§ 33-25A-7b — Loss ratio

If a health maintenance organization considers a loss ratio at the time of renewal of a policy, plan, or contract, the health maintenance organization shall, upon request of a subscriber, provide the loss ratio and the components of the loss ratio calculation to the subscriber no more than 90 days but no less than 60 days before the renewal date of the policy, plan, or contract. For purposes of this section, "loss ratio" means the total losses paid out in medical claims divided by the total earned premiums:Provided, however, That medical claims do not include dental only or vision only coverage. For purposes of this section, "subscriber" does not include a subscriber or beneficiary of any policy, plan, or contract approved by the Bureau of Medical Services and entered into by a health maintenance organization with Medicaid or the Children’s Health Insurance Program.

Legislative History

2024 Reg. Sess., HB4274; 2022 Reg. Sess., SB568