CHAPEL HILL, N.C. – Blue Cross and Blue Shield of North Carolina (BCBSNC) has again exceeded the federal requirement for health care spending by $365 million in 2014.
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. The MLR rule protects consumers from unjustified rate increases and uncertainties in the rate-setting process. Insurers who fail to meet those requirements must send the difference back to the customer in the form of rebates.
During 2014, BCBSNC spent over 87 cents per premium dollar on the medical care of its customers. The company MLRs exceeded the requirements for the fourth consecutive year at 88.3 percent for individual, 87 percent for small groups, 91.3 percent for large groups and 90 percent for student groups2.
"We have exceeded the federal requirements every year. However, the extremely high rate of health care spending we saw in 2014 cannot be sustained over time as shown by our financial losses last year,” said BCBSNC President and CEO Brad Wilson.
The company lost over $120 million in ACA (Affordable Care Act) business due to a sharp rise in claims and medical costs contributing to a net loss of $50.6 million for 2014. BCBSNC is a fully taxed, not-for-profit business and incurred $266.7 million in state, federal and local taxes in 20143.
Blue Cross and Blue Shield of North Carolina improves the health and well-being of our customers and communities by providing innovative health care products, services and information to more than 3.91 million members, including approximately 1 million served on behalf of other Blue Plans. Since 1933, we have worked to make North Carolina a better place to live through our support of community organizations, programs and events that promote good health. We have been recognized as one of the World’s Most Ethical Companies by Ethisphere Institute every year since 2012. 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. All other marks are the property of their respective owners.
1. 45 C.F.R. § 158.210
2. Based on 2014 federal MLR and Risk Corridors reporting
3. Based on BCBSNC's Annual Statement for the Year Ended December 31, 2014