finance
that goes toward non-medical expenses such as administration , marketing , overheads and profits . The MLR is set at 85 percent for the large group market and at 80 percent for the small group market .
This provision will lead to limited bottom-line growth as carriers
will be forced to spend a minimum amount on the insured , with failure to abide leading to carriers rebating the excess money back to the insured or lowering the premium .
Pre-Existing Conditions Before , it was common among insurers to deny coverage to applicants with a pre-existing disease . In doing so , claim payments were kept at bay . With the Affordable Care Act in place , insurers must cover individuals regardless of any pre-existing conditions . This will lead to lower profit per policy as previously , individuals with pre-existing conditions were charged two to five times higher than those with average health .
With the Affordable Care Act in place , insurers must cover individuals regardless of any pre-existing conditions .