HealthHelp Programs Allow Insurers to Meet MLR Requirement

First Health Care Services Company to Meet MLR Requirement

HOUSTON--(BUSINESS WIRE)-- Leading specialty benefit management company HealthHelp announced today that many of its programs qualify as “activities that improve health care quality” under the new federal medical-loss ratio (MLR) requirement, which took effect Jan. 1 as part of the Patient Protection and Affordable Care Act (PPACA).

The requirement states that all health-insurance issuers must spend 85 percent of the total premiums in the large-group market, or 80 percent of the total premiums in the small-group or individual market, on “reimbursement for clinical services provided to enrollees” or “activities that improve health-care quality,” with the remaining 15 percent or 20 percent going toward administrative costs. If an insurer does not meet the MLR requirement, it must return the difference to customers as a rebate.

“Private insurers are having a difficult enough time managing the constant changes that come with the new health care bill,” said HealthHelp president and CEO, Cherrill Farnsworth. “HealthHelp has identified ways within its existing suite of programs to make the process easier and more affordable for these health plans.”

The majority of HealthHelp’s diagnostic imaging, radiation and medical oncology, and diagnostic cardiology programs, which include new diagnostic cardiac catheterization services, meet the latter MLR condition, as they enhance physician knowledge of the latest medical evidence, which over the long-term changes inappropriate ordering patterns and lowers unnecessary radiation exposure to patients. Other specialty benefit management companies qualify as an administrative cost because of their business model of taking risk. Such a qualification will make it difficult for these companies to help their clients meet the MLR requirement.

To identify which HealthHelp programs qualify as “activities that improve health-care quality,” company representatives offer clients and potential clients assistance with their MLR analysis and reporting. Such assistance, along with the qualification itself, serve as yet another way HealthHelp programs benefit insurers, their providers, and their members.

HealthHelp has prepared a white paper outlining the details of the MLR and identifies how and which of HealthHelp’s programs fall into the health insurers’ MLR requirements. The white paper is available for download at

About HealthHelp®

HealthHelp, a leader in specialty benefit management, generates significant savings and return on investment for health care payers by enhancing physician knowledge, improving quality of care, and reducing unnecessary radiation exposure. Each of its programs addresses a different aspect of diagnostic imaging, cardiology, and radiation oncology. The clients of Houston-based HealthHelp administer local, statewide, and national health care plans across the country. For more information about HealthHelp’s programs, visit


Eric Herrera, 713-292-6435 or 713-867-9807
[email protected]

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