NAIC Approves Medical Loss Ratio Template

Janice Simmons, for HealthLeaders Media , August 20, 2010

However, America's Health Insurance Plans President and CEO Karen Ignagni said in her letter to NAIC after the vote on the template that "the current proposal could have the unintended consequence of turning-back-the-clock on efforts to improve patient safety, enhance the quality of care, and fight fraud."

In its statement, DMAA: The Care Continuum Alliance, a Washington-based trade group representing wellness and disease management program vendors, said the template "has strongly made the case that such services should be recognized as medical or quality improvement expenses in the medical-loss ratio."

HHS Secretary Kathleen Sebelius, writing in her blog earlier this week, said HHS has recently heard reports that some issuers were making decisions about participation in particular markets—based on the effect of these requirements.

"As we move forward, I urge insurance companies, consumer groups and other stakeholders to continue to participate in the process," she said. "It is premature for insurers to make business decisions about participation in particular markets based on rules that have yet to be published, or to apply for exemptions to rules that have not yet been drafted."

Janice Simmons is a senior editor and Washington, DC, correspondent for HealthLeaders Media Online. She can be reached at

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