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Maine.gov > PFR Home > Insurance Regulation > Bureau Reports>  Financial Results for Health Insurance Companies in Maine

2012 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)
  • Individual (those who buy their own health insurance)

The summaries below show information for each of Maine’s largest health insurers (those companies that have at least $2 million of health insurance premium in Maine). The “All Other Companies” category includes aggregate data (except for enrollment and per member per month data) for companies with less than $2 million of premium. The following information is shown:

  • The number of people enrolled
  • Premiums (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)

People Enrolled

Table 1. 2012 Enrollees as of December 31, 2012
  Totals Large Group Small Group Individual
Insurers 2012 Change
%
2012 Change
%
2012 Change
%
2012 Change
%
Aetna Health Inc + Aetna Life Ins Co 40,425 -9% 17,608 -2% 22,773 -14% 44 16%
Anthem Health Plans of ME Inc 195,186 -4% 133,314 -4% 45,123 -5% 16,749 3%
Commercial Travelers 13,619 NA 13,619 NA 0 NA 0 NA
Connecticut General Life Ins Co + CIGNA Health & Life Ins Co 34,023 NA 34,010 NA 7 NA 6 NA
Harvard Pilgrim Health Care Inc. and HPHC 46,485 5% 23,372 6% 19,513 15% 3,600 -27%
Mega Life & Health Ins Co 12,877 -7% 0 0% 1,127 -17% 11,750 -6%
Nationwide Life Ins Co 2,734 -49% 2,734 -49% 0 0% 0 0%  
United Healthcare Ins Co 2,825 11% 2,238 12% 587 6% 0 0%
Total 348,174 NA 226,895 NA 89,130 NA 32,149 -5%

Notes: 1. Small Group and Individual columns include the DirigoChoice product. This product is sold through Harvard Pilgrim. 2. Only Long form filers provide Enrollee data. 3. NA stands for Not Available. 4. Commercial Travelers and Nationwide Life Ins Co data is for student policies.

Percent of Enrollees by Company

Large Group Enrollees Small Group Enrollees
Individual Enrollees Total Enrollees

 

Premiums

Table 2. 2012 Premium
  Totals Large Group Small Group Individual
Insurers 12/31/2012 Change
%
12/31/2012 Change
%
12/31/2012 Change
%
12/31/2012 Change
%
Aetna Health Inc + Aetna Life Ins Co $187,978,781 4% $92,021,388 7% $95,749,102 1% $208,291 21%
Anthem Health Plans of ME Inc $964,098,685 0% $696,161,731 1% $210,187,959 -2% $57,748,995 -8%
Commercial Travelers $2,003,509 37% $2,003,509731 47% $0 -100% $0 0%
Connecticut General Life Ins Co + CIGNA Health & Life Ins Co $145,139,279 -8% $145,044,827 -8% $62,098 -74% $32,354 -20%
Harvard Pilgrim Health Care Inc. and HPHC $230,173,005 2% $113,736,870 1% $83,301,276 11% $33,134,859 -12%
Mega Life & Health Ins Co $34,774,332 -3% $0 0% $2,800,316 -9% $31,134,859 -2%
Nationwide Life Ins Co $4,165,802 -10% $4,165,802 -10% $0 0% $0 0%
United Healthcare Ins Co $15,105,466 9% $12,150,235 11% $2,955,231 6% $0 0%
All Other Companies $5,998,564 -27% $2,653,611 -21% $410,048 -75% $2,934,905 -42%
Totals: $1,589,437,423 0% $1,067,937,973 4% $395,466,030 1% $126,033,420 -9%

Premiums are the dollars paid by employers and employees and by individuals for insurance coverage.
Notes: 1. Small Group and Individual include the DirigoChoice product. This product is sold through Harvard Pilgrim. 2. Commercial Travelers and Nationwide Life Ins Co data is for student policies.

Premiums by Market Segment

Premiums for Aetna Health Inc and Aetna Life Ins Co Premiums for Anthem Health Plans of ME Inc
Premiums for Connecticut General Premiums for Harvard Pilgrim and HPHC
Premiums for Mega Life and Health Ins Co Premiums for Nationwide Life
Premiums for United Healthcare Ins Co Premiums for All Other Companies
Premiums for All Other Companies  

 

Premium 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. 2012 Premium Per Member Month
  Large Group Small Group Individual
  2012 Change
%
2012 Change
%
2012 Change
%
Aetna (Aetna Health Inc + Aetna Life Ins Co) $428 5% $318 8% $446 18%
Anthem Health Plans of ME Inc $432 5% $389 4% $294 -5%
Commercial Travelers $36 NA $0 0% $0 0%
Connecticut General Life Ins Co + CIGNA Health & Life $456 NA $675 NA $449 NA
Harvard Pilgrim Health Care Inc. & HPHC $418 3% $402 0% $645 3%
Mega Life & Health Ins Co $0 0% $194 7% $225 2%
Nationwide Life Ins Co $125 -38% $0 0% $0 0%
United Healthcare Ins Co $452 0% $437 -1% $0 0%
Total $431 NA $370 NA $322 NA

Notes: 1. The average premium is calculated by dividing the premium in Table 2 by the number of member months.2. Small Group and Individual include the DirigoChoice product. This product is sold through Harvard Pilgrim. 3. NA stands for not available. 4. Commercial Travelers and Nationwide Life Ins Co data is for student policies.


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. 2012 Dollar Amount Spent on Claims and Percentage of Premium
  Totals Large Group Small Group Individual
Insurers 2012 Claims 2012 Claims % of
Premium
2012 Claims % of
Premium
2012 Claims % of
Premium
Aetna Health & Aetna Life $151,362,934 $71,731,619 78% $78,635,631 82% $995,684 478%
Anthem $831,900,171 $612,946,537 88% $173,141,428 82% $45,812,206 79%
Commercial Travelers $1,310,405 $1,310,405 65% $0 0% $0 0%
Connecticut General & CIGNA Health and Life $110,622,402 $110,622,402 76% $68,272 110% $51,805 160%
Harvard Pilgrim & HPHC $184,767,022 $94,848,878 83% $60,609,700 73% $29,308,444 88%
Mega $27,426,565 $0 0% $3,435,838 123% $23,990,727 75%
Nationwide Life Ins Co $3,818,752 $3,818,752 92% $0 0% $0 0%
United Healthcare $11,377,245 $9,418,439 78% $1,958,806 66% $0 0%
All Other Insurers $4,759,040 $2,056,535 77% $544,163 133% $2,158,342 74%
Total $1,327,344,536 $906,633,490 85% $318,393,838 81% $102,317,208 81%

Notes: 1. Small Group and Individual include the DirigoChoice product. This product is sold through Harvard Pilgrim. 2. Commercial Travelers and Nationwide Life Ins Co data is for student policies.

Percent of Premium Paid for Claims

 

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. 2012 Claims Per Member Month
  Large Group Small Group Individual
  2012 % Change 2012 % Change 2012 % Change
Aetna Health + Aetna Life $334 -2% $261 2% $2,132 30%
Anthem Health Plans of ME Inc $380 5% $320 4% $233 -17%
Commercial Travelers $24 NA $0 0% $0 0%
Connecticut General & CIGNA Health & Life $348 NA $742 NA $720 NA
Harvard Pilgrim & HPHC $348 0% $292 -14% $571 -2%
Mega Life & Health Ins Co $0 0% $238 38% $169 10%
Nationwide Life Ins Co $114 9% $0 0% $0 0%
United Healthcare Ins Co $350 -2% $290 -2% $0 0%
Total $366 NA $298 NA $262 NA

Notes: 1. The average monthly claims are calculated by dividing the dollar amount spent on claims in Table 4 by the number of member months. 2. Small Group and Individual include the DirigoChoice product. This product is sold through Harvard Pilgrim. 3. NA stands for not available. 4. Commercial Travelers and Nationwide Life Ins Co data is for student policies.

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. 2012 Amount for Administrative Expenses and Percentage of Premiums Paid for Administrative Expenses
  Totals Large Group Small Group Individual
  2012 2012 % of
Premium
2012 % of
Premium
2012 % of
Premium
Aetna Health & Aetna Life $60,550,288 $27,745,406 30% $32,771,788 34% $33,094 16%
Anthem $89,391,585 $54,672,078 8% $26,959,412 13% $7,760,095 13%
Commercial Travelers $681,375 $681,375 34% $0 0% $0 0%
Connecticut General & CIGNA Health and Life $20,928,104 $20,906,659 14% $16,055 26% $5,390 17%
Harvard Pilgrim & HPHC $41,161,218 $19,686,285 17% $17,093,014 21% $4,381,919 13%
Mega $10,266,187 $0 0% $873,655 31% $9,392,532 29%
Nationwide Life Ins Co $1,233,756 $1,233,756 30% $0 0% $0 0%
United Healthcare $3,074,922 $2,397,639 20% $677,283 23% $0 0%
All other Companies $970,812 $212,361 8% $121,379 28% $637,072 22%
Total $228,258,247 $127,535,559 12% $78,512,586 20% $22,210,102 18%

Notes: 1. Small Group and Individual include the DirigoChoice product. This product is sold through Harvard Pilgrim. 2. Commercial Travelers and Nationwide Life Ins Co data is for student policies.

Percentage of Premiums Paid for Administrative Expenses

 

Underwriting Gain/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. 2012 Underwriting Gain/Loss
  Totals Large Group Small Group Individual
  2012 % of
Premium
2012 % of
Premium
2012 % of
Premium
2012 % of
Premium
Aetna Health & Aetna Life -$23,858,745 -13% -$7,455,637 -8% -$15,658,317 -16% -$744,791 -358%
Anthem Health Plans of ME Inc. $42,806,929 4% $28,543,116 4% $10,087,119 5% $4,176,694 7%
Commercial Travelers $11,729 1% $11,729 1% $0 0% $0 0%
Connecticut General & CIGNA Health & Life $13,588,773 9% $13,635,002 9% -$22,229 -36% -$24,841 -77%
Harvard Pilgrim & HPHC $4,244,765 2% -$798,293 -1% $5,598,562 7% -$555,504 -2%
Mega Life & Health Insurance Co. -$1,916,732 -6% $0 0% -$1,505,512 -54% -$411,220 -1%
Nationwide Life Ins Co -$548,205 -13% -$548,205 -13% $0 0% $0 0%
United Healthcare Insurance Co. $484,010 3% 192,095 2% $291,915 10% $0 0%
All other Companies $695,095 12% $412,174 16% -$255,495 -62% $538,416 18%
Total $35,507,619 2% $33,992,822 3% -$1,463,957 0% $2,978,754 2%

Notes: 1. Small Group and Individual include the DirigoChoice product. This product is sold through Harvard Pilgrim. 2. Commercial Travelers and Nationwide Life Ins Co data is for student policies.

For More Information:

These summaries are based on more detailed tables which can be viewed at http://www.maine.gov/pfr/insurance/consumer/financial_results_health_insurers_formula_version.htm.

The reports from the largest health insurers can be viewed at http://www.maine.gov/pfr/insurance/reports/rule945reports.htm.

 

 

Last Updated: December 16, 2013