HF572 Summary

• Establishes minimum loss ratio requirements for health plans: 80 percent for individual and small employer markets, and 85 percent for large groups (51+ covered persons), meaning insurers must return that percentage of earned premiums as benefits.

• Requires health carriers to submit annual compliance reports to the commissioner by June 1, with the commissioner authorized to order rebates to enrollees if loss ratios fall below required thresholds.

• Rebates must be issued by August 1 following the applicable year and may be paid as lump-sum checks, reimbursements, or direct premium deductions for current enrollees.

• Directs the commissioners of commerce and health to jointly issue public annual reports listing actual loss ratios by health carrier for each market segment, released no later than June 1.

• Restricts nonprofit health maintenance organizations from distributing net earnings for purposes other than comprehensive health care, with limited exceptions for provider efficiency incentives and quality care payments.