The ratio of a health insurer’s healthcare-related expenses to its premium revenue, reflecting the percentage of premium revenue spent on medical claims and quality improvement activities, as opposed to administrative costs and profits.
The total amount of money collected by an insurance company from policyholders for providing healthcare coverage.
Costs incurred by insurers in providing medical services to policyholders, including payments for medical claims, prescription drugs, and quality improvement initiatives.
Expenses incurred by policyholders for medical services covered under their health insurance plans, including doctor visits, hospital stays, surgeries, and diagnostic tests.
Initiatives undertaken by insurers to enhance the quality and efficiency of healthcare services provided to policyholders, such as disease management programs, preventive care initiatives, and patient safety efforts.
Overhead expenses incurred by insurers in managing their operations, including salaries, marketing expenses, underwriting costs, and general administrative expenses.
The percentage of premium revenue retained by insurers as profit after deducting healthcare-related expenses and administrative costs.
Regulatory requirements set by government authorities, specifying the minimum percentage of premium revenue that insurers must spend on medical claims and quality improvement activities to comply with MLR regulations.
Refunds issued by insurers to policyholders if their MLR falls below the mandated thresholds, aiming to ensure that a significant portion of premium revenue is used for healthcare services rather than administrative expenses or profits.
The process through which insurers calculate and report their MLR to regulatory authorities, typically on an annual basis, providing transparency and accountability regarding the allocation of premium revenue towards healthcare services.