For Health Insurance Brokers

Stop Clients From Overpaying.
Start Earning Rebate Advisory Fees.

Free MLR calculator that shows which clients are at risk — and what the rebate exposure actually means for your renewal conversation.

Open Calculator Broker Checklist

No account required · Works in under 2 minutes · Based on ACA MLR rules

Live Calculator

Calculate MLR & Rebate Exposure

Enter plan data once. See MLR, rebate risk, and compliance status instantly.

Plan Details

Small Group ≥80% MLR required
Large Group ≥85% MLR required
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Enter plan data and click
Calculate MLR

MLR = (Clinical Spending + Quality Improvement Spending) ÷ Total Premium Revenue
Rebates due if MLR is below the ACA threshold. Amount shown is illustrative — verify with carrier actuals.

Quick Reference

ACA MLR Rules — Cheat Sheet

Everything you need to know, nothing you don't.

The Thresholds

  • Small Group (≤50 employees): ≥80% MLR or rebate due
  • Large Group (>50 employees): ≥85% MLR or rebate due
  • Mini-Med Plans (under $1,200/yr): ≥80% (separate rules apply)
  • Rebates are paid to employer and employees, proportional to share of premium

Rebate Calendar

  • Reporting Year: Jan 1 – Dec 31
  • Data Due to CMS: July 31 following year
  • Rebates Issued: By September 30 (following year)
  • Example: 2025 data → reported July 2026 → rebates sent September 2026

Quality Improvement (QI)

  • Counts as MLR: wellness programs, care coordination, health IT, provider training
  • Does NOT count: marketing, admin salaries, network development fees
  • NudgeWell qualifies as QI spend — automated benefit utilization reminders are an approved category

For Your Practice

Broker MLR Checklist

Use this before every renewal. Spot risk, start the conversation, win the account.

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Pull 3-Year MLR History

Ask the carrier for the last 3 years of MLR data. Trends matter more than a single year. Clients consistently above threshold are prime for benefit improvement talks.

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Identify Below-Threshold Clients

Any client under 80/85% is legally owed a rebate. Frame this as money already on the table — your job is to help them get more value before the next cycle.

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Segment by Utilization Gaps

Low FSA/HSA spend, missed preventive care, unused EAP — these are your QI levers. NudgeWell automates the outreach that turns utilization gaps into MLR-compliant spend.

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Lead With Rebate Risk, Not Features

"You're $18,000 below your MLR threshold" is a more compelling opener than "our platform has AI nudges." Let the math open the door.

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Quote Plans Above MLR Threshold

When competing on renewal, model which carriers consistently hit threshold. Clients who understand MLR will reward brokers who optimize for it.

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Document Rebate Exposure in Writing

Include estimated rebate amounts in your renewal proposal. Shows due diligence and justifies the conversation about benefit improvement investment.

Turn MLR Compliance Into
a Retention Tool

NudgeWell helps brokers demonstrate value by closing the utilization gap that drives below-threshold MLR. Your clients get more from their benefits. You get more renewals.

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