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.

Medical Loss Ratio

Maine 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 for up to three years 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: Maine

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- 58 KB)
    This file contains Maine’s request for an adjustment to MLR standard to 65 percent excluding Federal adjustments for quality improvement expenses and taxes (received by HHS on 12/16/10).
  2. HHS MML Adjustment Request (PDF – 66 KB)
    This file contains data on issuers in Maine’s individual market pursuant to §158.321(d) (received by HHS on 12/16/10).
  3. Appendix A July Letter (PDF – 81 KB)
    This document is a July 1, 2010 letter from Maine Superintendent of Insurance to the Secretary requesting an adjustment to MLR standard to 65 percent excluding Federal adjustments for quality improvement expenses and taxes (received as part of the 12/16/10 package, but originally submitted on July 1, 2010).
  4. Appendix B1 Anthem Rates (PDF – 33 KB)
    This file contains premium data on Anthem products (received by HHS on 12/16/10).
  5. Appendix B2 MEGA Rates (PDF – 493 KB)
    This file contains premium data on MEGA products (received by HHS on 12/16/10).
  6. Appendix B3 HPHC DirigoChoice (PDF – 71 KB)
    This file contains premium data on DirigoChoice products (received by HHS on 12/16/10).
  7. Appendix B4 Anthem HMO Rates (PDF – 22 KB)
    This file contains premium data on Anthem HMO products (received by HHS on 12/16/10).
  8. Appendix B5 Aetna HMO Rates (PDF – 254 KB)
    This file contains premium data on Aetna HMO products (received by HHS on 12/16/10).
  9. Appendix B6 Harvard Pilgrim HMO Rates (PDF – 31 KB)
    This file contains premium data on Harvard Pilgrim HMO products (received by HHS on 12/16/10).
  10. Appendix C Benefit Chart (PDF – 78 KB)
    This file contains charts comparing benefits offered under Maine's Standard plans and other select plans offered in the Maine individual market (received by HHS on 12/16/10).
  11. HHS Request for Additional Information (PDF – 44 KB)
    This document is a January 4, 2011 letter from the Director of the Office of Oversight to Maine requesting additional information in order for Maine’s application to be deemed complete.
  12. Maine Response to HHS Request for Additional Information (PDF – 58 KB)
    This document is a response letter from Maine to the Director of the Office of Oversight with responses to the requests in the Office of Oversight’s January 4, 2011 letter (received by HHS on 01/11/11).
  13. MEGA policies (PDF – 11 KB)
    This file contains information on the number of MEGA policies (received by HHS on 01/11/11).
  14. MEGA Rate Calculation (PDF – 8 KB)
    This file contains a sample MEGA rate calculation (received by HHS on 01/11/11).
  15. Revision of HHS MML Request (PDF – 66 KB)
    This file is a revision of the file labeled “HHS MML Adjustment Request” that was initially received by HHS on 12/16/10 (received by HHS on 01/11/11).
  16. HHS Follow-up Letter (PDF – 49 KB)
    This document is a January 12, 2011 letter from the Director of the Office of Oversight to Maine requesting additional information regarding Maine’s application, which is separate and distinct from requests for information for completeness.
  17. Maine Response to HHS Request for Supplemental Information (PDF – 60 KB)
    This document is a response letter from Maine to the Director of the Office of Oversight with responses to the requests in the Office of Oversight’s January 12, 2011 letter (received by HHS on 01/21/11).
  18. Senator Snowe Letter (PDF – 370 KB)
    This document is a November 8, 2010 letter from Senator Olympia Snowe to the Secretary requesting an adjustment to the MLR standard for the State of Maine (received as part of the 01/21/11 package, but originally submitted on November 8, 2010).
  19. DirigoChoice Worksheet (PDF – 56 KB)
    This file is a worksheet used to estimate discounts under the DirigoChoice program (received by HHS on 01/21/11).
  20. Anthem and MEGA Rate Comparison (PDF – 7 KB)
    This file is a spreadsheet comparing premium rates for Anthem and MEGA policies with $10,000 deductibles (received by HHS on 01/21/11).
  21. MEGA Member Distribution by Income (PDF – 40 KB)
    This file is a slide showing the distribution of MEGA’s members in Maine based on income bracket (received by HHS on 01/21/11)
  22. HHS Letter Deeming Maine’s Application Complete (PDF – 46 KB)
    This document is a January 25, 2011 letter from the Director of the Office of Oversight to Maine deeming Maine’s application complete and indicating the start of the HHS review period.
  23. Maine Response to Second HHS Request for Supplemental Information (PDF – 58 KB)
    This document is a response letter from Maine to the Director of the Office of Oversight with responses to the requests in the Office of Oversight’s January 25, 2011 letter (received by HHS on 01/31/11).
  24. Revision of MEGA Policies (PDF – 11 KB)
    This document is a revision of the file labeled “Mega policies,” which was initially received by HHS on 01/11/11, to include information on the number of MEGA enrollees (received by HHS on 01/31/11).
  25. Supplement to Revision of HHS MML Request (PDF – 40 KB)
    This document contains data that supplements the file labeled “Revision of HHS MML Request” that was initially received by HHS on 01/11/11 (received by HHS on 01/31/11).
  26. HHS Letter to Maine Extending the 30 Day Review Period for an Additional 30 days (PDF – 144 KB)
    This document is a February 24, 2011 letter from the Director of the Office of Oversight to Maine exercising the Secretary’s discretion to extend the 30-day review period for an additional 30 days.

Public Comments:

  1. UniteHere Public Comment (PDF – 112 KB)
    This file is a public comment from UniteHere regarding Maine’s request for an adjustment to the MLR standard (received by HHS on 12/27/2010).
  2. UniteHere Second Public Comment (PDF – 154 KB)
    This file is a second public comment from UniteHere regarding Maine’s request for an adjustment to the MLR standard (received by HHS on 01/31/2011).
  3. Timothy Jost Public Comment (PDF – 32 KB)
    This file is a public comment from Timothy Jost regarding Maine’s request for an adjustment to the MLR standard (received by HHS on 02/04/2011).