The National Association of Insurance Commissioners filed a letter to Health and Human Services Secretary Kathleen Sebelius on Wednesday, highlighting issues that have come up as they get closer to concluding work on medical loss ratio definitions.

Of concern are issues relating to whether insurers are able to financially withstand new mandates and if competition in markets would be threatened. Also, phase-in of MLR limits, expatriate policies and rebates. [click here to view the model regulation]

Solvency and competitive markets

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