---
title: UPMC Health Options, Inc. — Medical Loss Ratio & rebates (Pennsylvania, 2024)
license: CC0-1.0
source: CMS — Medical Loss Ratio (MLR) Public Use File, 2024 reporting year
---

# UPMC Health Options, Inc. — Medical Loss Ratio & rebates (Pennsylvania, 2024)

Medical Loss Ratio and rebate outcomes for UPMC Health Options, Inc. (parent group: UPMC HLTH System GRP, as reported) in Pennsylvania, 2024 MLR reporting year, by market: individual 91.9%, small group 90.4%, large group 86.2%. Met the 80/20-rule floor in every market; no rebate owed. RECORDED CMS-published MLR / standard / premium / rebate; rebate-as-%-of-premium is DERIVED. A spending ratio across the whole book in a market — not plan quality or advice. CC0.

## Claims

### UPMC Health Options, Inc. spent 91.9% of individual premiums on care in PA (2024)

**RECORDED.** In the Pennsylvania individual market, UPMC Health Options, Inc.'s three-year credibility-adjusted Medical Loss Ratio was 91.9% against the 80% floor, on $713,745,499 of 2024 premium earned. It met the floor; no rebate owed. RECORDED CMS-published figures (occurred=true; an actual backward-looking ratio insurers report under the 80/20 rule, adjudged=TRUE — CMS published it); rebate-per-enrollee is a DERIVED sub-figure.

Source: CMS — Medical Loss Ratio (MLR) Public Use File, 2024 reporting year — https://www.cms.gov/marketplace/private-health-insurance/medical-loss-ratio
Falsifier: A RECORD of measured/reported events (occurred=true) from CMS — Medical Loss Ratio (MLR) Public Use File, 2024 reporting year; superseded when CMS — Medical Loss Ratio (MLR) Public Use File, 2024 reporting year publishes its next release.

### UPMC Health Options, Inc. spent 90.4% of small group premiums on care in PA (2024)

**RECORDED.** In the Pennsylvania small group market, UPMC Health Options, Inc.'s three-year credibility-adjusted Medical Loss Ratio was 90.4% against the 80% floor, on $687,293,790 of 2024 premium earned. It met the floor; no rebate owed. RECORDED CMS-published figures (occurred=true; an actual backward-looking ratio insurers report under the 80/20 rule, adjudged=TRUE — CMS published it); rebate-per-enrollee is a DERIVED sub-figure.

Source: CMS — Medical Loss Ratio (MLR) Public Use File, 2024 reporting year — https://www.cms.gov/marketplace/private-health-insurance/medical-loss-ratio
Falsifier: A RECORD of measured/reported events (occurred=true) from CMS — Medical Loss Ratio (MLR) Public Use File, 2024 reporting year; superseded when CMS — Medical Loss Ratio (MLR) Public Use File, 2024 reporting year publishes its next release.

### UPMC Health Options, Inc. spent 86.2% of large group premiums on care in PA (2024)

**RECORDED.** In the Pennsylvania large group market, UPMC Health Options, Inc.'s three-year credibility-adjusted Medical Loss Ratio was 86.2% against the 85% floor, on $671,491,376 of 2024 premium earned. It met the floor; no rebate owed. RECORDED CMS-published figures (occurred=true; an actual backward-looking ratio insurers report under the 80/20 rule, adjudged=TRUE — CMS published it); rebate-per-enrollee is a DERIVED sub-figure.

Source: CMS — Medical Loss Ratio (MLR) Public Use File, 2024 reporting year — https://www.cms.gov/marketplace/private-health-insurance/medical-loss-ratio
Falsifier: A RECORD of measured/reported events (occurred=true) from CMS — Medical Loss Ratio (MLR) Public Use File, 2024 reporting year; superseded when CMS — Medical Loss Ratio (MLR) Public Use File, 2024 reporting year publishes its next release.

### What a Medical Loss Ratio is — and is NOT

**INTERPRETATION.** A Medical Loss Ratio is a spending ratio across an issuer's WHOLE book in a market for a past period — the share of premium spent on care + quality improvement versus administration and profit. It is NOT a measure of plan quality, of your individual plan's value, or of coverage availability, and it is NOT advice. A low MLR triggers a rebate; it does not rate care.

Source: Coverage Atlas L5 boundary (a book-level spending ratio ≠ plan quality) — https://coverage-atlas.ryanjhunter.workers.dev/
Falsifier: occurred=FALSE (a framing, not an event) and adjudged=FALSE (an in-house reading, not an authority's verdict) — the LOWEST-warrant claim here. A flat representation would render this identically to the official facts; the four-status does not.

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Every claim above carries a four-status warrant (RECORDED / MODELED / DERIVED / INTERPRETATION) and a named source you can re-fetch — this is a research object, not a flat fact. Structured: `https://coverage-atlas.ryanjhunter.workers.dev/coverage/mlr/16322-pa.jsonld`

## Data

### Medical Loss Ratio by market — UPMC Health Options, Inc. (Pennsylvania, 2024)

CMS-published credibility-adjusted MLR, standard, premium, and rebate (RECORDED). Rebate-per-enrollee is DERIVED.

| Market | 3-yr MLR | Floor | Met floor? | Premium (2024) | Rebate owed | Per enrollee | Warrant |
| --- | --- | --- | --- | --- | --- | --- | --- |
| Individual | 91.9% | 80% | yes | $713,745,499 | $0 | — | RECORDED |
| Small group | 90.4% | 80% | yes | $687,293,790 | $0 | — | RECORDED |
| Large group | 86.2% | 85% | yes | $671,491,376 | $0 | — | RECORDED |