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”.