Medical Loss Ratio · West Virginia · 2024 reporting year · Highmark GRP · not-for-profit
Highmark Blue Cross Blue Shield West Virginia
In West Virginia, over the three-year window through 2024, Highmark Blue Cross Blue Shield West Virginia spent 84.5% of individual premiums on care, 87.7% of small group premiums on care, and 94.7% of large group premiums on care (its Medical Loss Ratio). It met the 80/20-rule floor in every market, so no rebate was owed.
Where each premium dollar went
The filled bar is the share of premiums spent on medical care + quality improvement — the three-year Medical Loss Ratio. The marker is the legal floor for that market (80% individual & small group, 85% large group). Below the floor, the insurer rebates the shortfall (floor − MLR), applied to that year's premium.
See what Highmark Blue Cross Blue Shield West Virginiasells on the marketplace — plan footprint and premium positioning — on its company profile, or browse all West Virginia marketplace plans. Complaint counts and loss ratios for Highmark Blue Cross Blue Shield West Virginia (NAIC 54828) are on its carrier quality profile.
RECORDED — the Medical Loss Ratio, the 80/85% standard, premium earned, and the rebate owed are CMS-published figures (the 2024 MLR reporting year, a three-year window through 2024; rebates are paid the following year). DERIVED — rebate as a share of premium, and the rebate per enrollee (rebate ÷ member-years).
Machine-readable: JSON-LD · Markdown · Source: CMS — Medical Loss Ratio (MLR) Public Use File, 2024 reporting year
What this is — and is not
This is how Highmark Blue Cross Blue Shield West Virginia spent premium dollars across its entire West Virginia book in each market — it is not a measure of a specific plan's quality, your denial odds, or whether the insurer is right for you, and it is not advice. A rebate, if owed, is a rule-based payment to policyholders (a check or premium credit) the following year. To compare plans, check eligibility, and enroll, go to HealthCare.gov.