Requiring certain medical loss ratios for health benefit plans

Medical costs are defined in the bill as costs to provide medical services, supplies, and equipment and prescription drugs to insureds, as well as the cost of activities to improve health care quality. Health benefit plans are defined in the bill as any hospital or medical policy or certificate, but various types of limited coverage, such as limited-scope dental or vision plans, separate hospital indemnity policies, and automobile medical payment insurance, are excluded. Small group health benefit plans are those provided by or through an employer with 100 employees or fewer, and large group health benefit plans are those provided by or through an employer with at least 101 employees.

The medical loss ratio requirements apply to all individual and group health benefit plans issued in this state, including defined network plans, health care plans operated by cooperative associations, and health benefit plans offered by the state to its employees and to municipal employees.