Medical Loss Ratio

MLR

operations

Updated 5/16/2026

Definition

A regulatory financial metric defined under ACA as the ratio of incurred medical claims costs to earned premium revenue, reported at plan and market segment level. Payers must maintain MLR thresholds (80–85%) or issue member rebates. Calculated from claims and premium tables in financial reporting and actuarial data systems.

Standard Abbreviation

MLR

Database Usage

-- Example column naming
CREATE TABLE claims (
  clm_id VARCHAR(50),
  mlr VARCHAR(100),  -- Medical Loss Ratio (max 100 chars)
  ...
);

-- Example in SELECT
SELECT
  clm_id,
  mlr as medical_loss_ratio
FROM claims;

Common uses in healthcare data

Healthcare data warehouse schema design and modeling
Interoperability and cross-system data exchange
ETL pipeline development and orchestration
Master data management (MDM) programs
Analytics and business intelligence reporting

Example database column name

ISO-11179 snake_case standard

-- Recommended column name
mlr

-- Example DDL
CREATE TABLE healthcare_data (
  record_id   VARCHAR(50)   NOT NULL,
  mlr          VARCHAR(100),  -- Medical Loss Ratio (max 100 chars)
  created_dt  TIMESTAMP     NOT NULL DEFAULT NOW()
);

Column names follow the ISO-11179 naming convention: lowercase, underscore-separated, using the standard abbreviation as a prefix where applicable.

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