We're all laughing..that's less than half a month's premium..the big money comes back to folks with insurers returning money for not meeting medical loss goals. Remember this is an ACA rule, do you hate this too? The medical loss ratio (MLR) measures the percentage of health insurance premium dollars an insurer spends on medical claims and quality improvement rather than administrative costs and profits. The 80/20 Rule: Under the Affordable Care Act (ACA), individual and small-group health plans must spend at least 80% of premium revenue on medical care and quality enhancement