As t the article states, there are many smaller insurance companies in Iowa that are having trouble meeting the medical loss ratio numbers. The one big major player is doing fine at 80% so the relief is needed for the smaller businesses. It’s back to setting up the business models and the algorithms to comply. Earlier this year Aetna took out reinsurance so fi they were to get hit with catastrophic claims they would be covered, I think. BD
Aetna Takes Out Reinsurance Deal In The Cayman Islands- $150 Million to Kick When Medical Loss Ratio Hits 104%
Iowa is the eighth state to request relief from a provision in the federal health reform law that requires insurers to spend most member premiums on medical costs.
Florida, Georgia, Kentucky, Maine, Nevada, New Hampshire and North Dakota have also submitted medical loss ratio waiver requests to the HHS. Only Maine's has been approved.
In Iowa, the dominant insurer, Wellmark, already meets the 80% medical loss ratio standard but “Iowa has a number of smaller carriers, which need time to adjust their business models to comply,” Voss wrote in the letter, dated March 21.