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Medical Loss Ratio

North Dakota 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 Dakota

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 – 3.97 MB)
    This document contains North Dakota’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 03/18/11).
  2. Attachment A: Premium and Enrollee Information (PDF – 68 KB)
    This file contains premium and enrollee information for issuers in the North Dakota individual market (received by HHS on 03/18/11).
  3. Attachment B: Financial Information (PDF – 64 KB)
    This file contains financial information for issuers in the North Dakota individual market (received by HHS on 03/18/11).
  4. Attachment C: NAIFA-ND Letter (PDF – 3.76 MB)
    This document is a letter from the National Association of Insurance and Financial Advisors of North Dakota to Commissioner Hamm requesting that North Dakota apply for an MLR adjustment (received by HHS on 03/18/11).
  5. Attachment D: Data in Excel Format (XLS – 78 KB)
    This file contains the information provided in Attachments A and B in Excel spreadsheet format (received by HHS on 03/18/11).
  6. HHS Request for Additional Information (PDF – 33 KB)
    This document is an April 18, 2011 letter from the Acting Director of the Office of Oversight to North Dakota requesting additional information in order for North Dakota’s application to be deemed complete.
  7. HHS Follow-up Letter (PDF – 33 KB)
    This document is an April 18, 2011 letter from the Acting Director of the Office of Oversight to North Dakota requesting additional information regarding North Dakota’s application, which is separate and distinct from the request for information for completeness.
  8. North Dakota Response to HHS Request for Additional Information and Follow-up Letter (PDF – 884 KB)
    This document is a letter from North Dakota to the Acting Director of the Office of Oversight with responses to CCIIO’s April 18, 2011 letters requesting additional information (received by HHS on 05/05/11).
  9. North Dakota Updated Response to HHS Request for Additional Information and Follow-up Letter (PDF – 109 KB)
    This document is an update of the letter from North Dakota to the Acting Director of the Office of Oversight with responses to CCIIO’s April 18, 2011 letters requesting additional information (received by HHS on 05/06/11).
  10. HHS Letter Deeming North Dakota’s Application Complete (PDF – 32 KB)
    This document is a May 27, 2011 letter from the Acting Director of the Office of Oversight to North Dakota deeming North Dakota’s application complete, requesting clarifications regarding North Dakota’s May 5 and 6, 2011 responses, and indicating the start of the HHS review period.
  11. HHS Letter to North Dakota Extending the 30 Day Review Period for an Additional 30 days (PDF – 40 KB)
    This document is a June 24, 2011 letter from the Acting Director of the Office of Oversight to North Dakota exercising the Secretary’s discretion to extend the 30-day review period for an additional 30 days.

Public Comments:

  1. North Dakota Consumer Groups Public Comment (PDF – 110 KB)
    This file is a public comment from the American Cancer Society Cancer Action Network, Center for Rural Affairs Family Voices of North Dakota, and NDPeople.org regarding North Dakota’s request for an adjustment to the MLR standard.
  2. National Association of Health Underwriters Public Comment  (PDF – 215 KB)
    This file is a public comment from the National Association of Health Underwriters regarding North Dakota’s request for an adjustment to the MLR standard.