|June 4, 2013|
BlueCross Meets MLR Requirements of Health Care Reform Law
CHATTANOOGA, Tenn. — BlueCross BlueShield of Tennessee met the federal minimum medical loss ratio (MLR) requirements for all lines of business during 2012. As a result, it will not be required to issue rebates to customers this year.
The minimum MLR is 80 percent for the individual and the small group market segments (average of 100 or fewer employees) and 85 percent for the large group market segment (average of 101 or more employees). BlueCross’ MLR for the 2012 reporting year was 83.1 percent for individuals, 80.2 percent for small group and 89.1 percent for large group.
“Historically the BlueCross medical loss ratios have been within the ranges set by the Affordable Care Act as we’ve always worked to ensure our members’ premium dollars are going toward their care and peace of mind,” said Calvin Anderson, senior vice president and chief of staff for BlueCross. “We have a continuing commitment to control costs on all fronts and to improve the quality of care received by our members as well as their overall health.”
The health care reform law sets minimum requirements for how much insurance companies are required to spend on health care services and activities to improve health quality. MLR is calculated by totaling the amount spent on medical claims and quality improvement, and then dividing by the amount of premiums paid after subtracting allowable taxes and fees.
The portion of the premium that is not used to pay for medical services or quality improvements is used for operational expenses such as provider contracting, fraud prevention, broker commissions, claims processing and systems that support business operations, as well as profit and reserves.
In 2012, only 3 percent of pre-tax premium dollars paid (or 2 percent of premiums after tax) by BlueCross customers went toward the company’s profit margin.
For more information on MLR, visit bcbst.com (keyword: medical loss ratio).
BlueCross BlueShield of Tennessee's mission is to provide its customers and communities with peace of mind through affordable solutions for health and healing, life and living. Founded in 1945, the Chattanooga-based company is focused on reinventing the health plan for its 3 million members in Tennessee and across the country. Through its integrated health management approach, BlueCross provides patient-centric products and services that drive health improvement and positively impact health care quality and value. BlueCross BlueShield of Tennessee Inc. is an independent licensee of the BlueCross BlueShield Association. For more information, visit the company's website at www.bcbst.com.
Return to Press Releases