SFY 2018 - 2019 MC MLR Report Summary

MAP line of business

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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 $475,870,242 $0 Partially Credible 94,866
HealthPlus HP, LLC 82.25% $221,456 $269,240 $254,448 $0 Non-Credible 59
Senior Whole Health of New York, Inc. 89.05% $7,749,675 $8,702,535 $6,221,500 $0 Non-Credible 1,096
Village Senior Services Corp. (VillageCare Max) 91.71% $53,860,834 $64,222,558 $45,551,802 $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 $746,877,369 $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