['Employee Benefits']
['Patient Protection and Affordable Care Act']
12/05/2023
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The Secretary may consider the following criteria in assessing whether an adjustment to the 80 percent MLR standard, as calculated in accordance with this subpart, would be reasonably likely to help stabilize the individual market in a State that has requested such adjustment:
(a) The number and financial performance (based on data provided by a State under §158.321) of issuers actively offering individual health insurance coverage on- and off-Exchange, grandfathered health plans as defined in §147.140 of this subchapter, coverage that meets the criteria for transitional policies outlined in applicable guidance, and non-grandfathered single risk pool coverage; the number of issuers reasonably likely to cease or begin offering individual market coverage in the State; and the likelihood that an adjustment to the 80 percent MLR standard could help increase competition in the individual market in the State, including in underserved areas.
(b) Whether an adjustment to the 80 percent MLR standard for the individual market may improve consumers' access to agents and brokers.
(c) The capacity of any new issuers or issuers remaining in the individual market to write additional business in the event one or more issuers were to cease offering individual market coverage on the Exchange, in certain geographic areas, or in the entire individual market in the State.
(d) The impact on premiums charged, and on benefits and cost sharing provided, to consumers by issuers remaining in or entering the individual market in the event one or more issuers were to cease or begin offering individual market coverage on the Exchange, in certain geographic areas, or in the entire individual market in the State.
(e) Any other relevant information submitted by the State's insurance commissioner, superintendent, or comparable official in the State's request.
[75 FR 74931 Dec. 1, 2010; 83 FR 17071, April 17, 2018]
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