Medical Loss Ratio · Pennsylvania · 2024 reporting year · Highmark GRP · not-for-profit
Highmark Coverage Advantage Inc.
In Pennsylvania, over the three-year window through 2024, Highmark Coverage Advantage Inc. spent 86.1% of individual premiums on care, 89.2% of small group premiums on care, and 64.8% of large group premiums on care (its Medical Loss Ratio). Because that fell below the floor in one market, it must rebate the shortfall to its 2024 policyholders — $919,579 in all.
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 Coverage Advantage Inc.sells on the marketplace — plan footprint and premium positioning — on its company profile, or browse all Pennsylvania marketplace plans. Complaint counts and loss ratios for Highmark Coverage Advantage Inc. (NAIC 15507) 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 Coverage Advantage Inc. spent premium dollars across its entire Pennsylvania 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.