Spending More on Medical Care

CDPHP^® works hard to ensure our administrative costs are not our members’ burden, and that we spend a vast majority of your premium dollars on medical care. For the fourth year in a row, CDPHP has spent more than federal and state requirements on our members’ medical care and exceeded the standards for medical loss ratio.

An insurance company’s medical loss ratio (MLR) is a measurement of how premium dollars are spent. The state and federal governments requires all health insurers to spend a proportion of premiums on medical benefits, which includes things like payments to your doctors, hospitals, and other medical providers, as well as coverage of your prescription drugs.

Here in New York, health plans are required to spend at least 85% (for large employer groups) and 82% (for individuals and small employer groups) of your premium dollars on medical benefits.

When an insurer does not meet these standards, it must rebate its customers the difference. Because CDPHP exceeds these standards, we will not issue rebates.

Photo by 401(k) 2012 / CC BY