---
title: Highmark Health Insurance Company — Medical Loss Ratio & rebates (Pennsylvania, 2024)
license: CC0-1.0
source: CMS — Medical Loss Ratio (MLR) Public Use File, 2024 reporting year
---

# Highmark Health Insurance Company — Medical Loss Ratio & rebates (Pennsylvania, 2024)

Medical Loss Ratio and rebate outcomes for Highmark Health Insurance Company (parent group: Highmark GRP, as reported) in Pennsylvania, 2024 MLR reporting year, by market: small group 91.1%, large group 70.6%. Owed $2,274,270 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.

## Claims

### Highmark Health Insurance Company spent 91.1% of small group premiums on care in PA (2024)

**RECORDED.** In the Pennsylvania small group market, Highmark Health Insurance Company's three-year credibility-adjusted Medical Loss Ratio was 91.1% against the 80% floor, on $210,200,277 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 — 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of measured/reported events (occurred=true) from CMS — Medical Loss Ratio (MLR) Public Use File, 2024 reporting year; superseded when CMS — Medical Loss Ratio (MLR) Public Use File, 2024 reporting year publishes its next release.

### Highmark Health Insurance Company spent 70.6% of large group premiums on care in PA (2024) → $2,274,270 rebate

**RECORDED.** In the Pennsylvania large group market, Highmark Health Insurance Company's three-year credibility-adjusted Medical Loss Ratio was 70.6% against the 85% floor, on $15,793,544 of 2024 premium earned. It fell below the floor and owed $2,274,270 in rebates (≈$1,062 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 — 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.

### What a Medical Loss Ratio is — and is NOT

**INTERPRETATION.** 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) — 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.

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Every claim above carries a four-status warrant (RECORDED / MODELED / DERIVED / INTERPRETATION) and a named source you can re-fetch — this is a research object, not a flat fact. Structured: `https://coverage-atlas.ryanjhunter.workers.dev/coverage/mlr/70194-pa.jsonld`

## Data

### Medical Loss Ratio by market — Highmark Health Insurance Company (Pennsylvania, 2024)

CMS-published credibility-adjusted MLR, standard, premium, and rebate (RECORDED). Rebate-per-enrollee is DERIVED.

| Market | 3-yr MLR | Floor | Met floor? | Premium (2024) | Rebate owed | Per enrollee | Warrant |
| --- | --- | --- | --- | --- | --- | --- | --- |
| Small group | 91.1% | 80% | yes | $210,200,277 | $0 | — | RECORDED |
| Large group | 70.6% | 85% | no | $15,793,544 | $2,274,270 | ≈$1,062 | RECORDED |