Medical benefit ratio

As part of the Affordable Care Act (ACA), health plans are required to report their medical benefit ratios (MBRs) to the U.S. Department of Health and Human Services. An MBR (also known as a medical loss ratio) is the amount of premium revenue spent on medical care and services.

  • For large groups, the minimum amount is 85% of premium revenue.
  • For small groups, individuals, and student health plans, the minimum amount is 80% of premium revenue.

Health plans that don’t meet or exceed these amounts are required to issue rebates to customers.

Although the federal government refers to this requirement as a medical loss ratio, Kaiser Permanente and other health plans use the more descriptive and accurate term of medical benefit ratio. We don’t consider funds spent on care for members a “loss”.

Results for this year

In our August 17, 2020, final MBR filing for 2019, Kaiser Permanente’s MBR was above the ACA-established thresholds in nearly every jurisdiction and market segment.

What this means for you and your clients

You can rely on us to keep working to comply with all health care reform regulations while offering a wide range of services and support — like secure online access to your book of business. We value your partnership and will continue to invest in our relationships, build our service capabilities, and offer competitive broker compensation.

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