2022 Rate Justification MA

Harvard Pilgrim Health Care
Rate Justification for Massachusetts Merged Market Plans Rate
Change Effective January 1, 2022

Qualified Health Plan (QHP) issuers are required to post justifications for any QHP rate increases to their websites. Below, please find the justification for the rate increase effective January 1, 2022 for the Harvard Pilgrim Health Care Massachusetts Merged Market QHP plans.

Drivers of the rate increase

The average first quarter 2022 rate change for Harvard Pilgrim renewing members is a rate increase of 6.0%.

The rate increase is primarily driven by the increasing cost of medical services. HPHC has not explicitly reflected any rate impact related to COVID-19, except to cover the expected costs associated with vaccination.

Rate changes vary by plan and by account based on age composition and rating area.

Massachusetts requires that at least 88% of premium must be used for medical expenses (otherwise, a rebate is paid to subscribers). This rate increase is calculated to comply with this requirement.

Harvard Pilgrim’s strategy to keep premiums affordable

Harvard Pilgrim is committed to improving value and quality across the health care system. Some of the ways we are working to meet our goals include:

  • Establishing collaborative arrangements with health care providers that control costs and enhance health outcomes
  • Negotiating pharmacy contracts aligning payments with outcomes
  • Managing rare diseases through our nurse care managers
  • Updating our payment policies to deter inappropriate payment for services on selected medical infusible drug claims
  • Maintaining focus on reducing fraud waste and abuse

Continuing to find ways to lower health care costs while providing enhanced value to our customers through our products and services is a keystone to Harvard Pilgrim’s long-term strategy.

The combined organization of Harvard Pilgrim and Tufts Health Plan is committed to guiding and empowering healthier lives for everyone

In these trying times, our commitment to our members, customers, and communities is stronger than ever. Over the past year the combined organization of Harvard Pilgrim and Tufts Health Plan invested $6.1 million in strengthening MA communities with a focus on advancing pandemic recovery and racial justice. In early 2021, an additional $350,000 in grants were donated to community organizations to expand vaccine education, awareness and outreach in communities of color. Grants supported a range of organizations—from statewide organizations to local community nonprofits including the Massachusetts League of Community Health Centers, Massachusetts Immigrant and Refugee Advocacy Coalition in Boston, Worcester Interfaith, the Public Health Institute of Western Mass, Greater Lawrence Community Action Council, and Pinnacle Partnerships of Brockton. This investment was an immediate response to emerging needs in Black and Brown communities across the region disproportionately impacted by the COVID-19 pandemic. The combined organization also initiated ‘Mobile Vax’ with an investment of $1 million, an initiative to reach and vaccinate more people in several Massachusetts cities and towns for COVID-19, particularly in underserved communities and non-English speaking populations. The initiative was supported by The East Boston Neighborhood Health Center (EBNHC) and Last Mile Vaccine Delivery, a new public/private partnership service that aims to accelerate vaccine distribution.