Blue Cross Blue Shield of Texas vows to give back $213 million through refunds, lower rates - The Dallas Morning News

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Blue Cross Blue Shield of Texas, the state’s largest health insurer, plans to give back $104 million to employers in the form of premium credits and reduce its rates by $109 million next year.

Despite a worldwide health crisis from the COVID-19 pandemic, fewer people are visiting doctors' offices and surgical centers because of the risk of contracting the coronavirus. But that’s been offset, at least partially, by the high costs of care for COVID-19, which has now infected more than 7.4 million people in the U.S, including nearly 800,000 in Texas.

“The ongoing pandemic, and the resulting stay-at-home orders and other public health guidelines, caused deferrals in routine, non-emergent care and procedures, which temporarily lowered the volume of health care claims below what was anticipated when monthly premiums were set in 2019 for 2020,” said BCBS of Texas spokesman James Campbell.

However, it doesn’t necessarily mean premiums will be lower next year, he said.

“The caveat being there continues to be uncertainty surrounding health care spending and the impact of deferred care for the remainder of the year,” Campbell said. “So our pricing is always based on anticipated medical costs.”

BCBS of Texas, which has about 8 million Texans on its health plans, collected $10 billion in premiums in 2018, according to the Texas Department of Insurance. The company is legally obligated to give refunds to customers if it doesn’t spend at least 80% of premiums on health care costs.

Through the first half of the year, profits for Health Care Service Corp., the parent company of BCBS of Texas, were up 58% compared with the same period last year.

BCBS of Texas already refunded about $250 million to customers covered under health exchange plans for individuals and small groups.

With the pandemic still raging and uncertainty about the economy, it’s unclear what will happen to health care premiums next year, although many employers expect them to increase, according to Business Group on Health, a Dallas-based nonprofit that advocates for large employers on health care issues.

“What employees will pay for health care benefits, including premiums and out-of-pocket costs, may rise along with total health benefit costs, which employers expect to rise an average of 5% in 2021,” the business group said in a report released at the end of September. “On top of already high levels, these increases are larger than wage growth and overall economic growth.”

Employers will continue to pay about 70% of workers’ health care premiums, the business group said.

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