Medical Loss Ratio
ACA Section 2718 MLR calculation, reporting, and rebate management — Plan Year 2025
MLR Calculation — Individual Market
Plan Year 2025 · All Regions · Reported to CMS by Jun 1, 2026
COMPLIANT — 80% Threshold Met
Incurred Claims
$8,400,000
Medical claims paid
+
Quality Improvement
$300,000
QI activities
÷
Adjusted Premium
$10,100,000
$10.4M − $300K taxes
86.1%
Medical Loss Ratio
ACA minimum for individual market: 80%
Margin above threshold: +6.1 pp — No rebate required
$10,400,000
Earned Premium
$300,000
Federal / State Taxes
$1,700,000
Admin & Profit (13.9%)
MLR Quarterly Trend — Plan Year 2025
Quarterly Detail
| Quarter | Claims | Premium | MLR | Status |
|---|---|---|---|---|
| Q1 2025 | $2.1M | $2.6M | 82.3% | OK |
| Q2 2025 | $2.0M | $2.5M | 81.0% | OK |
| Q3 2025 | $2.2M | $2.6M | 86.9% | OK |
| Q4 2025 | $2.1M | $2.7M | 79.0% | Near |
| Full Year | $8.4M | $10.4M | 86.1% | Compliant |