2011 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. 2011 Enrollees as of December 31, 2011
	Totals		Large Group		Small Group		Individual
Insurers	2011	Change %	2011	Change %	2011	Change %	2011	Change %
Aetna Health Inc + Aetna Life Ins Co	44,324	-10%	17,889	2%	26,397	-17%	38	-16%
Anthem Health Plans of ME Inc	203,249	-1%	139,402	1%	47,614	-6%	16,233	-7%
Connecticut General Life Ins Co	27,493	3%	27,475	3%	14	-48%	4	-33%
Harvard Pilgrim Health Care Inc. and HPHC	44,072	8%	22,127	-2%	17,021	28%	4,924	-1%
Mega Life & Health Ins Co	13,864	-5%			1,351	-13%	12,513	-4%
Nationwide Life Ins Co	5,400	332%	5,400	332%
United Healthcare Ins Co	2,549	41%	1,995	30%	554	95%
Total	340,951	0%	214,288	3%	92,951	-5%	33,712	-5%

Note: Small Group and Individual include the DirigoChoice product. This product was sold through Anthem in 2007 and moved to Harvard Pilgrim in 2008.

Percent of Enrollees by Company

Premiums

Table 2. 2011 Premium
	Totals		Large Group		Small Group		Individual
Insurers	12/31/2011	Change %	12/31/2011	Change %	12/31/2011	Change %	12/31/2011	Change %
Aetna Health Inc + Aetna Life Ins Co	$180,904,186	-19%	$85,739,529	-9%	$94,993,008	0%	$171,649	20%
Anthem Health Plans of ME Inc	$967,390,702	2%	$690,275,486	3%	$214,557,142	2%	$62,558,074	1%
Connecticut General Life Ins Co	$157,450,379	10%	$157,263,147	2%	$146,770	2%	$40,462	1%
Harvard Pilgrim Health Care Inc. and HPHC	$225,239,886	21%	$112,837,016	32%	$74,791,858	29%	$37,611,012	-2%
Mega Life & Health Ins Co	$35,865,880	5%			$3,086,969	-15%	$32,778,911	8%
Nationwide Life Ins Co	$4,614,934	55%	$4,614,934
United Healthcare Ins Co	$13,707,434	35%	$10,906,618	18%	$2,800,816	100%
All Other Companies	$11,590,255	-60%	$4,743,687	-16%	$1,746,406	-33%	$5,100,162	-41%
Totals:	$1,596,763,656	1%	$1,030,689,069	3%	$392,122,969	2%	$138,260,270	-2%

Premiums are the dollars paid by employers and employees and by individuals for insurance coverage.
Note: Small Group and Individual include the DirigoChoice product. This product was sold through Anthem in 2007 and moved to Harvard Pilgrim in 2008.

Premiums by Market Segment

Average Monthly Premium per Person

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. 2011 Average Monthly Premium per Person
	Large Group		Small Group		Individual
	2011	Change %	2011	Change %	2011	Change %
Aetna (Aetna Health Inc + Aetna Life Ins Co)	$410	0%	$294	-3%	$376	-7%
Anthem Health Plans of ME Inc	$413	2%	$374	3%	$311	11%
Connecticut General Life Ins Co	$470	5%	$503	22%	$920	65%
Harvard Pilgrim Health Care Inc.	$406	6%	$403	-4%	$626	2%
Mega Life & Health Ins Co			$181	-7%	$220	-3%
Nationwide Life Ins Co	$200	-81%
United Healthcare Ins Co	$452	-10%	$440	6%
Total	$420	2%	$355	2%	$336	1%

Note: The average premium is calculated by dividing the premium in Table 2 by the number of member months.

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. 2011 Dollar Amount Spent on Claims and Percentage of Premium
	Totals	Large Group		Small Group		Individual
Insurers	2011 Claims	2011 Claims	% of Premium	2011 Claims	% of Premium	2011 Claims	% of Premium
Aetna	$154,226,054	$70,920,629	83%	$82,555,166	87%	$750,259	437%
Anthem	$838,699,907	$605,470,861	88%	$176,996,063	82%	$56,232,983	90%
Connecticut General	$121,254,565	$121,153,521	77%	$74,379	51%	$26,665	66%
Harvard	$194,291,919	$96,512,207	86%	$62,889,374	84%	$34,890,338	93%
Mega	$25,845,410			$2,931,468	95%	$22,913,942	70%
Nationwide Life Ins Co	$849,383	$849,383	18%
United Healthcare	$10,500,104	$8,623,315	79%	$1,876,789	67%
All Other Insurers	$6,708,070	$3,250,413	69%	$958,288	55%	$2,499,369	49%
Total	$1,352,375,412	$906,780,329	85%	$328,281,527	84%	$117,313,556	85%

Note: Small Group and Individual include the DirigoChoice product. This product was sold through Anthem in 2007 and moved to Harvard Pilgrim in 2008.

Percent of Premium Paid for Claims

Average Monthly Claims per Person

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. 2011 Average Monthly Claims per Person
	Large Group		Small Group		Individual
	2011	% Change	2011	% Change	2011	% Change
Aetna (Aetna Health Inc + Aetna Life Ins Co)	$339	-1%	$256	-4%	$1,645	160%
Anthem Health Plans of ME Inc	$362	1%	$309	5%	$279	13%
Connecticut General Life Ins Co	$362	2%	$255	-3%	$606	-7%
Harvard Pilgrim Health Care Inc.	$347	3%	$339	0%	$581	15%
Mega Life & Health Ins Co			$172	25%	$154	10%
Nationwide Life Ins Co	$37	-90%
United Healthcare Ins Co	$357	-10%	$295	15%
Total	$357	0%	$297	3%	$285	10%

Note: The average monthly claims are calculated by dividing the dollar amount spent on claims in Table 4 by the number of member months.

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. 2011 Amount for Administrative Expenses and Percentage of Premiums Paid for Administrative Expenses
	Totals	Large Group		Small Group		Individual
	2011	2011	% of Premium	2011	% of Premium	2011	% of Premium
Aetna	$58,236,405	$22,025,885	26%	$36,181,508	38%	$29,012	17%
Anthem	$83,304,484	$49,413,194	7%	$27,017,058	13%	$6,874,232	11%
Connecticut General	$12,755,483	$12,740,624	8%	$11,790	8%	$3,069	8%
Harvard	$31,532,993	$16,710,926	15%	$9,425,936	13%	$5,396,131	14%
Mega	$10,238,591			$962,452	31%	$9,276,139	28%
Nationwide Life Ins Co	$1,422,844	$1,422,844	31%
United Healthcare	$3,259,490	$2,499,049	23%	$760,441	27%
All other Companies	$2,127,122	$572,319	12%	$572,665	33%	$982,138	19%
Total	$202,877,412	$105,384,841	10%	$74,931,850	19%	$22,560,721	16%

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. 2011 Underwriting Gain/Loss
	Totals		Large Group		Small Group		Individual
	2011	% of Premium	2011	% of Premium	2011	% of Premium	2011	% of Premium
Aetna	-$31,681,161	-18%	-$7,206,985	-8%	-$23,743,666	-25%	-$730,510	-426%
Anthem Health Plans of ME Inc.	$45,386,301	5%	$35,391,431	5%	$10,544,021	5%	-$549,151	-1%
Connecticut General	$23,440,331	15%	$23,369,002	15%	$60,601	41%	$10,728	27%
Harvard Pilgrim Health Care Inc.	-$585,026	0%	-$386,117	0%	$2,476,548	3%	-$2,675,457	-7%
Mega Life & Health Insurance Co.	-$1,063,388	-3%			-$776,935	-25%	-$286,453	-1%
Nationwide Life Ins Co	$1,109,816	24%	$1,109,816	24%
United Healthcare Insurance Co.	-$214,625	-2%	-$350,445	-3%	$135,820	5%
All other Companies	$2,677,875	23%	$801,522	17%	$231,065	13%	$1,645,288	32%
Total	$39,070,123	2%	$52,728,224	5%	-$11,072,546	-3%	-$2,585,555	-2%

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/consumer/rule945reports.htm.