Highmark meets Affordable Care Act net loss requirement


Highmark Health Services announced  that for the second consecutive year, its insured health plans in all of its markets met the medical loss ratio (MLR) requirements of the Affordable Care Act, and  will not be required to issue rebates. Highmark operates Highmark Blue Cross Blue Shield  Delaware.

MLR is the share of premium revenues that an insurer spends on patient care and quality improvement activities as opposed to administration and profits. Under reform, insurers in the large group market must meet an MLR standard of 85 percent annually, and insurers in the small group and individual markets must meet an MLR standard of 80 percent annually, or issue rebates.

Highmark Health Services has now met the MLR requirements for both of the years – 2011 and 2012– that MLR reporting has been required by the U.S. Department of Health and Human Services. The company met the requirements for its large group (51 or more employees), small group (2 to 50 employees) and individual health insurance plans offered through each of its health insurer affiliates.

“Highmark Health Services continues to serve as a trusted steward of our members’ investments in their health,” said Vik Mangalmurti, vice president, Highmark Health Services. “Meeting the MLRs reflects our sustained efforts to ensure our members receive health coverage they can count on to be of high quality and high value.”

“Still, we remain very concerned about the rising cost of medical care, and we are taking bold, proactive steps to transform health care delivery and financing in ways that will help to make health care more affordable in the future,” said Mangalmurti

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