name = "MAMSI Life and Health Insurance Company — Medical Loss Ratio & rebates (Maryland, 2024)"
description = "Medical Loss Ratio and rebate outcomes for MAMSI Life and Health Insurance Company (parent group: Unitedhealth GRP, as reported) in Maryland, 2024 MLR reporting year, by market: small group 76.0%, large group 79.7%. Owed $2,488,663 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/65635-md.jsonld"

[[claims]]
id = "https://coverage-atlas.ryanjhunter.workers.dev/coverage/mlr/65635-md/small_group"
warrant = "RECORDED"
name = "MAMSI Life and Health Insurance Company spent 76.0% of small group premiums on care in MD (2024) → $2,317,143 rebate"
text = "In the Maryland small group market, MAMSI Life and Health Insurance Company's three-year credibility-adjusted Medical Loss Ratio was 76.0% against the 80% floor, on $61,199,793 of 2024 premium earned. It fell below the floor and owed $2,317,143 in rebates (≈$278 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of measured/reported events (occurred=true) from CMS — Medical Loss Ratio (MLR) Public Use File, 2024 reporting year; superseded when CMS — Medical Loss Ratio (MLR) Public Use File, 2024 reporting year publishes its next release."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/65635-md/large_group"
warrant = "RECORDED"
name = "MAMSI Life and Health Insurance Company spent 79.7% of large group premiums on care in MD (2024) → $171,520 rebate"
text = "In the Maryland large group market, MAMSI Life and Health Insurance Company's three-year credibility-adjusted Medical Loss Ratio was 79.7% against the 85% floor, on $3,438,846 of 2024 premium earned. It fell below the floor and owed $171,520 in rebates (≈$169 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/65635-md/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 = "Small group"
3_yr_MLR = "76.0%"
Floor = "80%"
Met_floor_ = "no"
Premium__2024_ = "$61,199,793"
Rebate_owed = "$2,317,143"
Per_enrollee = "≈$278"
Warrant = "RECORDED"

[[mlr-by-market]]
Market = "Large group"
3_yr_MLR = "79.7%"
Floor = "85%"
Met_floor_ = "no"
Premium__2024_ = "$3,438,846"
Rebate_owed = "$171,520"
Per_enrollee = "≈$169"
Warrant = "RECORDED"
