Excellus BCBS says it exceeded standards for the amount spent on medical care in 2012

DeWITT — Excellus BlueCross BlueShield (BCBS), Central New York’s largest health insurer, today said it exceeded federal and state standards by $330 million in the amount it spent on medical benefits on behalf of its membership in 2012.

The Patient Protection and Affordable Care Act and state regulations set certain medical-benefit spending levels for insurers that are intended to cap profits and administrative costs of health plans to maximize medical benefits for consumers.

Excellus BCBS has exceeded the standards for the second straight year, the insurer said in a news release.

“What this means is that our members collectively got more hospital and physician services, prescriptions and other medical benefits throughout the year than what federal and state government standards require,” Christopher Booth, CEO of Excellus BCBS, said in the news release.

Some health insurers that didn’t meet the standards will be required to pay refunds, Booth added.

State and federal standards, as they apply to New York commercial-insurance customers, set the minimum level of benefits at 82 percent of premium revenues in the individual direct-pay market and the small-group market, along with 85 percent for large groups.

Excellus BCBS spent nearly 95 percent of premium revenues on medical benefits for its individual direct-pay membership, 92.5 percent for small groups, and 92 percent for large groups, the health insurer said.

Out of $4.1 billion in premium revenues collected, the health insurer paid out $3.8 billion in medical benefits for its customers, representing about $330 million above what the federal and state mandates require, Excellus said.

Contact Reinhardt at ereinhardt@cnybj.com