Excellus requests approval to raise rates for thousands of members

Some Excellus customers may see increased rates as soon as January of next year as outlined in a request filed by the company on May 15.

Excellus Health Plan Inc. — which does business as Excellus BlueCross BlueShield and Univera Healthcare — is seeking approval of the Superintendent of the Department of Financial Services of the State of New York for small group and individual health plan community rate increases in 2025.

Excellus currently provides health insurance and administration services for around 1.5 million people in upstate New York in 39 counties, the filed request states.

“As a result of significant increases in the cost of care and the severity of our members’ illnesses, Excellus BCBS has requested an average rate increase of 19.5% for its community-rated products for 2025,” Excellus Vice President of Corporate Communications Joy Auch said Friday. “More than half of our rate increase request is due to hospital costs as more upstate New Yorkers are going to the hospital for more severe and high-cost procedures …”

Here’s what to know about the proposed rate increases.

How you’ll be affected by increased Excellus rates

The proposed premium rate increases would affect about 167,000 members, or 11.5%, of Excellus’ total membership, according to the filed request.

Both community-rated small group plans and individual plans would be seeing a premium rate adjustment averaging 19.5%, if approved.

Excellus has also filed premiums that target an operating margin of 2% for small group plans and 1.5% for individual plans.

Why Excellus wants to raise rates

Excellus’ request states the company’s premium rate requests between 2021 and 2024 in their individual and small group markets were among the lowest in the state.

However, due mainly to rising health care costs, such as rising prescription drug prices, additional spending for hospital services and increases in outpatient services such as hip and knee surgeries, a rate increase is necessary, the insurance provider said.

The compounding effects of price and utilization, leveraging, operating expenses and quality improvements are contributing factors as well.

Excellus also expects to have to pay more into the federal Risk Adjustment Program, which assesses a charge on health plans that have low-risk members and uses the revenue to compensate plans with higher-risk members, for small group business and individual plans next year.

If these rate increases aren’t approved, Excellus says it “would only lead to the need for even greater rate increases in the future.”

Other insurance providers also asked for both individual and small group rate increases this year, including Aetna, MVP and UnitedHealthcare, according to the Department of Financial Services. Their individual plan increase requests ranged from 8.8% to 51%.

When the proposed increases would go into effect

Policyholders with renewal dates next year would receive rate adjustments on their next anniversary date on or after Jan. 1, 2025.


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