NAHU represents licensed health insurance agents, brokers, consultants and benefit professionals who serve the health insurance needs of employers and individuals seeking health insurance coverage.
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Medical Loss Ratio

The MLR requirements were designed to limit the amount that a health insurance company can spend on administrative costs. Specifically, the MLR requirement states that 80% of all premium dollars must go to medical care, with the remaining 20% going to administrative costs. While NAHU agrees with the goal of providing consumers with more value for healthcare dollars spent, the PPACA MLR requirements significantly and negatively impact access to health insurance agents and brokers by wrongfully including agent and broker commissions in with administrative costs, at the very time health insurance consumers have the most need for help. Bipartisan legislation has been introduced into the 114th Congress by Representatives Billy Long (R-MO) and Kurt Schrader (D-OR) to remove independent health insurance agents and brokers from PPACA’s Medical Loss Ratio requirements.

NAHU has supported the reintroduction H.R. 815, Access to Independent Health Insurance Advisors Act of 2015, bipartisan legislation that would remove agent and broker compensation from the Medical Loss Ratio requirement.

Resources

NAHU’s Issue Summary on MLR
NAHU has developed an issue summary highlighting the negative impact MLR has on independent health insurance agents and brokers.

Myths and Realities of PPACA’s Medical Loss Ratio Requirements

Economic Impact of MLR
This paper examines exactly how the Medical Loss Ratio requirements of PPACA impact independent health insurance agents and brokers.

NAIC Resolution on MLR

NAHU Comments on MLR

MLR Impact on Jobs
The Medical Loss Ratio requirement has resulted in a lack of consumer access to health insurance agents and brokers.

MLR Impact on Businesses
NAHU surveyed over 2,000 brokers on how the MLR has affected their business.

GAO Report on the Medical Loss Ratio

MLR Rebate Checks: A Case Study on Rebate Distribution to Employer Group Plan Participants

MLR Rebate Checks: An Overview for Advising Employer Group Clients