The 80/20 Rule in health insurance, also known as the Medical Loss Ratio (MLR) rule from the Affordable Care Act, requires insurers to spend at least 80% (or 85% for large groups) of premium dollars on actual medical care and quality improvements, with the rest going to administration, marketing, and profit.

 If they don’t meet this standard, they must issue rebates to consumers, ensuring more premium money is used for care and providing rebates when companies fall short, improving transparency and value.