“Fully-insured carriers have to have a medical-loss ratio (MLR) of at least 85%, which means that 85% of the premium needs to go toward medical care. If a group has fewer expenses than that amount, the carrier needs to refund those premiums. This setup does not incentivize prudent financial behavior. For the health plan, it does not matter if a group has 60% or 70% in medical expenses. They will always make the same profit” – Jan-Felix Schneider
