Loss ratio reflects the amount of money an insurer earns in premium receipts minus the amount spent in claims payments and claims administrative costs. Along with expense ratios, loss ratios can determine an insurance company’s financial stability.
While loss ratios can impact insurance rates, federal and state regulations dictate earnings and loss margins of some insurance products. Let’s look at how they work.
- Loss ratio is a measure of an insurance company’s earnings and losses.
- Federal law regulates health insurance loss ratios.
- State laws often regulate property and casualty loss ratios.
- An expense ratio reflects the cost of selling and maintaining insurance policies.
- Meeting acceptable loss-ratio targets is one step in ensuring an insurance company’s profits.
Definition and Example of a Loss Ratio
In the insurance industry, loss ratio is the amount of money an insurer pays in claims and claims-handling costs as a proportion to the amount it receives in premiums. It’s expressed as a percentage.
The loss ratio calculation includes adding the total claims reported and the administrative costs of processing claims, then dividing by the total premiums received.
For example, if a provider spends $600,000 paying claims, incurs $100,000 in administrative costs processing the claims, and receives $1 million in premiums, it will earn $300,000. So the carrier would have a loss ratio of 70% and a profit ratio of 30%.
$600,000 + $100,000 / $1,000,000 = 0.70 (70%)
100% - 70% = 30%
Understanding Loss Ratio
Loss ratio margins vary among insurance products. Federal law regulates loss ratios for health care, and state insurance codes regulate loss margins for other types of insurance products.
Medical Loss Ratio (MLR)
The Affordable Care Act (ACA) requires health insurance companies to spend a minimum of 80% to 85% of premiums received on medical care or health care improvements, according to the Centers for Medicare and Medicaid Services.
That means a health insurance issuer can’t have a Medical Loss Ratio (MLR) below 80%. MLR rates apply to a specific calendar year and are subject to change. The ACA requires health insurance companies to provide MLR data to ensure compliance. If an insurer doesn’t meet this minimum standard, it must issue rebates to its policyholders.
In 2021, health insurance issuers are on track to issue rebates to an estimated 10.8 million people, according to preliminary estimates from the Kaiser Family Foundation (KFF). Those rebates are expected to exceed $2 billion, with an average payment of $198.
The MLR applies to all health insurance companies, but does not apply to self-insured employer plans, according to the National Conference of State Legislatures. Prior to the passage of ACA, some states set their own MLR rates. However, ACA provisions preempt state-imposed limits that fall below 80%, unless a carrier qualifies for a waiver.
Loss Ratios for Other Insurance Products
Average loss ratios vary for insurance products beyond health care insurance, such as commercial insurance and property casualty insurance.
According to a PwC survey of commercial insurance leaders, covering 2014 to 2018, top insurers operate with an average loss ratio of 47%, while low-performing producers maintain loss ratios that exceed 70%.
Although property and casualty issuers can operate with lower loss ratios than the health insurance industry, state insurance codes can apply.
For example, the Rhode Island Department of Business Regulation recommends that property and casualty insurers operate at a loss ratio of no less than 60%. Carriers that wish to operate with loss ratios below 60% must seek approval from the state and explain why their products provide enough added value to policyholders to justify the lower loss margin.
Loss Ratio vs. Expense Ratio
Although loss ratios and expense ratios both involve losses to earned premiums, they are not the same. A loss ratio reflects the proportionate relationship between all losses, including paid claims and the administrative cost of paying claims.
On the other hand, an insurer’s expense ratio reflects the percentage of the premium used to pay costs such as acquiring, servicing, and writing an insurance policy. Costs may include agent salaries or commissions, underwriting costs, and policy management expenses. Insurance companies apply their expense ratios when rating policy premiums.
Acceptable Loss Ratio
If an insurance company’s loss ratio exceeds 100%, that means a company is paying out more than it’s taking in, which could impact its ability to cover losses, including claims. An acceptable loss ratio, which varies by the type of insurance, enables an insurer to earn a profit.
For example, in the health care industry, insurers must maintain a loss ratio of 80% or above as a way to ensure they are using most of their premium funds on health care and improving the quality of services. In other industries, insurers aim to be more profitable.
Several factors can increase an insurer’s loss ratio, including:
- Underestimating risk: An insurer may underestimate the risks of insuring certain drivers, or the risks of insuring property in areas prone to catastrophic losses. Underestimating risk can lead to a high loss ratio at the policyholder level or a broader level, such as a geographic area.
- Natural disasters: Natural occurrences such as hurricanes and wildfires can dramatically increase claims and insurers’ loss ratios.
- Operations issues: Problems such as needless overhead costs or poor insurance-adjuster protocols can lead to increased loss ratios.
The Bottom Line
An insurance company’s loss ratio is a measure of its earnings performance. While loss ratio reflects the cost of paying claims and expenses, a carrier’s expense ratio focuses on the cost of offering, writing, and maintaining policies as a proportion of its premiums. To maximize earnings, providers strive to operate with lower loss ratios.
Federal law sets limits on health insurance loss ratios, while some state insurance codes regulate the loss ratios of other insurance products. Loss ratio regulations help moderate the cost of insurance and urge the industry to provide high-quality products.