Experts Provide Guidance on Medical Loss Ratio (MLR) Provisions
Atlantic Information Services, Inc. (AIS) - August 1, 2011 - Washington, DC

The publisher of industry-leading newsletters AIS’s Health Reform Week, Health Plan Week and Medicare Advantage News assembled a team of experts to write a comprehensive guide on medical loss ratio (MLR) implementation. A Practical Guide to Federal Medical Loss Ratio Requirements offers critical guidance on the big-dollar questions stemming from the medical loss ratio (MLR) provisions in the health reform law. And it provides valuable insights into their possible ramifications for everyone in the health insurance business — on benefit design, broker commissions, technology investments, medical utilization review and more.

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A Practical Guide to Federal Medical Loss Ratio Requirements was written by a team of expert authors that includes: Henry Loubet, chief strategy officer at Keenan; William MacBain, senior vice president, finance, at Gorman Health Group; Carl McDonald, director and senior analyst at Citi Investment Research; Kenneth B. Schnoll, partner at SNR Denton; David Tuomala, director of actuarial services at Ingenix Consulting; and Brian Weible, president of Wakely Consulting Group.

Inside A Practical Guide to Federal Medical Loss Ratio Requirements, readers will find answers to these and other pressing questions:

  • How has HHS defined quality improvement activities that may be included in MLR calculations? How will that affect the actuarial value of insurers’ benefit designs?

  • Without a “pass-through” for broker commissions, how will insurers adjust broker pay while maintaining that distribution channel?

  • What is likely to be the impact of MLR provisions on commercial and Medicare insurers’ earnings?

  • What steps are insurers likely to take to ratchet down other administrative spending, without jeopardizing important areas such as technology investment, and fraud and abuse prevention?

  • What are the hidden compliance hurdles in complying with the reporting and rebate requirements?

  • What steps will Medicare Advantage plans take to adjust benefit designs and distribution channels to meet their 85% minimum MLR requirement?

Ramifications of the new MLR provisions are potentially staggering for everyone in the health insurance business. So it’s critical that health plans, brokers, employers, benefits consultants and others with a vested interest have a resource that can help them implement these complex regulations.

Visit for more information and to view a detailed Table of Contents.

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AIS develops highly targeted news, data and strategies for managers in hospitals, health plans, medical group practices, pharmaceutical companies and other health care organizations. Learn more at

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Atlantic Information Services
1100 17th St., NW Ste 300
Washington, DC 20036
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