42 CFR § 403.215 - Loss ratio standards.

---
identifier: "/us/cfr/t42/s403.215"
source: "ecfr"
legal_status: "authoritative_unofficial"
title: "42 CFR § 403.215 - Loss ratio standards."
title_number: 42
title_name: "Public Health"
section_number: "403.215"
section_name: "Loss ratio standards."
chapter_name: "CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES"
subchapter_number: "A"
subchapter_name: "GENERAL PROVISIONS"
part_number: "403"
part_name: "SPECIAL PROGRAMS AND PROJECTS"
positive_law: false
currency: "2026-04-05"
last_updated: "2026-04-05"
format_version: "1.1.0"
generator: "[email protected]"
authority: "42 U.S.C. 1302 and 1395hh."
cfr_part: "403"
---


# 403.215 Loss ratio standards.

(a) The policy must be expected to return to the policyholders, in the form of aggregate benefits provided under the policy—

(1) At least 75 percent of the aggregate amount of premiums in the case of group policies; and

(2) At least 60 percent of the aggregate amount of premiums in the case of individual policies.

(b) For purposes of loss ratio requirements, policies issued as a result of solicitation of individuals through the mail or by mass media advertising are considered individual policies.