name = "Community Insurance Company — Medical Loss Ratio & rebates (Ohio, 2024)"
description = "Medical Loss Ratio and rebate outcomes for Community Insurance Company (parent group: Elevance Hlth Inc Grp, as reported) in Ohio, 2024 MLR reporting year, by market: individual 84.6%, small group 76.4%, large group 89.9%. Owed $13,110,003 in rebates. 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."
license = "CC0-1.0"
jsonld = "https://coverage-atlas.ryanjhunter.workers.dev/coverage/mlr/29276-oh.jsonld"

[[claims]]
id = "https://coverage-atlas.ryanjhunter.workers.dev/coverage/mlr/29276-oh/individual"
warrant = "RECORDED"
name = "Community Insurance Company spent 84.6% of individual premiums on care in OH (2024)"
text = "In the Ohio individual market, Community Insurance Company's three-year credibility-adjusted Medical Loss Ratio was 84.6% against the 80% floor, on $677,782,177 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"
sourceUrl = "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of measured/reported events (occurred=true) from CMS — Medical Loss Ratio (MLR) Public Use File, 2024 reporting year; superseded when CMS — Medical Loss Ratio (MLR) Public Use File, 2024 reporting year publishes its next release."

[[claims]]
id = "https://coverage-atlas.ryanjhunter.workers.dev/coverage/mlr/29276-oh/small_group"
warrant = "RECORDED"
name = "Community Insurance Company spent 76.4% of small group premiums on care in OH (2024) → $13,110,003 rebate"
text = "In the Ohio small group market, Community Insurance Company's three-year credibility-adjusted Medical Loss Ratio was 76.4% against the 80% floor, on $379,752,448 of 2024 premium earned. It fell below the floor and owed $13,110,003 in rebates (≈$286 per enrollee). 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"
sourceUrl = "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."

[[claims]]
id = "https://coverage-atlas.ryanjhunter.workers.dev/coverage/mlr/29276-oh/large_group"
warrant = "RECORDED"
name = "Community Insurance Company spent 89.9% of large group premiums on care in OH (2024)"
text = "In the Ohio large group market, Community Insurance Company's three-year credibility-adjusted Medical Loss Ratio was 89.9% against the 85% floor, on $3,219,552,589 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"
sourceUrl = "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."

[[claims]]
id = "https://coverage-atlas.ryanjhunter.workers.dev/coverage/mlr/29276-oh/boundary"
warrant = "INTERPRETATION"
name = "What a Medical Loss Ratio is — and is NOT"
text = "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)"
sourceUrl = "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."

[[mlr-by-market]]
Market = "Individual"
3_yr_MLR = "84.6%"
Floor = "80%"
Met_floor_ = "yes"
Premium__2024_ = "$677,782,177"
Rebate_owed = "$0"
Per_enrollee = "—"
Warrant = "RECORDED"

[[mlr-by-market]]
Market = "Small group"
3_yr_MLR = "76.4%"
Floor = "80%"
Met_floor_ = "no"
Premium__2024_ = "$379,752,448"
Rebate_owed = "$13,110,003"
Per_enrollee = "≈$286"
Warrant = "RECORDED"

[[mlr-by-market]]
Market = "Large group"
3_yr_MLR = "89.9%"
Floor = "85%"
Met_floor_ = "yes"
Premium__2024_ = "$3,219,552,589"
Rebate_owed = "$0"
Per_enrollee = "—"
Warrant = "RECORDED"
