Bill > SB5953

This bill establishes a requirement that health insurance plans must spend at least 90 percent of their premium revenues on direct medical care and quality improvement activities, beginning January 1, 2027. The medical loss ratio (MLR) is defined by referencing the federal regulation 45 C.F.R., which typically means that insurers must spend at least 90 cents of every premium dollar on healthcare services and healthcare quality improvement, rather than administrative costs, marketing, or profits. The state insurance commissioner is granted the authority to create and implement rules to enforce this requirement. By mandating this high medical loss ratio, the bill aims to ensure that health insurance companies are primarily focused on providing healthcare services rather than generating excessive profits, which could help make healthcare more affordable and efficient for consumers.

Health and Social Services

https://app.leg.wa.gov/billsummary?BillNumber=5953&Year=2025&Initiative=false