name = "Harvard Pilgrim Health Care, Inc. — Medical Loss Ratio & rebates (Massachusetts, 2024)"
description = "Medical Loss Ratio and rebate outcomes for Harvard Pilgrim Health Care, Inc. (parent group: Harvard Pilgrim HTH CARE GRP, as reported) in Massachusetts, 2024 MLR reporting year, by market: individual 87.6%, small group 87.6%, large group 89.6%. Owed $3,707,036 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/36046-ma.jsonld"

[[claims]]
id = "https://coverage-atlas.ryanjhunter.workers.dev/coverage/mlr/36046-ma/individual"
warrant = "RECORDED"
name = "Harvard Pilgrim Health Care, Inc. spent 87.6% of individual premiums on care in MA (2024) → $851,579 rebate"
text = "In the Massachusetts individual market, Harvard Pilgrim Health Care, Inc.'s three-year credibility-adjusted Medical Loss Ratio was 87.6% against the 88% floor, on $215,814,011 of 2024 premium earned. It fell below the floor and owed $851,579 in rebates (≈$8 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of measured/reported events (occurred=true) from CMS — Medical Loss Ratio (MLR) Public Use File, 2024 reporting year; superseded when CMS — Medical Loss Ratio (MLR) Public Use File, 2024 reporting year publishes its next release."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/36046-ma/small_group"
warrant = "RECORDED"
name = "Harvard Pilgrim Health Care, Inc. spent 87.6% of small group premiums on care in MA (2024) → $2,855,457 rebate"
text = "In the Massachusetts small group market, Harvard Pilgrim Health Care, Inc.'s three-year credibility-adjusted Medical Loss Ratio was 87.6% against the 88% floor, on $716,774,955 of 2024 premium earned. It fell below the floor and owed $2,855,457 in rebates (≈$27 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/36046-ma/large_group"
warrant = "RECORDED"
name = "Harvard Pilgrim Health Care, Inc. spent 89.6% of large group premiums on care in MA (2024)"
text = "In the Massachusetts large group market, Harvard Pilgrim Health Care, Inc.'s three-year credibility-adjusted Medical Loss Ratio was 89.6% against the 85% floor, on $1,187,094,713 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/36046-ma/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 = "87.6%"
Floor = "88%"
Met_floor_ = "no"
Premium__2024_ = "$215,814,011"
Rebate_owed = "$851,579"
Per_enrollee = "≈$8"
Warrant = "RECORDED"

[[mlr-by-market]]
Market = "Small group"
3_yr_MLR = "87.6%"
Floor = "88%"
Met_floor_ = "no"
Premium__2024_ = "$716,774,955"
Rebate_owed = "$2,855,457"
Per_enrollee = "≈$27"
Warrant = "RECORDED"

[[mlr-by-market]]
Market = "Large group"
3_yr_MLR = "89.6%"
Floor = "85%"
Met_floor_ = "yes"
Premium__2024_ = "$1,187,094,713"
Rebate_owed = "$0"
Per_enrollee = "—"
Warrant = "RECORDED"
