name = "Capital Health Plan — Medical Loss Ratio & rebates (GRAND TOTAL, 2024)"
description = "Medical Loss Ratio and rebate outcomes for Capital Health Plan (parent group: Blue Cross and Blue Shield of Florida, Inc., as reported) in GRAND TOTAL, 2024 MLR reporting year, by market: individual 97.7%, small group 95.5%, large group 98.1%. Met the 80/20-rule floor in every market; no rebate owed. 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/95112-grand-total.jsonld"

[[claims]]
id = "https://coverage-atlas.ryanjhunter.workers.dev/coverage/mlr/95112-grand-total/individual"
warrant = "RECORDED"
name = "Capital Health Plan spent 97.7% of individual premiums on care in GRAND TOTAL (2024) → $0 rebate"
text = "In the GRAND TOTAL individual market, Capital Health Plan's three-year credibility-adjusted Medical Loss Ratio was 97.7% against the 80% floor, on $66,767,644 of 2024 premium earned. It fell below the floor and owed $0 in rebates. 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of measured/reported events (occurred=true) from CMS — Medical Loss Ratio (MLR) Public Use File, 2024 reporting year; superseded when CMS — Medical Loss Ratio (MLR) Public Use File, 2024 reporting year publishes its next release."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/95112-grand-total/small_group"
warrant = "RECORDED"
name = "Capital Health Plan spent 95.5% of small group premiums on care in GRAND TOTAL (2024) → $0 rebate"
text = "In the GRAND TOTAL small group market, Capital Health Plan's three-year credibility-adjusted Medical Loss Ratio was 95.5% against the 80% floor, on $85,714,378 of 2024 premium earned. It fell below the floor and owed $0 in rebates. 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/95112-grand-total/large_group"
warrant = "RECORDED"
name = "Capital Health Plan spent 98.1% of large group premiums on care in GRAND TOTAL (2024) → $0 rebate"
text = "In the GRAND TOTAL large group market, Capital Health Plan's three-year credibility-adjusted Medical Loss Ratio was 98.1% against the 80% floor, on $653,277,922 of 2024 premium earned. It fell below the floor and owed $0 in rebates. 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/95112-grand-total/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 = "97.7%"
Floor = "80%"
Met_floor_ = "no"
Premium__2024_ = "$66,767,644"
Rebate_owed = "$0"
Per_enrollee = "—"
Warrant = "RECORDED"

[[mlr-by-market]]
Market = "Small group"
3_yr_MLR = "95.5%"
Floor = "80%"
Met_floor_ = "no"
Premium__2024_ = "$85,714,378"
Rebate_owed = "$0"
Per_enrollee = "—"
Warrant = "RECORDED"

[[mlr-by-market]]
Market = "Large group"
3_yr_MLR = "98.1%"
Floor = "80%"
Met_floor_ = "no"
Premium__2024_ = "$653,277,922"
Rebate_owed = "$0"
Per_enrollee = "—"
Warrant = "RECORDED"
