Which elements must health insurers submit data on under MLR regulations?

The correct choice identifies key components that health insurers must report under the Medical Loss Ratio (MLR) regulations established by the Affordable Care Act. MLR regulations are designed to ensure that a significant portion of premium dollars are spent on medical care and improving health outcomes rather than on administrative costs or profits.

The elements of aggregate premiums, claims experience, quality improvement, and non-claims costs each serve a specific purpose in evaluating an insurer’s spending:

• Aggregate premiums refer to the total amount of money collected from policyholders, which is essential for measuring how much revenue the insurer has at its disposal for healthcare services.
• Claims experience provides insight into the amount spent on medical claims, which is used to determine the efficiency of an insurer in utilizing premium funds effectively for member care.
• Quality improvement expenses are those investments made by insurers to enhance healthcare services, ensuring that premium dollars are directed towards initiatives that improve patient care.
• Non-claims costs encompass administrative expenses and other costs that do not directly relate to paying healthcare providers but are still essential for the functioning of the insurance plan.

These elements collectively ensure that insurers are accountable for how they allocate premium dollars, reinforcing the intent of MLR guidelines to prioritize patient care over profits and administrative overhead.

The other choices