name = "UnitedHealthcare of North Carolina, Inc. — Medical Loss Ratio & rebates (North Carolina, 2024)"
description = "Medical Loss Ratio and rebate outcomes for UnitedHealthcare of North Carolina, Inc. (parent group: Unitedhealth GRP, as reported) in North Carolina, 2024 MLR reporting year, by market: individual 79.4%, small group 85.8%, large group 84.5%. Owed $1,853,992 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/54332-nc.jsonld"

[[claims]]
id = "https://coverage-atlas.ryanjhunter.workers.dev/coverage/mlr/54332-nc/individual"
warrant = "RECORDED"
name = "UnitedHealthcare of North Carolina, Inc. spent 79.4% of individual premiums on care in NC (2024) → $1,801,751 rebate"
text = "In the North Carolina individual market, UnitedHealthcare of North Carolina, Inc.'s three-year credibility-adjusted Medical Loss Ratio was 79.4% against the 80% floor, on $315,877,889 of 2024 premium earned. It fell below the floor and owed $1,801,751 in rebates (≈$40 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of measured/reported events (occurred=true) from CMS — Medical Loss Ratio (MLR) Public Use File, 2024 reporting year; superseded when CMS — Medical Loss Ratio (MLR) Public Use File, 2024 reporting year publishes its next release."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/54332-nc/small_group"
warrant = "RECORDED"
name = "UnitedHealthcare of North Carolina, Inc. spent 85.8% of small group premiums on care in NC (2024)"
text = "In the North Carolina small group market, UnitedHealthcare of North Carolina, Inc.'s three-year credibility-adjusted Medical Loss Ratio was 85.8% against the 80% floor, on $91,615,496 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/54332-nc/large_group"
warrant = "RECORDED"
name = "UnitedHealthcare of North Carolina, Inc. spent 84.5% of large group premiums on care in NC (2024) → $52,241 rebate"
text = "In the North Carolina large group market, UnitedHealthcare of North Carolina, Inc.'s three-year credibility-adjusted Medical Loss Ratio was 84.5% against the 85% floor, on $10,502,837 of 2024 premium earned. It fell below the floor and owed $52,241 in rebates (≈$29 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/54332-nc/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 = "79.4%"
Floor = "80%"
Met_floor_ = "no"
Premium__2024_ = "$315,877,889"
Rebate_owed = "$1,801,751"
Per_enrollee = "≈$40"
Warrant = "RECORDED"

[[mlr-by-market]]
Market = "Small group"
3_yr_MLR = "85.8%"
Floor = "80%"
Met_floor_ = "yes"
Premium__2024_ = "$91,615,496"
Rebate_owed = "$0"
Per_enrollee = "—"
Warrant = "RECORDED"

[[mlr-by-market]]
Market = "Large group"
3_yr_MLR = "84.5%"
Floor = "85%"
Met_floor_ = "no"
Premium__2024_ = "$10,502,837"
Rebate_owed = "$52,241"
Per_enrollee = "≈$29"
Warrant = "RECORDED"
