kentucky’s application complete and indicating the start of the HHS review period.

Public Comments:

  1. Kentucky Association of Health Underwriters Public Comment (PDF – 614 KB)
    This file is a public comment from Kentucky Association of Health Underwriters regarding Kentucky’s request for an adjustment to the MLR standard (received by HHS on 05/19/11).
  2. Kentucky Voices for Health Public Comment (PDF – 94 KB)
    This file is a public comment from Kentucky Voices for Health regarding Kentucky’s request for an adjustment to the MLR standard (received by HHS on 06/10/11).
  3. Kentucky Equal Justice Center Public Comment (PDF – 162 KB)
    This file is a public comment from Kentucky Equal Justice Center regarding Kentucky’s request for an adjustment to the MLR standard (received by HHS on 06/10/11).
  4. Consumer Watchdog Public Comment (PDF – 94)
    This file is a public comment from Consumer Watchdog regarding Kentucky’s request for an adjustment to the MLR standard (received by HHS on 06/10/11).
  5. Kentucky Equal Justice Center Additional Public Comment (PDF – 45 KB) 
    This file is a second public comment from Kentucky Equal Justice Center regarding Kentucky’s request for an adjustment to the MLR standard (received by HHS on 07/20/11).