Excellus BlueCross BlueShield members benefit from high portion of premiums spent on medical care

ROCHESTER, NY (06/10/2014)(readMedia)-- Excellus BlueCross BlueShield paid out $864 million more for medical care on behalf of its insured membership than what federal and state standards required for the first three years of newly required reporting, officials said today.

To cap profits and administrative costs of health plans in order to maximize medical benefits to consumers, the federal Patient Protection and Affordable Care Act and state regulations set certain medical benefit spending levels for insurers. In the third consecutive year of the new rules and reporting, Excellus BlueCross BlueShield well exceeded the standards for the benefit of its membership.

"Our members are getting high value from the premiums they pay," said Christopher Booth, chief executive officer of the health plan. "Collectively our members get more hospital and physician services, prescriptions and other medical benefits throughout the year than what federal and state government standards require." Some health insurers that don't meet the standards are required to pay refunds, but only to levels that would bring their membership up to the minimum thresholds.

State and federal standards, as they apply to New York commercial insurance customers, set the minimum level of benefits to be 82 percent of premium revenues in the individual direct-pay and small group markets and 85 percent for large groups. Excellus BCBS reports that it spent 94.2 percent of premium revenues on medical benefits for its individual direct pay membership, 91 percent for small groups and 91.8 percent for large groups in 2013.

Out of $3.9 billion in premium revenues collected last year, the health plan paid out $3.6 billion in medical benefits for its customers, about $292 million more than federal and state mandates require.

Under new federal and state rules for 2014, health plans are now required to report three-year cumulative amounts for 2011-2013. For Excellus BlueCross BlueShield's membership, benefit payments exceeded the standards by $864 million. Here are the amounts by membership type:

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Excellus BlueCross BlueShield, a nonprofit independent licensee of the BlueCross BlueShield Association, is part of a family of companies that finances and delivers vital health care services to about. 1.8 million people across upstate New York. Excellus BlueCross BlueShield provides access to high-quality, affordable health coverage, including valuable health-related resources that our members use every day, such as cost-saving prescription drug discounts and wellness tracking tools in our Step Up program. To learn more, visit excellusBCBS.com