; Highmark Health Plans Meet Medical Loss Ratio Requirements Under Health Care Reform For Second Consecutive Year
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Press Release

Highmark Health Plans Meet Medical Loss Ratio Requirements Under Health Care Reform For Second Consecutive Year

June 25, 2013

PITTSBURGH - Highmark Health Services announced today 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 it will not be required to issue rebates.

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, including Highmark Blue Cross Blue Shield in western Pennsylvania, Highmark Blue Shield in central Pennsylvania and the Lehigh Valley, Highmark Blue Cross Blue Shield West Virginia and Highmark Blue Cross Blue Shield Delaware.

"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, Office of Health Care Reform. "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."

Highmark Health Services has historically operated its business very efficiently. In Pennsylvania, its largest market, the company has typically spent nearly 90 percent of the premium dollars it collects to pay for the medical care its members receive and to improve the quality of medical care its members receive through programs such pay-for-performance incentives for hospitals and doctors, clinical initiatives to reduce health disparities and chronic disease management.

"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.

Highmark Health Services
Highmark Health Services is among the largest health insurers in the United States and the fourth-largest Blue Cross and Blue Shield-affiliated company. Highmark Health Services operates health insurance plans in Pennsylvania, Delaware and West Virginia that serve 5.3 million members. Its diversified health businesses serve group customer and individual health needs across the United States through dental insurance, vision care and other related health businesses. Highmark Health Services is an independent licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield companies. For more information, visit www.highmark.com.

The Blue Cross and Blue Shield Association is a national federation of 37 independent, community-based and locally-operated Blue Cross and Blue Shield companies that collectively provide healthcare coverage for nearly 100 million members – one-in-three Americans.  For more information on the Blue Cross and Blue Shield Association and its member companies, please visit bcbs.com. We encourage you to connect with us on Facebook, check out our videos on YouTube, follow us on Twitter and check out The BCBS Blog, for up-to-date information about BCBSA.