Blue Cross Blue Shield of North Carolina reported Thursday that it had exceeded health care spending benchmarks by spending 87 percent of premium revenues on paying for care for its customers.
Under the Affordable Care Act, insurance carriers must spend at least 80 percent of the money they take in from premiums for individual and small group coverage on paying for health care services and improving quality. That benchmark is set higher for large group coverage, at 85 percent.
The goal is to reduce the portion of premiums that is paid for administrative expenses or racked up as profit and spend a higher percentage directly on care.
If carriers don’t hit those target ratios, called medical loss ratios, they are required to refund the difference to their customers. North Carolina health insurance customers recently learning that they were in line for close to $10 million in rebates, as reported earlier by The Business Journal.
Blue Cross Blue Shield reported it saw a medical loss ratio of 88.7 percent within the individual market, 85.2 percent for the small group market and 92.5 percent for large groups, with an overal ratio of 87 percent in 2012. The carrier’s overall medical loss ratio of 87 percent was up two percentage points in 2012.
Overall, Blue Cross Blue Shield reported it spent $260 million above the benchmarked requirement on health care services.
Blue Cross Blue Shield is the largest insurance carrier in North Carolina, with 3.74 million members.