SFY 2018 - 2019 MC MLR Report Summary
MAP line of business
- Report also available in Portable Document Format (PDF)
| SFY 2018 - 2019 MC MLR Report Summary | ||||||||
|---|---|---|---|---|---|---|---|---|
| MAP line of business | ||||||||
| Plan | MLR AFTER Credibility Adjustment |
Medical Expense (Total Numerator) |
Premium USED FOR MLR% (Total Denominator) |
Medicaid Only Premium USED FOR REMITTANCE |
Remittance | Credible | MMs | |
| Elderplan, Inc. d/b/a Homefirst | 85.98% | $98,986,539 | $122,235,632 | $86,402,296 | $17,280 | Partially Credible | 16,941 | |
| New York State Catholic Health Plan, Inc. (Fidelis Legacy) | 100.00% | $7,918,099 | $7,918,191 | $4,986,093 | $0 | Non-Credible | 1,145 | |
| GuildNet, Inc. | 96.97% | $26,899,189 | $27,739,563 | $19,979,516 | $0 | Non-Credible | 3,780 | |
| Healthfirst Healthplan, Inc. | 92.57% | $616,798,167 | $681,205,289 | $476,277,800 | $0 | Partially Credible | 94,866 | |
| HealthPlus HP, LLC | 82.25% | $221,456 | $269,240 | $269,240 | $0 | Non-Credible | 59 | |
| Senior Whole Health of New York, Inc. | 89.05% | $7,749,675 | $8,702,535 | $6,313,945 | $0 | Non-Credible | 1,096 | |
| Village Senior Services Corp. (VillageCare Max) | 91.71% | $53,860,834 | $64,222,558 | $45,683,039 | $0 | Partially Credible | 6,760 | |
| VNS (d/b/a VNSNY Choice) and Subsidiary | 86.17% | $121,116,618 | $148,454,152 | $107,611,472 | $0 | Partially Credible | 19,878 | |
| Total | $933,550,578 | $1,060,747,160 | $747,523,401 | $17,280 | 144,525 | |||
NOTES:
Please note that the Remittance is for this line of business for one year ONLY based on a MLR Target of 86%.
The MLR% calculation for the Medicaid/Medicare integrated lines of business includes both the Medicare and Medicaid experience.
Remittances, if applicable, are calculated by multiplying the MLR% by the Medicaid Only Premium.
No remittance for plan if Non-Credible
Updated 11/6/2023
