2020 Rate Justification MA

Harvard Pilgrim Health Care
Rate Justification for Massachusetts Merged Market Plans
Rate Change Effective January 1, 2020

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, 2020, for the Harvard Pilgrim Health Care Massachusetts Merged Market QHP plans.

Drivers of the rate increase

The average first quarter 2020 rate change for Harvard Pilgrim renewing members is a rate decrease of -0.3%.

While medical trend generally leads to a positive rate increase year over year, Harvard Pilgrim is implementing a rate decrease for the first quarter of 2020. This is a result of our cost containment initiatives, stable administrative expenses and commitment to keeping premiums affordable.

Rate changes vary by plan and by account, and while some members may see an increase in their premium, the majority of our customers can expect to see a rate decrease in the first quarter of 2020.

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.