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Medical Loss Ratio

Wisconsin 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: Wisconsin

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  (255 KB)
    This document contains Wisconsin’s request to adjust the MLR standard to 71 percent, 74 percent, and 77 percent for 2011, 2012, and 2013, respectively (received by HHS on 10/25/11).
  2. HHS Letter Deeming Wisconsin's Application Complete (PDF - 272 KB)
    This document is a January 9, 2012 letter from the Acting Director of the Office of Oversight to Wisconsin deeming Wisconsin’s application complete and indicating the start of the HHS review period
  3. Wisconsin Supplemental Information Cover Letter (PDF – 65 KB )
    This document is a cover letter to Wisconsin’s January 27, 2012 responses to CCIIO's request for additional information included in CCIIO’s January 9, 2012 letter (received by HHS on 1/27/12)
  4. Attachment 1: Wisconsin Supplemental Information (PDF – 221 KB )
    This document is a January 27, 2012 letter from Wisconsin to the Acting Director of the Office of Oversight with responses to CCIIO's request for additional information included in CCIIO’s January 9, 2012 letter (received by HHS on 1/27/12).
  5. Attachment 2: 2010 Supplemental Health Care Exhibits (PDF – 4.6 MB )
    This file contains the 2010 Supplemental Health Care Exhibits for the largest issuers in the Wisconsin individual market (received by HHS on 1/27/12).
  6. Attachment 3: List of Counties with High Market Concentration (PDF – 103 KB )
    This file contains the list of Wisconsin counties with high market concentration and medically underserved populations (received by HHS on 1/27/12).
  7. Attachment 4: Regional Market Enrollment Data (PDF – 105 KB )
    This file contains enrollment data by issuer for six Wisconsin regional markets (received by HHS on 1/27/12).
  8. Attachment 5: 2010-2011 MLR and Rebate Estimates by Issuer (PDF – 58 KB )
    This file contains MLR and rebate estimates by issuer (received by HHS on 1/27/12).
  9. Attachment 6: American Enterprise Letter (PDF – 303 KB )
    This document is an October 20, 2011 letter from the American Enterprise Group to Wisconsin notifying Wisconsin that American Republic and World are withdrawing from all individually underwritten comprehensive major medical insurance markets (received by HHS on 1/27/12).
  10. Attachment 7: American Community and Consumers Life Letters (PDF – 156 KB )
    This file contains an October 19, 2010 letter from American Community Mutual Ins. Co. to Wisconsin notifying Wisconsin that American Community Mutual is withdrawing from all individual and small group markets, and a June 22, 2011 letter from Consumers Life Ins. Co. to Wisconsin notifying Wisconsin that Consumers Life is withdrawing from the individual market (received by HHS on 1/27/12)
  11. HHS Letter to Wisconsin Extending the 30 Day Review Period for an Additional 30 days  (PDF – 195 KB)
    This document is a February 8, 2012 letter from the Acting Director of the Office of Oversight to Wisconsin exercising the Secretary’s discretion to extend the 30-day review period for an additional 30 days.

Public Comments

  1. Consumer Public Comments (PDF – 75 KB )
    This file contains seven public comments from Wisconsin consumers regarding Wisconsin’s request for an adjustment to the MLR standard (received by HHS between 12/09/11 and 1/30/12).
  2. ABC for Health Public Comment (PDF – 677 KB )
    This file is a public comment from Advocacy & Benefits Counseling for Health regarding Wisconsin’s request for an adjustment to the MLR standard (received by HHS on 1/19/12).
  3. PILS Public Comment (PDF – 33 KB )
    This file is a public comment from the Public Interest Law Section of the State Bar of Wisconsin regarding Wisconsin’s request for an adjustment to the MLR standard (received by HHS on 1/19/12).
  4. Consumers Union Public Comment (PDF – 96 KB )
    This file is a public comment from Consumers Union regarding Wisconsin’s request for an adjustment to the MLR standard (received by HHS on 1/20/12).
  5. NPAF Public Comment (PDF – 2.9 MB )
    This file is a public comment from the National Patient Advocacy Foundation regarding Wisconsin’s request for an adjustment to the MLR standard (received by HHS on 1/20/12).
  6. Consumer Groups Public Comment (PDF – 84 KB )
    This file is a public comment from ten consumer groups and a former Member of Congress regarding Wisconsin’s request for an adjustment to the MLR standard (received by HHS on 1/20/12)..