The MLR is the amount a health plan spends on delivering actual health care services to members, administration and marketing but not on profits. Under the Affordable Care Act, small group and individual health plans must spend at least 80 cents of every dollar on health care, administration and marketing or provide a rebate to members.
Health plans for large groups (usually more than 50 employees) must spend at least 85 cents from every dollar on health care, administration and marketing.