Code of Massachusetts Regulations
211 CMR - DIVISION OF INSURANCE
Title 211 CMR 147.00 - Methodology For Calculating And Reporting Medical Lass Ratios (mlrs) Of Health Benefit Plans
Section 147.02 - Definitions

For purposes of 211 CMR 147.00, the following words shall mean:

Carrier. An insurer licensed or otherwise authorized to transact accident or health insurance under M.G.L. c. 175; a nonprofit hospital service corporation organized under M.G.L. c. 176A; a nonprofit medical service corporation organized under M.G.L. c. 176B; a health maintenance organization organized under M.G.L. c. 176G; and an organization entering into a preferred provider arrangement under M.G.L. c. 176I, but not including an employer purchasing coverage or acting on behalf of its employees or the employees of one or more subsidiaries or affiliated corporations of the employer. Unless otherwise noted, Carrier shall not include any entity to the extent it offers a policy, certificate or contract that is not a health benefit plan, as defined in M.G.L. c. 176J, § 1.

Commissioner. The Commissioner of Insurance appointed pursuant to M.G.L. c. 26, § 6, or his or her designee.

Commonwealth. The Commonwealth of Massachusetts.

Health Benefit Plan. A policy, contract, certificate or agreement entered into, offered or issued by a Carrier to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services.

Health Care Services. Services for the diagnosis, prevention, treatment, care or relief of a health condition, illness, injury or disease.

MLR. Medical Loss Ratio, which is the ratio of the incurred loss (or incurred claims) plus the loss adjustment expense (or change in contract reserves) to earned premiums, according to current NAIC methodology and with reference to federal guidance, or as otherwise determined by the Commissioner.

NAIC. The National Association of Insurance Commissioners.

Third-party Administrator. A person who, on behalf of a health insurer or purchaser of health benefits, receives or collects charges, contributions or premiums for, or adjusts or settles claims on or for residents of the Commonwealth.