<?xml version='1.0' encoding='utf-8'?>
<section article="gin" article_name="Insurance" number="15-1A-16" title_number="15" title_name="Health Insurance" subtitle_number="1A" subtitle_name="Consumer Protections">
  <level label="a">
    <level label="1">
      <text>For purposes of this section, “medical loss ratio”:</text>
      <level label="i">
        <text>has the meaning established in 45 C.F.R. § 158.221; or</text>
      </level>
      <level label="ii">
        <text>if the Commissioner adopts regulations as described in paragraph (2) of this subsection, has the meaning established by the adopted regulations.</text>
      </level>
    </level>
    <level label="2">
      <text>To the extent necessary, the Commissioner shall adopt regulations that:</text>
      <level label="i">
        <text>establish a definition for “medical loss ratio”; and</text>
      </level>
      <level label="ii">
        <text>are consistent with 45 C.F.R. § 158.221 and any corresponding federal rules and guidance as those provisions were in effect December 31, 2024.</text>
      </level>
    </level>
  </level>
  <level label="b">
    <text>This section applies to all grandfathered plans and to every health benefit plan that is not a grandfathered plan.</text>
  </level>
  <level label="c">
    <text>The minimum acceptable medical loss ratio is:</text>
    <level label="1">
      <text>for the large group market, 85% or a higher percentage as determined by the Commissioner in regulations; and</text>
    </level>
    <level label="2">
      <text>for the small group market and individual market, 80% or a higher percentage as determined by the Commissioner in regulations.</text>
    </level>
  </level>
  <level label="d">
    <level label="1">
      <text>Except as provided in paragraph (2) of this subsection, each carrier shall comply with the requirements for calculating medical loss ratios and related reporting and rebate requirements established in 45 C.F.R. Part 158 and any corresponding federal rules and guidance.</text>
    </level>
    <level label="2">
      <text>If the Commissioner adopts regulations as described in subsection (e) of this section, each carrier shall comply with the requirements in the adopted regulations.</text>
    </level>
  </level>
  <level label="e">
    <text>To the extent necessary, the Commissioner shall adopt regulations that:</text>
    <level label="1">
      <text>establish requirements for calculating medical loss ratios and related reporting and rebate requirements; and</text>
    </level>
    <level label="2">
      <text>are consistent with 45 C.F.R. Part 158 and any corresponding federal rules and guidance as those provisions were in effect December 31, 2024.</text>
    </level>
  </level>
</section>
