The National Association of Health Underwriters (NAHU) will be asking Congress to change the medical loss ratio (MLR) formula in the interim regulations released Monday by the U.S. Department of Health and Human Services (HHS).
HHS released interim final minimum MLR provision regulations Monday.
The regulations will guide implementation of provisions in the Affordable Care Act, the legislative package that includes the Patient Protection and Affordable Care Act (PPACA), that will require 85% of large group revenue and 80% of individual and small group revenue to be spent on patient care and quality improvement efforts.
The provisions are set to take effect Jan. 1, 2011.
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Health insurance agents and brokers want to HHS to classify producer commissions as a medical expense or else leave them out of MLR calculations altogether. Producers say a commission “pass through” provision makes sense, because insurers simply collect commissions from the true payers of the commissions – customers – and pass the commission on to the producers.