Highmark health plans meet medical loss ratio requirements for second consecutive year

July 1, 2013

Highmark Health Services announced recently that, for the second consecutive year, its insured health plans in all of its markets met the medical loss ratio 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.”

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

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 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

Highmark Blue Cross Blue Shield Delaware is headquartered in Wilmington.

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