OpenChainGraph Suite · ART-344 · US Health Insurance Compliance

MLR Rebate Calculator

Medical Loss Ratio numerator/denominator, credibility-adjustment tier, 3-year premium-weighted averaging, and rebate math per 45 CFR 158 (ACA MLR rule). Classifies member life-years into non-credible / partially-credible / fully-credible bands, computes the current-year adjusted MLR and the 3-year average against the market threshold, and applies the de minimis payment floor.

45 CFR 158 Credibility-Adjusted 3-Year Averaging Individual · Small Group · Large Group

🔒 All inputs are processed locally in your browser. No data is transmitted. Do not enter real personal data — use synthetic or anonymised inputs only.

Market & Reporting Year

Market

Reporting year

Premium & Claims (Current Year)

Earned premium ($)

Federal taxes/fees ($)

State taxes/licensing fees ($)

Incurred claims ($)

Quality-improvement expenditures ($)

Reinsurance recoveries ($)

Risk-adjustment net transfer ($)

Positive = net receivable (adds to claims); negative = net payable.

Risk-corridors net transfer ($)

Member life-years

<1,000 non-credible · 1,000–74,999 partially credible · ≥75,000 fully credible.

Prior Years (3-Year Averaging, Optional)

Prior year 1 — adjusted MLR (%)

Prior year 1 — earned premium ($)

Prior year 2 — adjusted MLR (%)

Prior year 2 — earned premium ($)

MLR & Rebate Detail

Execution Hash (SHA-256)