(with respect to healthcare insurance and specifically to individual market policies)
I already know (generally) how the Medical Loss Ratio (MLR) is calculated, what I'm specifically interested in is the granularity of the testing to determine if the required threshold has been met.
Skip ahead if it is already clear what I'm asking about. Otherwise: for example, Insurance provider "A" has been selling policies in all 67 counties in Pennsylvania. In some counties "A" has sold 4 different policies, in other counties "A" has sold 8 different policies.
When the time arrives to determine if "A" has achieved the required 80% MLR are:
ALL policies aggregated together (irrespective of county or differences in policies) ?
All policies sold within a specific county aggregated (irrespective of differences between policies) ?
Is each policy tested independently?
I am not interested in hearing opinions about whether MLR is a good thing or a bad thing. Unfortunately personal contact with US HHS has been unsuccessful in finding an answer.
I am posting to politics because the information is useful in the US healthcare insurance reform debate.