Under PPACA, the goal was that at least ____ of all premium dollars collected from large employers were spent on healthcare services and supported quality improvement.

Under PPACA, the goal was that at least ____ of all premium dollars collected from large employers were spent on healthcare services and supported quality improvement.

• A. 65%
• B. 75%
• C. 85%
• D. 95%

Answer: (C)

The question hinges on the medical loss ratio requirements established by the ACA. These rules require insurers to spend a minimum share of premium dollars on medical care and quality improvement. For plans covering large employers, that floor is 85 percent. So, at least 85% of premium dollars must go toward healthcare services and activities that improve quality, while the remaining 15% covers administrative costs, marketing, and profits. If an issuer falls short of 85%, they must issue rebates to enrollees. The other figures don’t match the large-group standard, since 85% is the mandated minimum.

The question hinges on the medical loss ratio requirements established by the ACA. These rules require insurers to spend a minimum share of premium dollars on medical care and quality improvement. For plans covering large employers, that floor is 85 percent. So, at least 85% of premium dollars must go toward healthcare services and activities that improve quality, while the remaining 15% covers administrative costs, marketing, and profits. If an issuer falls short of 85%, they must issue rebates to enrollees. The other figures don’t match the large-group standard, since 85% is the mandated minimum.