Navigate Your Medical Loss Ratio with HealthHelp

The implementation of the Patient Protection and Affordable Care Act (PPACA) has begun, prompting many questions within the health-insurance industry regarding the new federal medical loss ratio (MLR) requirement. This requirement states that a health-insurance issuer must spend 85% of total premiums in the large-group market, or 80% of total premiums in the small-group or individual market, on “reimbursement for clinical services provided to enrollees” or “for activities that improve health-care quality.”

HealthHelp offers specialty benefit management services that not only provide significant and sustained savings, but also improve health-care quality overall. This means that some of our diagnostic imaging, radiation and medical oncology, and diagnostic cardiology programs qualify as activities that improve health-care quality, thus meeting the latter MLR requirement. HealthHelp worked with NAIC and HHS through its counsel Epstein, Becker & Green in Washington to define and then document our programs and determine which qualify for the 85% portion of the Medical Loss Ratio.

For more information on how to meet your Medical Loss Ratio requirement,  please read the following white paper on Medical Loss Ratio by Cherril Farnsworth, President and CEO of HealthHelp.