SFY 2018 - 2019 MC MLR Report Summary

Medicaid Advantage (MA) line of business

  • Report also available in Portable Document Format (PDF)
SFY 2018 - 2019 MC MLR Report Summary
Medicaid Advantage (MA) 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
New York State Catholic Health Plan, Inc. (Fidelis Legacy) 96.39% $22,904,277 $25,089,371 $23,331,897 $0 Partially Credible 16,243
United Healthcare of New York, Inc. 115.45% $50,749,567 $45,357,721 $42,236,638 $0 Partially Credible 33,640
VNS (d/b/a VNSNY Choice) and Subsidiary 100.30% $3,976,934 $3,965,166 $3,655,767 $0 Non-Credible 3,797
WellCare of New York, Inc. 106.40% $28,749,303 $28,140,370 $24,619,459 $0 Partially Credible 22,327
Total   $106,380,081 $102,552,628 $93,843,761 $0   76,007

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
Please note that Medicaid Advantage line of business has a Calendar Year (CY) 1/1-12/31 rating period.