The Empire Plan is a unique health insurance plan designed especially for public employees in New York State. Empire Plan benefits include inpatient and outpatient hospital coverage, medical/surgical coverage, Centers of Excellence for transplants, infertility and cancer, home care services, equipment and supplies, mental health and substance abuse coverage and prescription drug coverage.
KATHY HOCHUL
Governor
TIMOTHY R. HOGUES
Commissioner
NY22-19
PE22-15
TO: New York State and Participating Employer Health Benefits Administrators
FROM: Employee Benefits Division
SUBJECT: MVP (HMO) Medical Loss Ratio Rebate
DATE: September 23, 2022
NYSHIP HMO MVP Health Care did not meet the Medical Loss Ratio (MLR) standard set by New York State for the Large Group market in 2021. This standard requires insurers to spend at least 85% of paid premiums on health care and no more than 15% of premiums can be spent on administrative services. In 2021, MVP spent 83.6% of premium dollars on health care.
As a result of not meeting the standard, MVP is required to rebate 1.4% of the premium paid by New York State and enrollees in MVP commercial coverage. This rebate can be distributed by either reducing premium for the upcoming year or providing rebates directly to enrollees. The Department will be applying the rebate to the 2023 premium for MVP. The Department will not be issuing rebates directly to enrollees.
MVP is also required to notify enrollees of the 2021 MLR results. Their letter will explain the MLR standard and the methods of rebate.