BCBSNC Exceeds Affordable Care Act’s Health Care Spending Requirements for Third Consecutive Year

Chapel Hill, N.C. -- Blue Cross and Blue Shield of North Carolina (BCBSNC) has again exceeded the federal requirement for health care spending by $272.3 million in 2013.

The medical loss ratio (MLR) rule requires insurers spend at least 80 percent of premium revenues for individuals, 80 percent for small groups, 85 percent for large groups and 80 percent for student groups on health care services and improving health care quality1. Insurers who fail to meet those requirements must issue the difference in the form of rebates. 

BCBSNC MLRs exceeded these requirements for the third consecutive year at 85.9 percent for individual, 86.5 percent for small groups, 91.8 percent for large groups and 91.7 percent for student groups2.

 “Exceeding the requirements assures Blue Cross customers of the value they receive from their insurance plan knowing that a vast majority of their premium dollar is spent on health care services,” said BCBSNC President and CEO, Brad Wilson. 

During 2013, BCBSNC spent nearly 86 cents per premium dollar on the medical care of its customers. The company’s net income ratio (profit margin) for 2013 was 1.4 percent. BCBSNC is a fully taxed, not-for-profit business and incurred $118.3 million in state, federal and local taxes in 20133.

About BCBSNC:

Blue Cross and Blue Shield of North Carolina is a leader in delivering innovative health care products, services and information to more than 3.84 million members, including approximately 1 million served on behalf of other Blue Plans. Since 1933, the company has served its customers by offering health insurance at a competitive price and has served the people of North Carolina through support of community organizations, programs and events that promote good health. Blue Cross and Blue Shield of North Carolina was recognized as one of the World’s Most Ethical Companies by Ethisphere Institute in 2012, 2013 and 2014. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Visit BCBSNC online at bcbsnc.com.

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  1. www.gpo.gov/fdsys/pkg/FR-2012-05-16/pdf/2012-11753.pdf
  2. Based on 2013 filings submitted to the federal government on 06/01/2014
  3. Based on BCBSNC data 02/28/2014