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Medical Loss Ratio

Texas 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: Texas

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 – 18 KB)
    This document is a cover letter to the State of Texas’ request for adjustment to the MLR standard (received by HHS on 07/29/11).
  2. MLR Adjustment Request  (PDF – 4 MB)
    This document contains Texas’ request to adjust the MLR standard to 71 percent, 74 percent, and 77 percent for 2011, 2012, and 2013, respectively (received by HHS on 07/29/11).
  3. Financial Information by Issuer  (XLS – 21 KB)
    This document contains enrollee, premium, market share, and financial data by issuer in the Texas individual market (received by HHS on 07/29/11).
  4. HHS Follow-up Letter  (PDF – 297 KB)
    This document is a September 7, 2011 letter from the Acting Director of the Office of Oversight to Texas requesting additional information and clarifications regarding Texas’ application.
  5. HHS Follow-up Timeframe Inquiry  (PDF – 207 KB)
    This file contains an October 25, 2011 email from the Office of Oversight to Texas requesting an estimate of the timeframe for receiving Texas’ responses to CCIIO’s September 7, 2011 letter, and a November 1, 2011 email from Texas to the Office of Oversight indicating the timeframe for Texas’ responses.
  6. Texas Response to HHS Follow-up Letter  (PDF – 853 KB)
    This document is a November 14, 2011 letter from Texas to the Acting Director of the Office of Oversight with responses to CCIIO's September 7, 2011 letter requesting additional information (received by HHS on 11/14/11).
  7. Financial Information by Issuer – Revised  (XLSX – 39 KB)
    This file contains updated enrollee, premium, market share, and financial data by issuer in the Texas individual market (received by HHS on 11/14/11).
  8. Texas Department of Insurance Questionnaire  (PDF – 1 MB)
    This file contains the blank questionnaire sent by the Texas Department of Insurance to issuers in the Texas individual market in the process of preparing Texas’ request for an adjustment to the MLR standard (received by HHS on 11/14/11).
  9. 2010 Supplemental Health Care Exhibits  (ZIP – 680 KB)
    This file contains the 2010 Supplemental Health Care Exhibits for the largest issuers in the Texas individual market (received by HHS on 11/14/11). The zip file contains 33 individual excel workbooks. Please contact MLRAdjustments@hhs.gov if you are unable to open the zip file.
  10. HHS Letter Deeming Texas’ Application Complete  (PDF – 222 KB)
    This document is a November 28, 2011 letter from the Acting Director of the Office of Oversight to Texas deeming Texas’ application complete and indicating the start of the HHS review period.
  11. Texas Response to Additional Question in HHS Letter Deeming Texas’ Application Complete  (PDF – 82 KB)
    This document is a letter from Texas to the Acting Director of the Office of Oversight with responses to follow-up question in CCIIO’s November 28, 2011 letter (received by HHS on 12/12/11).
  12. Financial Information by Issuer – Revised  (XLSX – 39 KB)
    This file contains updated enrollee, premium, market share, and financial data by issuer in the Texas individual market (received by HHS on 12/12/11).
  13. American Enterprise Group Letter  (PDF – 194 KB)
    This document is an October 27, 2011 letter from the American Enterprise Group to Texas notifying Texas that American Republic and World are withdrawing from all individually underwritten comprehensive major medical insurance markets (received by HHS on 12/12/11).
  14. National Health Letter  (PDF – 36 KB)
    This document is a June 10, 2010 letter from the National Health Ins. Co. to Texas notifying Texas that National Health is withdrawing from the Texas individual market (received by HHS on 12/12/11).
  15. Tower Life Letter  (PDF – 35 KB)
    This document is a June 14, 2011 letter from the Tower Life Ins. Co. to Texas notifying Texas that Tower Life is withdrawing from the Texas individual market (received by HHS on 12/12/11).
  16. 2010 Supplemental Health Care Exhibit – National Health  (XLSX – 36 KB)
    This file contains the 2010 Supplemental Health Care Exhibit for National Health Ins. Co. (received by HHS on 12/12/11).
  17. 2010 Supplemental Health Care Exhibit – Tower Life  (XLSX – 36 KB)
    This file contains the 2010 Supplemental Health Care Exhibit for Tower Life Ins. Co. (received by HHS on 12/12/11).
  18. HHS Letter to Texas Extending the 30 Day Review Period for an Additional 30 days (PDF – 202 KB)
    This document is a December 28, 2011 letter from the Acting Director of the Office of Oversight to Texas exercising the Secretary’s discretion to extend the 30-day review period for an additional 30 days.

Public Comments:

  1. Consumer Public Comments  (PDF – 64 KB)
    This file contains three public comments from Texas consumers regarding Texas’ request for an adjustment to the MLR standard (received by HHS on 12/07/11).
  2. TAHU Public Comment  (PDF – 36 KB)
    This file is a public comment from the Texas Association of Health Underwriters regarding Texas’ request for an adjustment to the MLR standard (received by HHS on 12/07/11).
  3. Texas State Legislators Letter  (PDF – 312 KB)
    This document is a December 7, 2011 letter from 15 Texas State Representatives to the Secretary requesting that HHS deny Texas’ request for an adjustment to the MLR standard (received by HHS on 12/07/11).
  4. Representative Burnam Letter  PDF – 117 KB)
    This document is a December 8, 2011 letter from Texas State Representative Lon Burnam to the Secretary requesting that HHS deny Texas’ request for an adjustment to the MLR standard (received by HHS on 12/08/11).
  5. IIAT Public Comment (PDF – 57 KB)
    This file is a public comment from the Independent Insurance Agents of Texas regarding Texas’ request for an adjustment to the MLR standard (received by HHS on 12/08/11).
  6. National Patient Advocate Foundation Public Comment  (PDF – 502 KB)
    This file is a public comment from the National Patient Advocate Foundation regarding Texas’ request for an adjustment to the MLR standard (received by HHS on 12/08/11).
  7. Consumer Groups Public Comment  (PDF – 153 KB)
    This file is a public comment from 11 consumer and patient advocacy organizations regarding Texas’ request for an adjustment to the MLR standard (received by HHS on 12/08/11).
  8. Consumers Union Public Comment  (PDF – 139 KB)
    This file is a public comment from Consumers Union regarding Texas’ request for an adjustment to the MLR standard (received by HHS on 12/08/11).
  9. Texas Consumers Petition  (PDF – 410 KB)
    This file is a petition by Texas consumers requesting that HHS deny Texas’ request for an adjustment to the MLR standard (received by HHS on 12/08/11).
  10. Texas Congressional Delegation Letter  (PDF – 780 KB)
    This document is a December 21, 2011 letter from eight members of the Texas Congressional delegation to the Secretary requesting that HHS deny Texas’ request for an adjustment to the MLR standard (received by HHS on 12/21/11).