12 pages. "[F]ollowing the implementation of the MLR program beginning in 2011, there was a sharp decline in payouts as insurance companies that did not meet the threshold adjusted their premiums to reduce future rebate payments. Excluding the anomaly observed in 2011, the large group market has been the most stable with the smallest amount of year over year change observed. The small group market had some small disruptions but remained relatively stable over the years while also following some of the same industry-wide patterns."  MORE >>