42 CFR 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.