Excellus Blue Cross Blue Shield won't be refunding its members under the reform law's medical-loss ratio (MLR) because it spent more on medical benefits than administrative services.
The insurer on Wednesday said it spent $255 million more on benefits, such as hospital and physician services and prescriptions, than federal and New York state standards required last year, reported the Saugerties Post Star.
Under the federal MLR rule, insurers must spend 85 percent of premiums from large group plans and 80 percent of premiums from small group plans on medical benefits. However, New York requires insurers to allocate 82 percent of premiums from small group plans toward benefits, the Rochester Business Journal reported.
Excellus said it spent 93.4 percent of individual policy premiums on benefits, 90.9 percent for small groups and 90.9 percent for large groups, the Syracuse Post-Standard reported. By surpassing both federal and state standards, Excellus is one of the few insurers that won't be rebating its customers, based on a Kaiser Family Foundation survey that found insurers will be refunding more than $1 billion to consumers.
"We seek to provide competitive, affordable access to coverage in our markets that maximize benefits for our customers," Christopher Booth, Excellus chief operating officer and CEO-elect, said in a statement. "By exceeding the standards, it means our members collectively got more in medical benefits throughout the year than the minimum amounts set by federal and state governments."