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

2013 Financial Results for Health Insurance Companies in Maine
(Detailed version)

The following tables show Maine data reported by leading health insurers and health maintenance organizations (HMOs) that provide medical expense insurance in Maine. Data is shown separately for each of three market segments: Large Group (employers with more than 50 employees), Small Group (employers with 50 or fewer employees), and Individual (people who are not covered by an employer plan and buy coverage directly). The data does not include stop loss, accidental injury, specified disease, hospital indemnity, Medicare Supplement, disability income, long-term care or other limited benefit coverage. In some cases, companies in the same insurance group are presented together in one table. Grand totals are shown for each market segment and they include information for Long form filers and for Short form filers (those with smaller premium volume). However, the "Grand Totals" exclude the following data for Short form filers because they are not required to report it: Number of Covered Lives, Number of Member Months during the Year, Number of Contracts Issued during the Year, and Number of Contracts Issued during the Year Covering Policyholders that were Uninsured for the Prior 90 Days. While the Bureau checks this data for consistency with other reported information, we cannot vouch for the accuracy of the data.

Here is a list of the items contained in the tables below along with a description of the items:

(1) Number of Covered Lives, Dec. 31: This is the number of people (including dependents) who were covered as of the end of the year.

(2) Member Months during Year: This the sum of the number of people covered during each month during the year. One person covered for the whole year represents 12 member months.

(3) Number of Contracts issued in 2013: This is the number of individual or group policies issued during the year and still in force at the end of the year.

(4) Number of contracts issued in 2013 covering policyholders who were uninsured for the prior 90 days: This is the number of individual policies issued to previously uninsured individuals and the number issued to small groups that did not have a previous health plan in the prior 90 days. Some carriers were unable to report this data.

(5) Premiums Earned: This is the amount paid for coverage during the year regardless of when it was paid. For example, premiums paid in December 2012 for coverage in January 2013 are included in 2013 premiums earned but premiums paid in December 2013 for coverage in January 2014 are not included.

(6) Claims Incurred: This is the amount paid for medical services provided during the year regardless of when it was paid. For example, claims paid in January 2013 for services provided in December 2012 are included in 2012 claims incurred but claims paid in January 2014 for services provided in December 2013 are included in 2013 claims incurred. Claims incurred are also shown as a percentage of premium. This is commonly called the “loss ratio” and is sometimes considered a measure of how good a value is received for the premium paid. However, it can be misleading. For example, an insurer that has healthier policyholders, on average, than another insurer may have a lower loss ratio even though it may charge less for similar coverage. Also, if the volume of business is small, experience is subject to random fluctuations.

(7) Increase in Policy Reserves: Policy reserves are held when future premiums are not expected to be sufficient to cover future claims. For example, some types of insurance policies have premiums based on the age when the policy was issued. Even though claims are expected to increase as the person ages, the premiums will not reflect this, so part of the premium in the early years is held in a reserve to cover later claims. This is generally not the case for medical expense insurance and therefore policy reserves are generally not a significant item.

(8) Administrative Expenses: This includes all expenses reported on the companies’ annual financial statement other than claims. Administrative expenses include office space, salaries, utilities, postage, office supplies, commissions, marketing, advertising, cost containment expenses, lobbying expenses, taxes (other than federal income tax), and other expenses. Cost containment expenses are expenses that reduce the amount of health care services provided, including utilization review, fraud prevention and detection, provider contracting, provider network development, smoking cessation programs, disease management programs, and case management.

(9) Underwriting Gain or (Loss): This is the amount of premium left over (or the shortfall) after claims and administrative expenses are paid and any needed increase is added to policy reserves. Underwriting gain differs somewhat from “profit” in that it does not reflect certain items, primarily income from investments, capital gains and losses, and federal income taxes.

(10) Premium per Member Month: This is the average monthly premium per person. It should be noted that policies vary widely with respect to features such as deductibles, copayments, policy limits, and restricted provider networks. Therefore comparing the average premium for different companies, products or market segments may be comparing “apples and oranges.” Also shown is the percentage increase (or decrease) from the prior year’s average premium. Here again, the comparison may reflect differing benefit levels. As rates increase, some employers and individuals increase their deductible or make other modifications to their policies in order to reduce the amount of the increase.

(11) Claims per Member Month: This is the average amount of monthly claims per person. Also shown is the percentage increase (or decrease) from the prior year’s average claims. The notes above concerning premium per member month apply equally here. The actual trend in health care costs may be more than the trend in claims because the claims trend may reflect a reduction in benefit levels such as an increased deductible.

The Annual Report Supplements (945 Reports) for Maine’s larger insurers is available on the Bureau of Insurance website. Here is the link: http://www.maine.gov/pfr/insurance/reports/rule945reports.htm.


Large Group
Aetna (Aetna Health Inc + Aetna Life Ins Co)
Insurer 2013 2012 2011
Amount % of
Premium
Amount % of
Premium
Amount % of
Premium
(1) Number of Covered Lives, Dec. 31 14,025   17,608   17,889  
(2) Member Months During Year 170,326   214,974   209,348  
(3) Number of Contracts issued during year 4   27   11  
(4) Number of contracts issued during year covering policyholders that were uninsured for the prior 90 days NA   NA   NA  
(5) Premiums Earned $69,775,934 100% $92,021,388 100% $85,739,529 100%
(6) Claims Incurred $53,345,488 76% $71,731,619 78% $70,920,629 83%
(7) Increase in Policy Reserves $0 0% $0 0% $0 0%
(8) Administrative Expenses $21,645,372 31% $27,745,406 30% $22,025,885 26%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)] -$5,214,926 -7% -$7,455,637 -8% -$7,206,985 -8%
(10a) Premium per Member Month [(5)/(2)] $410   $428   $410  
(10b) Premium Trend [(10a)/(10a prior year)-1] -4%   5%   0%  
(11a) Claims per Member Month [(6)/(2)] $313   $334   $339  
(11b) Claims Trend [(11a)/(11a prior year)-1] -6%   -2%   -1%  
Source: Rule Chapter 945 Long Form Large Group Totals

 

Large Group
Anthem Health Plans of ME Inc
Insurer 2013 2012 2011
Amount % of
Premium
Amount % of
Premium
Amount % of
Premium
(1) Number of Covered Lives, Dec. 31 137,626   133,314   139,402  
(2) Member Months During Year 1,594,287   1,612,164   1,671,071  
(3) Number of Contracts issued during year 0   0   0  
(4) Number of contracts issued during year covering policyholders that were uninsured for the prior 90 days NA   NA   NA  
(5) Premiums Earned $707,728,862 100% $696,161,731 100% $690,275,486 100%
(6) Claims Incurred $629,266,615 89% $612,946,537 88% $605,470,861 88%
(7) Increase in Policy Reserves $0 0% $0 0% $0 0%
(8) Administrative Expenses $55,771,229 8% $54,672,078 8% $49,413,194 7%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)] $22,691,018 3% $28,543,116 4% $35,391,431 5%
(10a) Premium per Member Month [(5)/(2)] $444   $432   $413  
(10b) Premium Trend [(10a)/(10a prior year)-1] 3%   5%   2%  
(11a) Claims per Member Month [(6)/(2)] $395   $380   $362  
(11b) Claims Trend [(11a)/(11a prior year)-1] 4%   5%   1%  
Source: Rule Chapter 945 Long Form Large Group Totals

 

Large Group
Connecticut General Life Ins Co & CIGNA Health & Life Ins Co
Insurer 2013 2012 2011
Amount % of
Premium
Amount % of
Premium
Amount % of
Premium
(1) Number of Covered Lives, Dec. 31 27,824   34,010   27,475  
(2) Member Months During Year 330,483   317,821   334,446  
(3) Number of Contracts issued during year 0   1   41  
(4) Number of contracts issued during year covering policyholders that were uninsured for the prior 90 days NA   NA   NA  
(5) Premiums Earned $166,110,629 100% $145,044,827 100% $157,263,147 100%
(6) Claims Incurred $126,681,996 76% $110,502,325 76% $121,153,521 77%
(7) Increase in Policy Reserves $0 0% $0 0% $0 0%
(8) Administrative Expenses $14,040,653 8% $20,906,659 14% $12,740,624 8%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)] $253,387,980 15% $13,635,843 9% $23,369,002 15%
(10a) Premium per Member Month [(5)/(2)] $503   $456   $470  
(10b) Premium Trend [(10a)/(10a prior year)-1] 10%   -3%   5%  
(11a) Claims per Member Month [(6)/(2)] $383   $348   $362  
(11b) Claims Trend [(11a)/(11a prior year)-1] 10%   -4%   2%  
Source: Rule Chapter 945 Long Form Large Group Totals

 

Large Group
Harvard Pilgrim (Includes Harvard Pilgrim Health Care Inc. & HPHC Insurance Company
Insurer 2013 2012 2011
Amount % of
Premium
Amount % of
Premium
Amount % of
Premium
(1) Number of Covered Lives, Dec. 31 29,878   23,372   22,127  
(2) Member Months During Year 338,655   272,307   277,744  
(3) Number of Contracts issued during year 244   158   237  
(4) Number of contracts issued during year covering policyholders that were uninsured for the prior 90 days NA   NA   NA  
(5) Premiums Earned $136,020,546 100% $113,736,870 100% $112,837,016 100%
(6) Claims Incurred $111,644,641 82% $94,848,878 83% $96,512,207 86%
(7) Increase in Policy Reserves $0 0% $0 0% $0 0%
(8) Administrative Expenses $22,243,741 16% $19,686,285 17% $16,710,926 15%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)] $2,132,164 2% -$798,293 -1% -$386,117 0%
(10a) Premium per Member Month [(5)/(2)] $402   $418   $406  
(10b) Premium Trend [(10a)/(10a prior year)-1] -4%   3%   6%  
(11a) Claims per Member Month [(6)/(2)] $330   $348   $347  
(11b) Claims Trend [(11a)/(11a prior year)-1] -5%   0%   3%  

Source: Rule Chapter 945 Long Form Large Group Totals

 

Large Group
Nationwide Life Ins Co
Insurer 2013 2012 2011
Amount % of
Premium
Amount % of
Premium
Amount % of
Premium
(1) Number of Covered Lives, Dec. 31 1,483   2,734   5,400  
(2) Member Months During Year 15,508   33,361   23,086  
(3) Number of Contracts issued during year 0   0   0  
(4) Number of contracts issued during year covering policyholders that were uninsured for the prior 90 days NA   NA   NA  
(5) Premiums Earned $4,876,032 100% $4,165,802 100% $4,614,934 100%
(6) Claims Incurred $3,341,863 69% $3,818,752 92% $2,422,016 52%
(7) Increase in Policy Reserves 685,676 14% -$338,501 -8% $1,232,891 27%
(8) Administrative Expenses $1,239,672 25% $1,233,756 30% $1,422,844 31%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)] -$391,179 -8% -$548,205 -13% -$462,817 -10%
(10a) Premium per Member Month [(5)/(2)] $314   $125   $200  
(10b) Premium Trend [(10a)/(10a prior year)-1] 152%   -38%   -81%  
(11a) Claims per Member Month [(6)/(2)] $215   $114   $105  
(11b) Claims Trend [(11a)/(11a prior year)-1] 88%   9%   -78%  
Source: Rule Chapter 945 Long Form Large Group Totals. Data is for student policies.

 

Large Group
United Healthcare Ins Co
Insurer 2013 2012 2011
Amount % of
Premium
Amount % of
Premium
Amount % of
Premium
(1) Number of Covered Lives, Dec. 31 2,523   2,238   1,995  
(2) Member Months During Year 29,141   26,874   24,146  
(3) Number of Contracts issued during year 36   1   0  
(4) Number of contracts issued during year covering policyholders that were uninsured for the prior 90 days NA   NA   NA  
(5) Premiums Earned $13,432,698 100% $12,150,235 100% $10,906,618 100%
(6) Claims Incurred $10,208,610 76% $9,418,439 78% $8,623,315 79%
(7) Increase in Policy Reserves $153,962 1% $142,063 1% $134,699 1%
(8) Administrative Expenses $2,648,683 20% $2,397,639 20% $2,499,049 23%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)] $421,443 3% $192,094 2% -$350,445 -3%
(10a) Premium per Member Month [(5)/(2)] $461   $452   $452  
(10b) Premium Trend [(10a)/(10a prior year)-1] 2%   0%   -10%  
(11a) Claims per Member Month [(6)/(2)] $350   $350   $357  
(11b) Claims Trend [(11a)/(11a prior year)-1] 0%   -2%   -10%  
Source: Rule Chapter 945 Long Form Large Group Totals

 

Large Group Grand Totals (Includes Long Form Filers Displayed Above and Short Form Filers with Smaller Premium Volume)
Insurer 2013 2012 2011
Amount % of
Premium
Amount % of
Premium
Amount % of
Premium
(1) Number of Covered Lives, Dec. 31 213,359   213,276   214,288  
(2) Member Months During Year 2,478,400   2,477,501   2,539,841  
(3) Number of Contracts issued during year 284   187   289  
(4) Number of contracts issued during year covering policyholders that were uninsured for the prior 90 days NA   NA   NA  
(5) Premiums Earned $1,102,965,126 100% $1,067,937,973 100% $1,066,380,416 100%
(6) Claims Incurred $938,533,675 85% $906,633,490 85% $908,352,962 85%
(7) Increase in Policy Reserves $1,713,038 0% $1,487,022 0%
(8) Administrative Expenses $118,434,748 11% $127,535,559 12% $105,384,841 10%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)] $44,283,665 4% $33,992,821 3% $51,155,591 5%
(10a) Premium per Member Month [(5)/(2)] $445   $431   $420  
(10b) Premium Trend [(10a)/(10a prior year)-1] 3%   3%   2%  
(11a) Claims per Member Month [(6)/(2)] $379   $366   $358  
(11b) Claims Trend [(11a)/(11a prior year)-1] 3%   2%   0%  

Source: Rule Chapter 945 Aggregate Totals for Long Form Large Group and Short Form Large Group
Note: The Number of Covered Lives, Number of Member Months, and the Contracts Issued totals do not include data for companies filing the Short Form (i.e., reporting less than $2 million in premium). Short Form filers are not required to report those figures.

 

Small Group
Aetna (Aetna Health Inc + Aetna Life Ins Co)
Insurer 2013 2012 2011
Amount % of
Premium
Amount % of
Premium
Amount % of
Premium
(1) Number of Covered Lives, Dec. 31 17,625   22,773   26,397  
(2) Member Months During Year 200,563   300,868   322,921  
(3) Number of Contracts issued during year 334   285   354  
(4) Number of contracts issued during year covering policyholders that were uninsured for the prior 90 days 114   130   94  
(5) Premiums Earned $69,811,867 100% $95,749,102 100% $94,993,008 100%
(6) Claims Incurred $58,685,782 84% $78,635,631 82% $82,555,166 87%
(7) Increase in Policy Reserves 1,745,686 3% 0 0% $0 0%
(8) Administrative Expenses $18,181,281 26% $32,771,788 34% $36,181,508 38%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)] -8,800,882 -13% -15,658,317 -16% -$23,743,666
-25%
(10a) Premium per Member Month [(5)/(2)] $348   $318   $294  
(10b) Premium Trend [(10a)/(10a prior year)-1] 9%   8%   -3%  
(11a) Claims per Member Month [(6)/(2)] $293   $261   $256  
(11b) Claims Trend [(11a)/(11a prior year)-1] 12%   2%   -4%  
Source: Rule Chapter 945 Long Form Small Group and Dirigo Small Group Totals.

 

Small Group
Anthem Health Plans of ME Inc
Insurer 2013 2012 2011
Amount % of
Premium
Amount % of
Premium
Amount % of
Premium
(1) Number of Covered Lives, Dec. 31 33,390   45,123   47,614  
(2) Member Months During Year 437,475   540,481   573,108  
(3) Number of Contracts issued during year 1,507   2,377   2,954  
(4) Number of contracts issued during year covering policyholders that were uninsured for the prior 90 days 423   666   440  
(5) Premiums Earned $179,718,804 100% $210,187,959 100% $214,557,142 100%
(6) Claims Incurred $141,967,970 79% $173,141,428 82% $176,996,063 82%
(7) Increase in Policy Reserves $0 0% $0 0% $0 0%
(8) Administrative Expenses $23,613,098 13% $26,959,412 13% $27,017,058 13%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)] $14,137,736 8% $10,087,119 5% $10,544,021 5%
(10a) Premium per Member Month [(5)/(2)] $411   $389   $374  
(10b) Premium Trend [(10a)/(10a prior year)-1] 6%   4%   3%  
(11a) Claims per Member Month [(6)/(2)] $325   $320   $309  
(11b) Claims Trend [(11a)/(11a prior year)-1] 1%   4%   5%  
Source: Rule Chapter 945 Long Form Small Group and Dirigo Small Group Totals.

 

Small Group
Connecticut General Life Ins Co & CIGNA Health and Life Ins Co
Insurer 2013 2012 2011
Amount % of
Premium
Amount % of
Premium
Amount % of
Premium
(1) Number of Covered Lives, Dec. 31 14   7   14  
(2) Member Months During Year 243   92   292  
(3) Number of Contracts issued during year 0   0   1  
(4) Number of contracts issued during year covering policyholders that were uninsured for the prior 90 days 0   0   0  
(5) Premiums Earned $178,311 100% $62,098 100% $146,770 100%
(6) Claims Incurred $121,053 68% $68,272 110% $74,379 51%
(7) Increase in Policy Reserves $0 0% $0 0% $0 0%
(8) Administrative Expenses $11,945 7% $16,055 26% $11,790 8%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)] 45,313 25% -$22,229 -36% $60,601 41%
(10a) Premium per Member Month [(5)/(2)] $734   $675   $503  
(10b) Premium Trend [(10a)/(10a prior year)-1] 9%   34%   22%  
(11a) Claims per Member Month [(6)/(2)] $498   $742   $255  
(11b) Claims Trend [(11a)/(11a prior year)-1] -33%   191%   -3%  
Source: Rule Chapter 945 Long Form Small Group and Dirigo Small Group Totals.

 

Small Group
Harvard Pilgrim Health Care (Includes Harvard Pilgrim Health Care Inc. & HPHC Insurance Company
Insurer 2013 2012 2011
Amount % of
Premium
Amount % of
Premium
Amount % of
Premium
(1) Number of Covered Lives, Dec. 31 29,997   19,513   17,021  
(2) Member Months During Year 341,187   207,284   185,740  
(3) Number of Contracts issued during year 2,007   1,308   1,437  
(4) Number of contracts issued during year covering policyholders that were uninsured for the prior 90 days 119   24   22  
(5) Premiums Earned $123,184,756 100% $83,301,276 100% $74,791,858 100%
(6) Claims Incurred 98,503,519 80% 60,609,700 73% $62,889,374 84%
(7) Increase in Policy Reserves 0 0% 0 0% $0 0%
(8) Administrative Expenses 24,489,980 20% 17,093,014 21% $9,425,936 13%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)] $191,257 0% $5,598,562 7% $2,476,548 3%
(10a) Premium per Member Month [(5)/(2)] $361   $402   $403  
(10b) Premium Trend [(10a)/(10a prior year)-1] -10%   0%   -4%  
(11a) Claims per Member Month [(6)/(2)] $289   $292   $339  
(11b) Claims Trend [(11a)/(11a prior year)-1] -1%   -14%   0%  
Source: Rule Chapter 945 Long Form Small Group and Dirigo Small Group Totals.

 

Small Group
Mega Life & Health Ins Co
Insurer 2013 2012 2011
Amount % of
Premium
Amount % of
Premium
Amount % of
Premium
(1) Number of Covered Lives, Dec. 31 877   1,127   1,351  
(2) Member Months During Year 11,855   14,464   17,072  
(3) Number of Contracts issued during year 0   1   1  
(4) Number of contracts issued during year covering policyholders that were uninsured for the prior 90 days 0   0   0  
(5) Premiums Earned $2,392,181 100% $2,800,316 100% $3,086,969 100%
(6) Claims Incurred $1,998,997 84% $3,435,838 123% $2,931,468 95%
(7) Increase in Policy Reserves -$237,734 -10% -$3,665 0% -$30,016 -1%
(8) Administrative Expenses $456,369 19% $873,655 31% 962,452 31%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)] 174,549 7% -$1,505,512 -54% -$776,935 -25%
(10a) Premium per Member Month [(5)/(2)] $202   $194   $181  
(10b) Premium Trend [(10a)/(10a prior year)-1] 4%   7%   -7%  
(11a) Claims per Member Month [(6)/(2)] $169   $238   $172  
(11b) Claims Trend [(11a)/(11a prior year)-1] -29%   38%   25%  
Source: Rule Chapter 945 Long Form Small Group and Dirigo Small Group Totals.

 

Small Group
United Healthcare Ins Co
Insurer 2013 2012 2011
Amount % of
Premium
Amount % of
Premium
Amount % of
Premium
(1) Number of Covered Lives, Dec. 31 545   587   554  
(2) Member Months During Year 5,522   6,756   6,370  
(3) Number of Contracts issued during year 65   2   0  
(4) Number of contracts issued during year covering policyholders that were uninsured for the prior 90 days 0   0   0  
(5) Premiums Earned $2,960,057 100% $2,955,231 100% $2,800,817 100%
(6) Claims Incurred $1,951,100 66% $1,958,806 66% $1,876,789 67%
(7) Increase in Policy Reserves $29,794 1% $27,226 1% $27,767 1%
(8) Administrative Expenses $668,252 23% $677,283 23% $760,441 27%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)] $310,911 11% $291,916 10% $135,820 5%
(10a) Premium per Member Month [(5)/(2)] $536   $437   $440  
(10b) Premium Trend [(10a)/(10a prior year)-1] 23%   -1%   6%  
(11a) Claims per Member Month [(6)/(2)] $353   $290   $295  
(11b) Claims Trend [(11a)/(11a prior year)-1] 22%   -2%   15%  
Source: Rule Chapter 945 Long Form Small Group and Dirigo Small Group Totals.

 

Small Group Grand Totals (Includes Long Form Filers Displayed Above and Short Form Filers with Smaller Premium Volume)
Insurer 2013 2012 2011
Amount % of
Premium
Amount % of
Premium
Amount % of
Premium
(1) Number of Covered Lives, Dec. 31 82,448   89,130   92,591  
(2) Member Months During Year 996,845   1,069,945   1,105,503  
(3) Number of Contracts issued during year 3,913   3,973   4,747  
(4) Number of contracts issued during year covering policyholders that were uninsured for the prior 90 days 656   820   556  
(5) Premiums Earned $378,247,418 100% $395,466,030 100% $392,122,970 100%
(6) Claims Incurred $303,228,421 80% $318,393,838 81% $328,281,527 84%
(7) Increase in Policy Reserves $1,537,659 0% $23,561 0% -$17,862 0%
(8) Administrative Expenses $67,452,183 18% $78,512,586 20% $74,931,850 19%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)] $6,029,155 2% -$1,463,955 0% -$11,072,545 -3%
(10a) Premium per Member Month [(5)/(2)] $379   $370   $355  
(10b) Premium Trend [(10a)/(10a prior year)-1] 3%   4%   2%  
(11a) Claims per Member Month [(6)/(2)] $304   $298   $297  
(11b) Claims Trend [(11a)/(11a prior year)-1] 2%   0%   3%  

Source: Rule Chapter 945 Aggregate Long Form Small Group and Dirigo Small Group Totals and Short Form Small Group and Dirigo Small Group Totals.
Note: The Number of Covered Lives, Number of Member Months, and the Contracts Issued totals do not include data for companies filing the Short Form (i.e., reporting less than $2 million in premium). Short Form filers are not required to report those figures.

 

Individual
Aetna (Aetna Health Inc + Aetna Life Ins Co)
Insurer 2013 2012 2011
Amount % of
Premium
Amount % of
Premium
Amount % of
Premium
(1) Number of Covered Lives, Dec. 31 55   44   38  
(2) Member Months During Year 622   467   456  
(3) Number of Contracts issued during year 21   0   0  
(4) Number of contracts issued during year covering policyholders that were uninsured for the prior 90 days 8   14   3  
(5) Premiums Earned $447,871 100% $208,291 100% $171,649 100%
(6) Claims Incurred $732,925 164% $995,684 478% $750,259 437%
(7) Increase in Policy Reserves $290,597 65% -$75,696 -36% $122,888 72%
(8) Administrative Expenses $75,643 17% $33,094 16% $29,012 17%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)] -$651,294 -145% -$744,791 -358% -$730,510 -426%
(10a) Premium per Member Month [(5)/(2)] $720   $446   $376  
(10b) Premium Trend [(10a)/(10a prior year)-1] 61%   18%   -7%  
(11a) Claims per Member Month [(6)/(2)] $1,178   $2,132   $1,645  
(11b) Claims Trend [(11a)/(11a prior year)-1] -45%   30%   160%  
Source: Rule Chapter 945 Long Form Individual and Dirigo Individual Totals.

 

Individual
Anthem Health Plans of ME Inc
Insurer 2013 2012 2011
Amount % of
Premium
Amount % of
Premium
Amount % of
Premium
(1) Number of Covered Lives, Dec. 31 18,351   16,749   16,233  
(2) Member Months During Year 216,638   196,538   201,259  
(3) Number of Contracts issued during year 3,778   2,445   653  
(4) Number of contracts issued during year covering policyholders that were uninsured for the prior 90 days 2,889   1,961   239  
(5) Premiums Earned $57,151,341 100% $57,748,995 100% $62,558,074 100%
(6) Claims Incurred $36,910,938 65% $45,812,206 79% $56,232,983 90%
(7) Increase in Policy Reserves $0 0% $0 0% $0 0%
(8) Administrative Expenses $9,620,160 17% $7,760,095 13% $6,874,232 11%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)] $10,620,243 19% $4,176,694 7% -$549,141 -1%
(10a) Premium per Member Month [(5)/(2)] 264   294   $311  
(10b) Premium Trend [(10a)/(10a prior year)-1] -10%   -5%   10%  
(11a) Claims per Member Month [(6)/(2)] $170   $233   $279  
(11b) Claims Trend [(11a)/(11a prior year)-1] -27%   -17%   13%  
Source: Rule Chapter 945 Long Form Individual and Dirigo Individual Totals.

 

Individual
Connecticut General Life Ins Co & CIGNA Health and Life Ins Co
Insurer 2013 2012 2011
Amount % of
Premium
Amount % of
Premium
Amount % of
Premium
(1) Number of Covered Lives, Dec. 31 2   6   4  
(2) Member Months During Year 49   72   44  
(3) Number of Contracts issued during year 0   0   0  
(4) Number of contracts issued during year covering policyholders that were uninsured for the prior 90 days 0   0   0  
(5) Premiums Earned $26,908 100% $32,354 100% $40,462 100%
(6) Claims Incurred $86,685 322% $51,805 160% $26,665 66%
(7) Increase in Policy Reserves $0 0% $0 0% $0 0%
(8) Administrative Expenses $7,666 28% $5,390 17% $3,069 8%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)] -$67,443 -251% -$24,841 -77% $10,728 27%
(10a) Premium per Member Month [(5)/(2)] $549   $449   $920  
(10b) Premium Trend [(10a)/(10a prior year)-1] 22%   -51%   65%  
(11a) Claims per Member Month [(6)/(2)] $1,769   $720   $606  
(11b) Claims Trend [(11a)/(11a prior year)-1] 146%   19%   -7%  
Source: Rule Chapter 945 Long Form Individual and Dirigo Individual Totals.

 

Individual
Harvard Pilgrim (Includes Harvard Pilgrim Health Care Inc. & HPHC Insurance Company)
Insurer 2013 2012 2011
Amount % of
Premium
Amount % of
Premium
Amount % of
Premium
(1) Number of Covered Lives, Dec. 31 2,862   3,600   4,924  
(2) Member Months During Year 39,119   51,371   60,070  
(3) Number of Contracts issued during year 2,237   3,050   3,224  
(4) Number of contracts issued during year covering policyholders that were uninsured for the prior 90 days 0   0   0  
(5) Premiums Earned $25,135,432 100% $33,134,859 100% $37,611,012 100%
(6) Claims Incurred $22,189,596 88% $29,308,444 88% $34,890,338 93%
(7) Increase in Policy Reserves $0 0% $0 0% $0 0%
(8) Administrative Expenses $3,833,167 15% $4,381,919 13% $5,396,131 14%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)] -$887,331 -4% -$555,504 -2% -$2,675,457 -7%
(10a) Premium per Member Month [(5)/(2)] $643   $645   $626  
(10b) Premium Trend [(10a)/(10a prior year)-1] 0%   3%   2%  
(11a) Claims per Member Month [(6)/(2)] $567   $571   $581  
(11b) Claims Trend [(11a)/(11a prior year)-1] -1%   -2%   15%  
Source: Rule Chapter 945 Long Form Individual and Dirigo Individual Totals.
Note: (4) was left blank on the report.

 

Individual
Mega Life & Health Ins Co
Insurer 2013 2012 2011
Amount % of
Premium
Amount % of
Premium
Amount % of
Premium
(1) Number of Covered Lives, Dec. 31 10,114   11,750   12,513  
(2) Member Months During Year 126,901   142,355   149,241  
(3) Number of Contracts issued during year 2,192   1,943   2,339  
(4) Number of contracts issued during year covering policyholders that were uninsured for the prior 90 days 258   229   1403  
(5) Premiums Earned $29,656,147 100% $31,974,016 100% $32,778,911 100%
(6) Claims Incurred $19,810,430 67% $23,990,727 75% $22,913,942 70%
(7) Increase in Policy Reserves -$277,297 -1% -$998,023 -3% $875,283 3%
(8) Administrative Expenses $8,220,423 28% $9,392,532 29% $9,276,139 28%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)] $1,902,591 6% -$411,220 -1% -$286,453 -1%
(10a) Premium per Member Month [(5)/(2)] $234   $225   $220  
(10b) Premium Trend [(10a)/(10a prior year)-1] 4%   2%   -3%  
(11a) Claims per Member Month [(6)/(2)] $156   $169   $154  
(11b) Claims Trend [(11a)/(11a prior year)-1] -7%   10%   10%  
Source: Rule Chapter 945 Long Form Individual and Dirigo Individual Totals.

 

Individual Grand Totals (Includes Long For Filers Displayed Above and Short Form Filers with Smaller Premium Volume)
Insurer 2013 2011 2010
Amount % of
Premium
Amount % of
Premium
Amount % of
Premium
(1) Number of Covered Lives, Dec. 31 31,384   36,832   35,486  
(2) Member Months During Year 383,329   431,782   417,365  
(3) Number of Contracts issued during year 8,228   6,216   6,350  
(4) Number of contracts issued during year covering policyholders that were uninsured for the prior 90 days 3,155   1,645   511  
(5) Premiums Earned $114,891,358 100% $133,160,108 100% $139,665,678 100%
(6) Claims Incurred $81,354,952 71% $114,814,188 86% $108,243,858 78%
(7) Increase in Policy Reserves -$31,622 0% $998,171 1% -$5,915,240 -4%
(8) Administrative Expenses $22,365,034 19% $21,578,583 16% $23,312,436 17%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)] $11,202,994 10% -$4,230,834 -3% $14,024,625 10%
(10a) Premium per Member Month [(5)/(2)] $300   $324   $335  
(10b) Premium Trend [(10a)/(10a prior year)-1] -7%   -3%   9%  
(11a) Claims per Member Month [(6)/(2)] $212   $279   $259  
(11b) Claims Trend [(11a)/(11a prior year)-1] -19%   8%   1%  

Source: Rule Chapter 945 Aggregate Long Form Individual and Dirigo Individual Totals and Short Form Individual and Dirigo Individual Totals.
Note: The Number of Covered Lives, Number of Member Months, and the Contracts Issued totals do not include data for companies filing Short Form (i.e., reporting less than $2 million in premium). Short Form filers are not required to report those figures.

 

 

 

 

Last Updated: June 23, 2014