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Medical Loss Ratio

North Carolina 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: North Carolina

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 – 148 KB)
    This document is a cover letter to North Carolina’s request for adjustment to the MLR standard (received by HHS on 09/06/11).
  2. MLR Adjustment Request  (PDF – 113 KB)
    This document contains North Carolina’s request to adjust the MLR standard to 72 percent, 74 percent, and 76 percent for 2011, 2012, and 2013, respectively (received by HHS on 09/06/11).
  3. Financial Information by Issuer  (XLS – 118 KB)
    This document contains enrollee, premium, market share, and financial data by issuer in the North Carolina individual market (received by HHS on 09/06/11).
  4. HHS Follow-up letter   (PDF – 68 KB)
    This document is an October 18, 2011 letter from the Acting Director of the Office of Oversight to North Carolina requesting additional information and clarifications regarding North Carolina’s application.
  5. North Carolina Response to HHS Follow-up Letter   (PDF – 272 KB)
    This document is a December 5, 2011 letter from North Carolina to the Acting Director of the Office of Oversight with responses to CCIIO's October 18, 2011 letter requesting additional information (received by HHS on 12/06/11).
  6. Issuer Responses to Question 4 of HHS Follow-up Letter   (PDF – 45 KB)
    This file contains issuers’ responses regarding whether they intend to price their products to meet an 80% MLR (received by HHS on 12/06/11).
  7. Issuer Responses to Question 5 of HHS Follow-up Letter   (PDF – 46 KB)
    This file contains select issuers’ responses regarding whether they have reduced commissions in 2010 or 2011 (received by HHS on 12/06/11).
  8. Issuer Responses to Question 6 of HHS Follow-up Letter  (PDF – 51 KB)
    This file contains issuers’ responses regarding whether they require additional time to modify their business models to meet the new ACA requirements (received by HHS on 12/06/11).
  9. Issuer Responses to Question 7 of HHS Follow-up Letter  (PDF – 44 KB)
    This file contains issuers’ responses regarding whether they have “locked-in” contracts with agents and brokers that prevent them from meeting the MLR requirements (received by HHS on 12/06/11).
  10. North Carolina Department of Insurance Questionnaire (PDF – 315 KB)  
    This file contains the blank survey, worksheets, and follow-up questions sent by the North Carolina Department of Insurance to issuers in the North Carolina individual market in the process of preparing North Carolina’s request for an adjustment to the MLR standard (received by HHS on 12/06/11).
  11. Financial Information by Issuer – Revised  (XLS – 47 KB)
    This document contains the corrected MLR and rebate estimates for the largest issuers in the North Carolina individual market (received by HHS on 12/06/11).
  12. 2010 Supplemental Health Care Exhibits  (XLS – 214 KB)
    This file contains the 2010 Supplemental Health Care Exhibits for select issuers in the North Carolina individual market (received by HHS on 12/06/11).
  13. 2010 Supplemental Health Care Exhibit – Wellpath   (PDF – 316 KB)
    This file contains the revised 2010 Supplemental Health Care Exhibit for Wellpath (received by HHS on 12/06/11).
  14. MEGA and Mid-West MLR Estimates  (XLS – 18 KB)
    This file contains the revised calculations of MEGA’s and Mid-West’s 2010 MLRs (received by HHS on 12/06/11).
  15. American Enterprise Group Letter   (PDF – 34 KB)
    This document is an October 24, 2011 letter from the American Enterprise Group to North Carolina notifying North Carolina that American Republic and World are withdrawing from all individually underwritten comprehensive major medical insurance markets (received by HHS on 12/06/11).
  16. HHS Letter Deeming North Carolina’s Application Complete    (PDF – 200 KB)
    This document is a January 9, 2012 letter from the Acting Director of the Office of Oversight to North Carolina deeming North Carolina’s application complete and indicating the start of the HHS review period.
  17. HHS Letter to North Carolina Extending the 30 Day Review Period for an Additional 30 Days (PDF – 17 KB)
    This document is a February 8, 2012 letter from the Acting Director of the Office of Oversight to North Carolina exercising the Secretary’s discretion to extend the 30-day review period for an additional 30 days.

Public Comments

  1. National Patient Advocate Foundation Public Comment (PDF – 3.2 MB)
    This file is a public comment from National Patient Advocate Foundation regarding North Carolina’s request for an adjustment to the MLR standard (received by HHS on 01/20/12)
  2. Consumers Union Public Comment (PDF – 190 KB)
    This file is a public comment from Consumers Union regarding North Carolina’s request for an adjustment to the MLR standard (received by HHS on 01/20/12)
  3. Action North Carolina Public Comment (HTM – 34 KB)
    This file is a public comment from Action North Carolina regarding North Carolina’s request for an adjustment to the MLR standard (received by HHS on 01/20/12)