2014 Financial Results for Health Insurance Companies in Maine

Transcription

1 Financial Results for Health Insurance Companies in Maine This publication contains summaries of the information that insurers must provide annually to the Bureau of Insurance. Information is displayed for each market segment of the fully insured market (i.e., for policies under the State s jurisdiction): Large group (employers with more than 50 employees) Small group (employers with 50 or fewer employees) (those who buy their own health insurance) The summaries below show information for each of Maine s largest health insurers (those companies that had $5 million or more in direct written health insurance premium in Maine for major medical and stop loss combined). The All Other Companies category includes aggregate data (except for enrollment and per member per month data) for companies with less than $5 million of premium. The following information is shown: The number of people enrolled s (how much money was collected) Claims (how much money was paid to healthcare providers) Administrative Expenses (how much money was spent on administration) Underwriting Gain or Loss (how much money was left)

2 People Enrolled The number of people enrolled is equivalent to the number of covered lives, including dependents, at the end of the prior calendar year. Table 1: Enrollees as of December 31, Insurers Totals Totals Large Large Small Small Aetna Health Inc. + Aetna Life Ins Co. 31, , , Anthem Health Plans of ME Inc. 173, , , ,733-3 CIGNA Health & Life Ins Co. 16, , Harvard Pilgrim Health Care Inc. + HPHC 66, , , Maine Community Health Options 39, ,499 37,885 MEGA Life & Health (Mid-West National Life of Tennessee) 5, ,239 Nationwide Life Ins Co. 3, , United Healthcare Ins Co. 2, , Total 339, ,392 70,808 61, Only 945 report Long form filers provide covered lives data. 2. Nationwide Life Insurance Company data is for student policies. 3. MEGA merged into Mid-West National Life Ins. Co. of Tennessee and is in the process of withdrawing from the market. 4. Maine Community Health Options entered the market.

3 Figure 1: Percentage of Large Enrollees by Company Nationwide Life, 1.6 Harvard, 17.7 United Healthcare, 1.2 Aetna, 7.6 Maine Community Health Options, 2.1 Harvard, 41.6 Figure 2: Percentage of Small Enrollees by Company United Healthcare, 0.7 Aetna, 22.6 CIGNA Health & Life, 8.0 Anthem, 63.9 Anthem, 33.0 Maine Community Health Options, 61.9 Figure 3: Percentage of Enrollees by Company Aetna, 0.1 MEGA (Mid- West National Life of TN), 1.6 Harvard, 19.5 Maine Community Health Options, 11.6 Figure 4: Percentage of Total Enrollees by Company Nationwide Life, 0.9 United Healthcare, 0.9 Aetna, 9.4 MEGA (Mid- West National Life of TN), 8.6 Harvard, 0.5 Anthem, 29.1 CIGNA Health & Life, 4.9 Anthem, 51.2

4 s Earned Table 2: s Earned Insurers Totals Totals Aetna Health Inc. + Aetna Life Ins Co. $144,068,249 3 $68,467,439-2 $75,306,519 8 $294, Anthem Health Plans of ME Inc. $956,204,010 1 $730,135,456 3 $148,611, $77,456, CIGNA Health & Life Ins Co. $85,927, $85,925, $1, $0 0 Harvard Pilgrim Health Care Inc. and HPHC $267,293,971-6 $148,973, $117,844,139-4 $1,177, Maine Community Health Options $172,257,261 $161,560 $4,799,619 $167,296,082 MEGA Life & Health (Mid-West National Life of Tennessee) $18,037,412 $0 ($9,135) $18,046,547 Nationwide Life Ins Co. $4,165, $4,165, $0 0 $0 0 United Healthcare Ins Co. $16,382,886 0 $14,468,332 8 $1,914, $0 0 All Other Companies $4,594, $2,439, $18, $2,136, Totals: $1,668,931,787 $1,054,737,065 $348,488,214 $266,408, Nationwide Life Insurance Company data is for student policies. 2. MEGA merged into Mid-West National Life Ins. Co. of Tennessee and is in the process of withdrawing from the market. 3. Maine Community Health Options entered the market.

5 s by Market Segment for Selected Companies Figure 5: Aetna Health Inc. + Aetna Life Ins Co. $75,306,519 $294,291 Figure 6: Anthem Health Plans of ME $148,611,914 $77,456,640 $68,467,439 $730,135,456 Figure 7: Harvard Pilgrim Healthcare Inc. + HPHC $117,844,139 $1,177,789 Figure 8: Maine Community Health $161,560 $4,799,619, $148,973,546 $167,296,082

6 per Member Month Insurance policies vary widely in terms of deductibles, co-payments, policy limits, and restricted provider networks. Therefore comparing the average premium for different companies may be like comparing apples and oranges. Also, when looking at the percentage change in average premium from year to year, keep in mind that some employers and individuals make changes to their policies to lower their premiums and this may lower the percentage increase from year to year. Table 3: per Member Month Insurers Large Small Aetna (Aetna Health Inc. + Aetna Life Ins Co.) $386-6 $372 7 $ Anthem Health Plans of ME Inc. $465 5 $435 6 $ CIGNA Health & Life $544-9 $0 0 $0 0 Harvard Pilgrim Health Care Inc. $ $343-5 $ Maine Community Health Options $493 $367 $444 MEGA Life & Health (Mid-West National Life of Tennessee) $0 ($32) $228 Nationwide Life Ins Co. $ $0 0 $0 0 United Healthcare Ins Co. $499 8 $ $0 0 Total $447 $384 $ Nationwide Life Insurance Company data is for student policies. 2. MEGA merged into Mid-West National Life Ins. Co. of Tennessee and is in the process of withdrawing from the market. 3. Maine Community Health Options entered the market.

7 Claims Paid The total claims paid are the amount of money paid by insurance companies to health care providers and hospitals for medical services received by their members. The table below shows the amount of claims paid by insurance company and how those claims payments compare to the amount of premiums paid to the insurance company. A percentage above 100 means that the company paid more to healthcare providers than they collected in premiums from employers and individuals. On the other hand, a percentage below 100 means that the company paid less to healthcare providers than they collected in premiums. The graph following this table shows the percentage of premiums paid for claims by market segment. Table 4: Dollar Amount Spent of Claims and Percentage of Total Claims Claims Claims s Claims s Insurers Aetna Health Inc. + Aetna Life Ins Co. $114,374,114 $55,694, $58,203, $476, Anthem Health Plans of ME Inc. $832,133,133 $635,449, $122,000, $74,682, CIGNA Health & Life Ins Co. $61,959,646 $61,959, $0 0 $0 0 Harvard Pilgrim Health Care Inc. + HPHC $226,838,938 $126,150, $100,152, $535, Maine Community Health Options $126,026,864 $70, $6,233, $119,722, MEGA Life & Health (Mid-West National Life of Tennessee) $16,710,351 $0 0 $1,263,473 $15,446, Nationwide Life Ins Co. $2,296,503 $2,296, $0 0 $0 0 United Healthcare Ins Co. $11,330,241 $9,854, $1,475, $0 0 All Other Insurers $3,644,613 $2,618, $29, $996, Total $1,395,314,403 $894,095, $289,358, $211,860, Nationwide Life Insurance Company data is for student policies. 2. MEGA merged into Mid-West National Life Ins. Co. of Tennessee and is in the process of withdrawing from the market. 3. Maine Community Health Options entered the market.

8 180 Figure 9. Percent of Paid for Claims by Company and Market Segment Aetna Health Inc. + Aetna Life Ins Co. Anthem Health Plans of ME Inc. CIGNA Health & Life Ins Co. Harvard Pilgrim Health Care Inc. + HPHC Maine Community Health Options Nationwide Life Ins Co. United Healthcare Ins Co.

9 Claims per Member Month When looking at the percentage change in average claims from year to year, keep in mind that some employers and individuals make changes to their policies to lower their premiums and this may lower the percentage increase. If employers and individuals choose plans with higher deductibles or fewer benefits to minimize increases in premiums, then their claim costs will only show part of the picture of the change in their healthcare costs. Table 5: Claims per Member Month Company Large Small Aetna Health Inc. + Aetna Life Ins Co. $314 0 $287-2 $ Anthem Health Plans of ME Inc. $405 3 $ $ CIGNA Health & Life Ins Co. $ $0 0 $0 0 Harvard Pilgrim Health Care Inc. + HPHC $304-8 $292 1 $ Maine Community Health Options $216 $476 $318 MEGA Life & Health (Mid-West National Life of Tennessee) $0 $4,449 $195 Nationwide Life Ins Co. $ $0 0 $0 0 United Healthcare Ins Co. $340-3 $ $0 0 Total $379 $319 $ Nationwide Life Insurance Company data is for student policies. 2. MEGA merged into Mid-West National Life Ins. Co. of Tennessee and is in the process of withdrawing from the market. 3. Maine Community Health Options entered the market.

10 Administrative Expenses Administrative expenses include all expenses other than claims paid to healthcare providers. These expenses include things like office space, salaries, office supplies, marketing, taxes (other than federal income tax), lobbying expenses, and cost containment expenses (which reduce the amount of healthcare services provided, including utilization review, fraud detection, disease management programs, and case management). Overall, administrative expenses were lower for large groups (employers with more than 50 employees). The graph below the table shows the percentage of premiums paid for administrative expenses by market segment. Table 6: Amount of Administrative Expenses and Percentage of s Paid for Administrative Expenses Company Totals Large Small Aetna Health Inc. + Aetna Life Ins Co. $34,682,244 $16,527, $18,104, $49, Anthem Health Plans of ME Inc. $102,507,271 $65,507,761 9 $21,765, $15,234, CIGNA Health & Life Ins Co. ($795,084) ($795,084) -1 $0 0 $0 0 Harvard Pilgrim Health Care Inc. + HPHC $51,087,197 $26,137, $24,776, $173, Maine Community Health Options $34,123,089 $28, $1,144, $32,949, MEGA Life & Health (Mid-West National Life of Tennessee) $4,213,509 $0 0 $55, $4,157, Nationwide Life Ins Co. $1,199,129 $1,199, $0 0 $0 0 United Healthcare Ins Co. $3,111,463 $2,705, $405, $0 0 All other Companies $897,056 $545, $47, $303, Total $231,025,874 $111,856, $66,300, $52,868, Nationwide Life Insurance Company data is for student policies. 2. MEGA merged into Mid-West National Life Ins. Co. of Tennessee and is in the process of withdrawing from the market. 3. Maine Community Health Options entered the market.

11 35 30 Figure 10. Percentage of s Paid for Administrative Expenses Aetna Health Inc. + Anthem Health Plans CIGNA Health & Life Harvard Pilgrim Aetna Life Ins Co. of ME Inc. Ins Co. Health Care Inc HPHC Maine Community Health Options Nationwide Life Ins Co. United Healthcare Ins Co.

12 Underwriting Gain or Loss The underwriting gain or loss is the amount of premium dollars left, or the shortfall, after claims and administrative expenses are paid. A negative number (displayed in red) means that the company lost money in that particular market segment. Underwriting gain is the major component of company profits. Profits also include investment income and are reduced by federal income tax. Table 7: Underwriting Gain or Loss Company Totals Aetna Health Inc. + Aetna Life Ins Co. -$2,868, $3,755,244-5 $744,592 1 $142, Anthem Health Plans of ME Inc. $21,563,606 2 $29,178,237 4 $4,845, $12,460, CIGNA Health and Life Ins Co. $24,762, $24,760, $1,936 $0 Harvard Pilgrim Health Care Inc. + HPHC -$10,632, $3,314, $7,085,209-6 $469, Maine Community Health Options $12,107,308 7 $62, $2,578, $14,623,678 9 MEGA Life & Health (Mid-West National Life of Tennessee) -$1,239,218-7 $0 0 -$988, $250,641-1 Nationwide Life Ins Co. $1,008, $1,008, $0 0 $0 0 United Healthcare Ins Co. $1,771, $1,760, $11,299 1 $0 0 All other Companies -$741, $751, $58, $69,234 3 Total $45,732,585 3 $48,948, $5,107,552-1 $1,891, Nationwide Life Insurance Company data is for student policies. 2. MEGA merged into Mid-West National Life Ins. Co. of Tennessee and is in the process of withdrawing from the market. 3. Maine Community Health Options entered the market.

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