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  "@id": "https://coverage-atlas.ryanjhunter.workers.dev/coverage/mlr/95923-grand-total.jsonld",
  "@type": "schema:Dataset",
  "name": "Geisinger Health Plan — Medical Loss Ratio & rebates (GRAND TOTAL, 2024)",
  "description": "Medical Loss Ratio and rebate outcomes for Geisinger Health Plan (parent group: Geisinger INS GRP, as reported) in GRAND TOTAL, 2024 MLR reporting year, by market: individual 85.3%, small group 91.2%, large group 100.2%. 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.",
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  "variableMeasured": [
    {
      "@type": "PropertyValue",
      "name": "Individual MLR",
      "value": 0.853,
      "minValue": 0.8,
      "unitText": "ratio",
      "description": "85.3% of premium on care vs 80% floor; rebate $0"
    },
    {
      "@type": "PropertyValue",
      "name": "Small group MLR",
      "value": 0.912,
      "minValue": 0.8,
      "unitText": "ratio",
      "description": "91.2% of premium on care vs 80% floor; rebate $0"
    },
    {
      "@type": "PropertyValue",
      "name": "Large group MLR",
      "value": 1.002,
      "minValue": 0.85,
      "unitText": "ratio",
      "description": "100.2% of premium on care vs 85% floor; rebate $0"
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  "temporalCoverage": "2024",
  "measurementTechnique": "Read of CMS MLR PUF part 3 (credibility-adjusted MLR, standard, rebate) joined to the submission template header (issuer, state, market).",
  "dateModified": "2026-06-22T16:51:57.453640+00:00",
  "isBasedOn": {
    "@type": "Dataset",
    "name": "CMS — Medical Loss Ratio (MLR) Public Use File, 2024 reporting year",
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    "creator": {
      "@type": "Organization",
      "name": "Centers for Medicare & Medicaid Services (CMS)"
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  "about": {
    "@type": "schema:Organization",
    "name": "Geisinger Health Plan",
    "identifier": "95923",
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      "@type": "schema:Organization",
      "name": "Geisinger INS GRP"
    }
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  "claims": [
    {
      "@id": "https://coverage-atlas.ryanjhunter.workers.dev/coverage/mlr/95923-grand-total/individual",
      "@type": "schema:Claim",
      "name": "Geisinger Health Plan spent 85.3% of individual premiums on care in GRAND TOTAL (2024)",
      "text": "In the GRAND TOTAL individual market, Geisinger Health Plan's three-year credibility-adjusted Medical Loss Ratio was 85.3% against the 80% floor, on $150,104,218 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.",
      "claimType": "official_fact",
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      "commercialInfluence": false,
      "epistemicStatus": {
        "occurred": true,
        "supported": true,
        "adjudged": true,
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      "grounding": {
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        "source": "CMS — Medical Loss Ratio (MLR) Public Use File, 2024 reporting year",
        "sourceUrl": "https://www.cms.gov/marketplace/private-health-insurance/medical-loss-ratio",
        "value": "MLR 85.3% vs 80% floor; met (no rebate)",
        "adjudicator": {
          "name": "CMS — Medical Loss Ratio (MLR) Public Use File, 2024 reporting year",
          "url": "https://www.cms.gov/marketplace/private-health-insurance/medical-loss-ratio"
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      },
      "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."
    },
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      "@id": "https://coverage-atlas.ryanjhunter.workers.dev/coverage/mlr/95923-grand-total/small_group",
      "@type": "schema:Claim",
      "name": "Geisinger Health Plan spent 91.2% of small group premiums on care in GRAND TOTAL (2024)",
      "text": "In the GRAND TOTAL small group market, Geisinger Health Plan's three-year credibility-adjusted Medical Loss Ratio was 91.2% against the 80% floor, on $32,070,451 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.",
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        "value": "MLR 91.2% vs 80% floor; met (no rebate)",
        "adjudicator": {
          "name": "CMS — Medical Loss Ratio (MLR) Public Use File, 2024 reporting year",
          "url": "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."
    },
    {
      "@id": "https://coverage-atlas.ryanjhunter.workers.dev/coverage/mlr/95923-grand-total/large_group",
      "@type": "schema:Claim",
      "name": "Geisinger Health Plan spent 100.2% of large group premiums on care in GRAND TOTAL (2024)",
      "text": "In the GRAND TOTAL large group market, Geisinger Health Plan's three-year credibility-adjusted Medical Loss Ratio was 100.2% against the 85% floor, on $161,956,121 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.",
      "claimType": "official_fact",
      "reviewStatus": "current",
      "commercialInfluence": false,
      "epistemicStatus": {
        "occurred": true,
        "supported": true,
        "adjudged": true,
        "operative": true
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      "grounding": {
        "groundingType": "SourceCitation",
        "source": "CMS — Medical Loss Ratio (MLR) Public Use File, 2024 reporting year",
        "sourceUrl": "https://www.cms.gov/marketplace/private-health-insurance/medical-loss-ratio",
        "value": "MLR 100.2% vs 85% floor; met (no rebate)",
        "adjudicator": {
          "name": "CMS — Medical Loss Ratio (MLR) Public Use File, 2024 reporting year",
          "url": "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."
    },
    {
      "@id": "https://coverage-atlas.ryanjhunter.workers.dev/coverage/mlr/95923-grand-total/boundary",
      "@type": "schema:Claim",
      "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.",
      "claimType": "interpretation",
      "reviewStatus": "current",
      "commercialInfluence": false,
      "epistemicStatus": {
        "occurred": false,
        "supported": true,
        "adjudged": false,
        "operative": true
      },
      "grounding": {
        "groundingType": "Interpretation",
        "source": "Coverage Atlas L5 boundary (a book-level spending ratio ≠ plan quality)",
        "sourceUrl": "https://coverage-atlas.ryanjhunter.workers.dev/",
        "value": "a book-level spending ratio, not plan quality or advice",
        "adjudicator": null
      },
      "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."
    }
  ],
  "hasPart": [
    {
      "@type": "schema:ItemList",
      "name": "Medical Loss Ratio by market — Geisinger Health Plan (GRAND TOTAL, 2024)",
      "numberOfItems": 3,
      "itemListElement": [
        {
          "@type": "schema:ListItem",
          "position": 1,
          "item": {
            "Market": "Individual",
            "3-yr MLR": "85.3%",
            "Floor": "80%",
            "Met floor?": "yes",
            "Premium (2024)": "$150,104,218",
            "Rebate owed": "$0",
            "Per enrollee": "—",
            "Warrant": "RECORDED"
          }
        },
        {
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          "position": 2,
          "item": {
            "Market": "Small group",
            "3-yr MLR": "91.2%",
            "Floor": "80%",
            "Met floor?": "yes",
            "Premium (2024)": "$32,070,451",
            "Rebate owed": "$0",
            "Per enrollee": "—",
            "Warrant": "RECORDED"
          }
        },
        {
          "@type": "schema:ListItem",
          "position": 3,
          "item": {
            "Market": "Large group",
            "3-yr MLR": "100.2%",
            "Floor": "85%",
            "Met floor?": "yes",
            "Premium (2024)": "$161,956,121",
            "Rebate owed": "$0",
            "Per enrollee": "—",
            "Warrant": "RECORDED"
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