Bill Summary: SB 204 - State Medical Loss Ratio

• Establishes a minimum state medical loss ratio of 82 percent for individual and small employer group health insurance policies; insurers must rebate enrollees if this threshold is not met.

• Requires health insurers and health care centers to submit consumer report card information to the Insurance Commissioner by May 15 each year, with civil penalties of $1,000-$10,000 per day for late submissions.

• Defines "state medical loss ratio" as the ratio of incurred claims to earned premiums and specifies what costs are and are not included (excludes stop loss, reinsurance, administrative costs, and out-of-pocket enrollee expenses).

• Mandates insurers include written notice disclosing their state and federal medical loss ratios with each health insurance application, based on the most recent Consumer Report Card.

• All provisions take effect January 1, 2013.