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

2012 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 2012: 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 2012 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 2011 for coverage in January 2012 are included in 2012 premiums earned but premiums paid in December 2012 for coverage in January 2013 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 2012 for services provided in December 2011 are included in 2011 claims incurred but claims paid in January 2013 for services provided in December 2012 are included in 2012 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 2012 2011 2010
Amount % of
Premium
Amount % of
Premium
Amount % of
Premium
(1) Number of Covered Lives, Dec. 31 17,608   17,889   17,598  
(2) Member Months During Year 214,974   209,348   229,463  
(3) Number of Contracts issued during year 27   11   16  
(4) Number of contracts issued during year covering policyholders that were uninsured for the prior 90 days NA   NA   NA  
(5) Premiums Earned $92,021,388 100% $85,739,529 100% $94,236,142 100%
(6) Claims Incurred $71,731,619 78% $70,920,629 83% $78,658,937 83%
(7) Increase in Policy Reserves $0 0% $0 0% $0 0%
(8) Administrative Expenses $27,745,406 30% $22,025,885 26% $12,716,658 13%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)] -$7,455,637 -8% -$7,206,985 -8% $2,860,547 3%
(10a) Premium per Member Month [(5)/(2)] $428   $410   $411  
(10b) Premium Trend [(10a)/(10a prior year)-1] 5%   0%   4%  
(11a) Claims per Member Month [(6)/(2)] $334   $339   $343  
(11b) Claims Trend [(11a)/(11a prior year)-1] -2%   -1%   6%  
Source: Rule Chapter 945 Long Form Large Group Totals

 

Large Group
Anthem Health Plans of ME Inc
Insurer 2012 2011 2010
Amount % of
Premium
Amount % of
Premium
Amount % of
Premium
(1) Number of Covered Lives, Dec. 31 133,314   139,402   137,497  
(2) Member Months During Year 1,612,164   1,671,071   1,658,211  
(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 $696,161,731 100% $690,275,486 100% $673,974,416 100%
(6) Claims Incurred $612,946,537 88% $605,470,861 88% $597,704,671 89%
(7) Increase in Policy Reserves $0 0% $0 0% 0 0%
(8) Administrative Expenses $54,672,078 8% $49,413,194 7% $48,505,094 7%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)] $28,543,116 4% $35,391,431 5% $27,764,651 4%
(10a) Premium per Member Month [(5)/(2)] $432   $413   $406  
(10b) Premium Trend [(10a)/(10a prior year)-1] 5%   2%   2%  
(11a) Claims per Member Month [(6)/(2)] $380   $362   $360  
(11b) Claims Trend [(11a)/(11a prior year)-1] 5%   1%   0%  
Source: Rule Chapter 945 Long Form Large Group Totals

 

Large Group
Commercial Travelers Mutual Insurance Company
Insurer 2012 2011 2010
Amount % of
Premium
Amount % of
Premium
Amount % of
Premium
(1) Number of Covered Lives, Dec. 31 13,619   N/A   N/A  
(2) Member Months During Year 55,090   N/A   N/A  
(3) Number of Contracts issued during year 0   N/A   N/A  
(4) Number of contracts issued during year covering policyholders that were uninsured for the prior 90 days N/A   N/A   N/A  
(5) Premiums Earned $2,003,509 100% $1,365,991 100% $1,342,434 100%
(6) Claims Incurred $1,310,405 65% $997,354 73% $1,084,114 81%
(7) Increase in Policy Reserves $0 0% $2,014 0% -$76,273 -6%
(8) Administrative Expenses $681,375 34% $225,748 17% $222,981 17%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)] $11,729 1% $140,875 10% $111,612 8%
(10a) Premium per Member Month [(5)/(2)] $36   N/A   N/A  
(10b) Premium Trend [(10a)/(10a prior year)-1] N/A   N/A   N/A  
(11a) Claims per Member Month [(6)/(2)] $24   N/A   N/A  
(11b) Claims Trend [(11a)/(11a prior year)-1] N/A   N/A   N/A  
Source: Rule Chapter 945 Long Form Large Group Totals. Data is for student policies.

 

Large Group
Connecticut General Life Ins Co & CIGNA Health & Life Ins Co
Insurer 2012 2011 2010
Amount % of
Premium
Amount % of
Premium
Amount % of
Premium
(1) Number of Covered Lives, Dec. 31 34,010   27,475   26,726  
(2) Member Months During Year 317,821   334,446   320,504  
(3) Number of Contracts issued during year 1   41   60  
(4) Number of contracts issued during year covering policyholders that were uninsured for the prior 90 days NA   NA   NA  
(5) Premiums Earned $145,044,827 100% $157,263,147 100% $143,487,477 100%
(6) Claims Incurred $110,502,325 76% $121,153,521 77% $113,714,738 79%
(7) Increase in Policy Reserves $0 0% $0 0% $0 0%
(8) Administrative Expenses $20,906,659 14% $12,740,624 8% $9,769,038 7%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)] $13,635,843 9% $23,369,002 15% $20,003,701 14%
(10a) Premium per Member Month [(5)/(2)] $456   $470   $448  
(10b) Premium Trend [(10a)/(10a prior year)-1] -3%   5%   -7%  
(11a) Claims per Member Month [(6)/(2)] $348   $362   $355  
(11b) Claims Trend [(11a)/(11a prior year)-1] -4%   2%   3%  
Source: Rule Chapter 945 Long Form Large Group Totals

 

Large Group
Harvard Pilgrim (Includes Harvard Pilgrim Health Care Inc. & HPHC Insurance Company
Insurer 2012 2011 2010
Amount % of
Premium
Amount % of
Premium
Amount % of
Premium
(1) Number of Covered Lives, Dec. 31 23,372   22,127   22,672  
(2) Member Months During Year 272,307   277,744   266,289  
(3) Number of Contracts issued during year 158   237   196  
(4) Number of contracts issued during year covering policyholders that were uninsured for the prior 90 days NA   NA   NA  
(5) Premiums Earned $113,736,870 100% $112,837,016 100% $101,640,051 100%
(6) Claims Incurred $94,848,878 83% $96,512,207 86% $89,807,234 88%
(7) Increase in Policy Reserves $0 0% $0 0% $0 0%
(8) Administrative Expenses $19,686,285 17% $16,710,926 15% $17,030,539 17%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)] -$798,293 -1% -$386,117 0% -$5,197,722 -5%
(10a) Premium per Member Month [(5)/(2)] $418   $406   $382  
(10b) Premium Trend [(10a)/(10a prior year)-1] 3%   6%   8%  
(11a) Claims per Member Month [(6)/(2)] $348   $347   $337  
(11b) Claims Trend [(11a)/(11a prior year)-1] 0%   3%   7%  

Source: Rule Chapter 945 Long Form Large Group Totals

 

Large Group
Nationwide Life Ins Co
Insurer 2012 2011 2010
Amount % of
Premium
Amount % of
Premium
Amount % of
Premium
(1) Number of Covered Lives, Dec. 31 2,734   5,400   1,249  
(2) Member Months During Year 33,361   23,086   2,860  
(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 $4,165,802 100% $4,614,934 100% $2,971,914 100%
(6) Claims Incurred $3,818,752 92% $2,422,016 52% $1,356,979 46%
(7) Increase in Policy Reserves -$338,501 -8% $1,232,891 27% $207,201 7%
(8) Administrative Expenses $1,233,756 30% $1,422,844 31% $1,310,036 44%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)] -$548,205 -13% -$462,817 -10% $97,698 3%
(10a) Premium per Member Month [(5)/(2)] $125   $200   $1,039  
(10b) Premium Trend [(10a)/(10a prior year)-1] -38%   -81%      
(11a) Claims per Member Month [(6)/(2)] $114   $105   $474  
(11b) Claims Trend [(11a)/(11a prior year)-1] 9%   -78%   0%  
Source: Rule Chapter 945 Long Form Large Group Totals. Data is for student policies.

 

Large Group
United Healthcare Ins Co
Insurer 2012 2011 2010
Amount % of
Premium
Amount % of
Premium
Amount % of
Premium
(1) Number of Covered Lives, Dec. 31 2,238   1,995   1,529  
(2) Member Months During Year 26,874   24,146   17,374  
(3) Number of Contracts issued during year 1   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 $12,150,235 100% $10,906,618 100% $8,745,782 100%
(6) Claims Incurred $9,418,439 78% $8,623,315 79% $6,914,692 79%
(7) Increase in Policy Reserves $142,063 1% $134,699 1% $108,172 1%
(8) Administrative Expenses $2,397,639 18% $2,499,049 23% $1,554,618 18%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)] $192,094 3% -$350,445 -3% $168,300 2%
(10a) Premium per Member Month [(5)/(2)] $452   $452   $503  
(10b) Premium Trend [(10a)/(10a prior year)-1] 0%   -10%   21%  
(11a) Claims per Member Month [(6)/(2)] $350   $357   $398  
(11b) Claims Trend [(11a)/(11a prior year)-1] -2%   -10%   19%  
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 2012 2011 2010
Amount % of
Premium
Amount % of
Premium
Amount % of
Premium
(1) Number of Covered Lives, Dec. 31 213,276   214,288   207,271  
(2) Member Months During Year 2,477,501   2,539,841   2,494,701  
(3) Number of Contracts issued during year 187   289   272  
(4) Number of contracts issued during year covering policyholders that were uninsured for the prior 90 days NA   NA   NA  
(5) Premiums Earned $1,067,937,973 100% $1,066,380,416 100% $1,030,689,069 100%
(6) Claims Incurred $906,633,490 85% $908,352,962 85% $891,215,114 86%
(7) Increase in Policy Reserves -$223,898 0% $1,487,022 0% $242,233 0%
(8) Administrative Expenses $127,535,559 12% $105,384,841 10% $91,316,670 9%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)] $33,992,821 3% $51,155,591 5% $47,915,053 5%
(10a) Premium per Member Month [(5)/(2)] $431   $420   $413  
(10b) Premium Trend [(10a)/(10a prior year)-1] 3%   2%   2%  
(11a) Claims per Member Month [(6)/(2)] $366   $358   $357  
(11b) Claims Trend [(11a)/(11a prior year)-1] 2%   0%   2%  

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 2012 2011 2010
Amount % of
Premium
Amount % of
Premium
Amount % of
Premium
(1) Number of Covered Lives, Dec. 31 22,773   26,397   31,752  
(2) Member Months During Year 300,868   322,921   428,716  
(3) Number of Contracts issued during year 285   354   381  
(4) Number of contracts issued during year covering policyholders that were uninsured for the prior 90 days 130   94   97  
(5) Premiums Earned $95,749,102 100% $94,993,008 100% $129,776,069 100%
(6) Claims Incurred $78,635,631 82% $82,555,166 87% $114,272,664 88%
(7) Increase in Policy Reserves 0 0% $0 0% $0 0%
(8) Administrative Expenses $32,771,788 34% $36,181,508 38% $12,136,571 9%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)] -15,658,317 -16% -$23,743,666
-25%
$3,366,835 3%
(10a) Premium per Member Month [(5)/(2)] $318   $294   $303  
(10b) Premium Trend [(10a)/(10a prior year)-1] 8%   -3%   5%  
(11a) Claims per Member Month [(6)/(2)] $261   $256   $267  
(11b) Claims Trend [(11a)/(11a prior year)-1] 2%   -4%   7%  
Source: Rule Chapter 945 Long Form Small Group and Dirigo Small Group Totals.

 

Small Group
Anthem Health Plans of ME Inc
Insurer 2012 2011 2010
Amount % of
Premium
Amount % of
Premium
Amount % of
Premium
(1) Number of Covered Lives, Dec. 31 45,123   47,614   50,765  
(2) Member Months During Year 540,481   573,108   583,112  
(3) Number of Contracts issued during year 2,377   2,954   2,968  
(4) Number of contracts issued during year covering policyholders that were uninsured for the prior 90 days 666   440   387  
(5) Premiums Earned $210,187,959 100% $214,557,142 100% $210,933,205 100%
(6) Claims Incurred $173,141,428 82% $176,996,063 82% $170,897,672 81%
(7) Increase in Policy Reserves $0 0% $0 0% $0 0%
(8) Administrative Expenses $26,959,412 13% $27,017,058 13% $26,023,964 12%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)] $10,087,119 5% $10,544,021 5% $14,011,569 7%
(10a) Premium per Member Month [(5)/(2)] $389   $374   $362  
(10b) Premium Trend [(10a)/(10a prior year)-1] 4%   3%   2%  
(11a) Claims per Member Month [(6)/(2)] $320   $309   $293  
(11b) Claims Trend [(11a)/(11a prior year)-1] 4%   5%   -3%  
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 2012 2011 2010
Amount % of
Premium
Amount % of
Premium
Amount % of
Premium
(1) Number of Covered Lives, Dec. 31 7   14   27  
(2) Member Months During Year 92   292   348  
(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 $62,098 100% $146,770 100% $143,631 100%
(6) Claims Incurred $68,272 110% $74,379 51% $91,504 64%
(7) Increase in Policy Reserves $0 0% $0 0% $0 0%
(8) Administrative Expenses $16,055 26% $11,790 8% $9,485 7%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)] -$22,229 -36% $60,601 41% $42,642 30%
(10a) Premium per Member Month [(5)/(2)] $675   $503   $413  
(10b) Premium Trend [(10a)/(10a prior year)-1] 34%   22%   -51%  
(11a) Claims per Member Month [(6)/(2)] $742   $255   $263  
(11b) Claims Trend [(11a)/(11a prior year)-1] 191%   -3%   -79%  
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 2012 2011 2010
Amount % of
Premium
Amount % of
Premium
Amount % of
Premium
(1) Number of Covered Lives, Dec. 31 19,513   17,021   13,324  
(2) Member Months During Year 207,284   185,740   138,004  
(3) Number of Contracts issued during year 1,308   1,437   2,158  
(4) Number of contracts issued during year covering policyholders that were uninsured for the prior 90 days 24   22   11  
(5) Premiums Earned $83,301,276 100% $74,791,858 100% $57,841,244 100%
(6) Claims Incurred 60,609,700 73% $62,889,374 84% $46,546,338 80%
(7) Increase in Policy Reserves 0 0% $0 0% $0 0%
(8) Administrative Expenses 17,093,014 21% $9,425,936 13% $8,452,290 15%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)] $5,598,562 7% $2,476,548 3% $2,842,615 5%
(10a) Premium per Member Month [(5)/(2)] $402   $403   $419  
(10b) Premium Trend [(10a)/(10a prior year)-1] 0%   -4%   6%  
(11a) Claims per Member Month [(6)/(2)] $292   $339   $337  
(11b) Claims Trend [(11a)/(11a prior year)-1] -14%   0%   -5%  
Source: Rule Chapter 945 Long Form Small Group and Dirigo Small Group Totals.

 

Small Group
Mega Life & Health Ins Co
Insurer 2012 2011 2010
Amount % of
Premium
Amount % of
Premium
Amount % of
Premium
(1) Number of Covered Lives, Dec. 31 1,127   1,351   1,560  
(2) Member Months During Year 14,464   17,072   18,625  
(3) Number of Contracts issued during year 1   1   3  
(4) Number of contracts issued during year covering policyholders that were uninsured for the prior 90 days 0   0   0  
(5) Premiums Earned $2,800,316 100% $3,086,969 100% $3,639,783 100%
(6) Claims Incurred $3,435,838 123% $2,931,468 95% $2,558,030 70%
(7) Increase in Policy Reserves -$3,665 0% -$30,016 -1% -$502,267 -14%
(8) Administrative Expenses $873,655 31% 962,452 31% $855,444 24%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)] -$1,505,512 -54% -$776,935 -25% $728,576 20%
(10a) Premium per Member Month [(5)/(2)] $194   $181   $195  
(10b) Premium Trend [(10a)/(10a prior year)-1] 7%   -7%   0%  
(11a) Claims per Member Month [(6)/(2)] $238   $172   $137  
(11b) Claims Trend [(11a)/(11a prior year)-1] 38%   25%   -8%  
Source: Rule Chapter 945 Long Form Small Group and Dirigo Small Group Totals.

 

Small Group
United Healthcare Ins Co
Insurer 2012 2011 2010
Amount % of
Premium
Amount % of
Premium
Amount % of
Premium
(1) Number of Covered Lives, Dec. 31 587   554   284  
(2) Member Months During Year 6,756   6,370   3,380  
(3) Number of Contracts issued during year 2   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 $2,955,231 100% $2,800,817 100% $1,401,495 100%
(6) Claims Incurred $1,958,806 66% $1,876,789 67% $867,018 62%
(7) Increase in Policy Reserves $27,226 1% $27,767 1% $11,870 1%
(8) Administrative Expenses $677,283 22% $760,441 27% $308,329 22%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)] $291,916 11% $135,820 5% $214,277 15%
(10a) Premium per Member Month [(5)/(2)] $437   $440   $415  
(10b) Premium Trend [(10a)/(10a prior year)-1] -1%   6%   45%  
(11a) Claims per Member Month [(6)/(2)] $290   $295   $257  
(11b) Claims Trend [(11a)/(11a prior year)-1] -2%   15%   33%  
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 2012 2011 2010
Amount % of
Premium
Amount % of
Premium
Amount % of
Premium
(1) Number of Covered Lives, Dec. 31 89,130   92,591   97,712  
(2) Member Months During Year 1,069,945   1,105,503   1,172,184  
(3) Number of Contracts issued during year 3,973   4,747   5,511  
(4) Number of contracts issued during year covering policyholders that were uninsured for the prior 90 days 820   556   495  
(5) Premiums Earned $395,466,030 100% $392,122,970 100% $406,333,843 100%
(6) Claims Incurred $318,393,838 81% $328,281,527 84% $336,382,190 83%
(7) Increase in Policy Reserves $23,561 0% -$17,862 0% -$475,126 0%
(8) Administrative Expenses $78,512,586 20% $74,931,850 19% $48,350,164 12%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)] -$1,463,955 0% -$11,072,545 -3% $22,076,615 5%
(10a) Premium per Member Month [(5)/(2)] $370   $355   $347  
(10b) Premium Trend [(10a)/(10a prior year)-1] 4%   2%   4%  
(11a) Claims per Member Month [(6)/(2)] $298   $297   $287  
(11b) Claims Trend [(11a)/(11a prior year)-1] 0%   3%   0%  

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 2012 2011 2010
Amount % of
Premium
Amount % of
Premium
Amount % of
Premium
(1) Number of Covered Lives, Dec. 31 44   38   45  
(2) Member Months During Year 467   456   602  
(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 14   3   0  
(5) Premiums Earned $208,291 100% $171,649 100% $244,370 100%
(6) Claims Incurred $995,684 478% $750,259 437% $380,630 156%
(7) Increase in Policy Reserves -$75,696 -36% $122,888 72% $36,118 15%
(8) Administrative Expenses $33,094 16% $29,012 17% $61,932 25%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)] -$744,791 -358% -$730,510 -426% -$234,310 -96%
(10a) Premium per Member Month [(5)/(2)] $446   $376   $406  
(10b) Premium Trend [(10a)/(10a prior year)-1] 18%   -7%   24%  
(11a) Claims per Member Month [(6)/(2)] $2,132   $1,645   $632  
(11b) Claims Trend [(11a)/(11a prior year)-1] 30%   160%   -31%  
Source: Rule Chapter 945 Long Form Individual and Dirigo Individual Totals.

 

Individual
Anthem Health Plans of ME Inc
Insurer 2012 2011 2010
Amount % of
Premium
Amount % of
Premium
Amount % of
Premium
(1) Number of Covered Lives, Dec. 31 16,749   16,233   17,503  
(2) Member Months During Year 196,538   201,259   220,711  
(3) Number of Contracts issued during year 2,445   653   794  
(4) Number of contracts issued during year covering policyholders that were uninsured for the prior 90 days 1,961   239   239  
(5) Premiums Earned $57,748,995 100% $62,558,074 100% $62,088,316 100%
(6) Claims Incurred $45,812,206 79% $56,232,983 90% $54,400,212 88%
(7) Increase in Policy Reserves $0 0% $0 0% -$6,347,696 -10%
(8) Administrative Expenses $7,760,095 13% $6,874,232 11% $6,720,874 11%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)] $4,176,694 7% -$549,141 -1% $7,314,926 12%
(10a) Premium per Member Month [(5)/(2)] 294   $311   $281  
(10b) Premium Trend [(10a)/(10a prior year)-1] -5%   10%   6%  
(11a) Claims per Member Month [(6)/(2)] $233   $279   $246  
(11b) Claims Trend [(11a)/(11a prior year)-1] -17%   13%   -1%  
Source: Rule Chapter 945 Long Form Individual and Dirigo Individual Totals.

 

Individual
Connecticut General Life Ins Co & CIGNA Health and Life Ins Co
Insurer 2012 2011 2010
Amount % of
Premium
Amount % of
Premium
Amount % of
Premium
(1) Number of Covered Lives, Dec. 31 6   4   6  
(2) Member Months During Year 72   44   72  
(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 $32,354 100% $40,462 100% $40,030 100%
(6) Claims Incurred $51,805 160% $26,665 66% $46,957 117%
(7) Increase in Policy Reserves $0 0% $0 0% $0 0%
(8) Administrative Expenses $5,390 17% $3,069 8% $2,734 7%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)] -$24,841 -77% $10,728 27% -$9,661 -24%
(10a) Premium per Member Month [(5)/(2)] $449   $920   $556  
(10b) Premium Trend [(10a)/(10a prior year)-1] -51%   65%      
(11a) Claims per Member Month [(6)/(2)] $720   $606   $652  
(11b) Claims Trend [(11a)/(11a prior year)-1] 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 2012 2011 2010
Amount % of
Premium
Amount % of
Premium
Amount % of
Premium
(1) Number of Covered Lives, Dec. 31 3,600   4,924   4,963  
(2) Member Months During Year 51,371   60,070   62,186  
(3) Number of Contracts issued during year 3,050   3,224   3,293  
(4) Number of contracts issued during year covering policyholders that were uninsured for the prior 90 days 0   0   0  
(5) Premiums Earned $33,134,859 100% $37,611,012 100% $38,262,645 100%
(6) Claims Incurred $29,308,444 88% $34,890,338 93% $31,432,220 82%
(7) Increase in Policy Reserves $0 0% $0 0% $0 0%
(8) Administrative Expenses $4,381,919 13% $5,396,131 14% $3,239,048 8%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)] -$555,504 -2% -$2,675,457 -7% $3,591,377 9%
(10a) Premium per Member Month [(5)/(2)] $645   $626   $615  
(10b) Premium Trend [(10a)/(10a prior year)-1] 3%   2%   5%  
(11a) Claims per Member Month [(6)/(2)] $571   $581   $505  
(11b) Claims Trend [(11a)/(11a prior year)-1] -2%   15%   7%  
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 2012 2011 2010
Amount % of
Premium
Amount % of
Premium
Amount % of
Premium
(1) Number of Covered Lives, Dec. 31 11,750   12,513   12,969  
(2) Member Months During Year 142,355   149,241   133,794  
(3) Number of Contracts issued during year 1,943   2,339   2,263  
(4) Number of contracts issued during year covering policyholders that were uninsured for the prior 90 days 229   1403   272  
(5) Premiums Earned $31,974,016 100% $32,778,911 100% $30,384,463 100%
(6) Claims Incurred $23,990,727 75% $22,913,942 70% $18,616,519 61%
(7) Increase in Policy Reserves -$998,023 -3% $875,283 3% $224,829 1%
(8) Administrative Expenses $9,392,532 29% $9,276,139 28% $8,741,654 29%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)] -$411,220 -1% -$286,453 -1% $2,801,461 9%
(10a) Premium per Member Month [(5)/(2)] $225   $220   $227  
(10b) Premium Trend [(10a)/(10a prior year)-1] 2%   -3%   23%  
(11a) Claims per Member Month [(6)/(2)] $169   $154   $139  
(11b) Claims Trend [(11a)/(11a prior year)-1] 10%   10%   17%  
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 2012 2011 2010
Amount % of
Premium
Amount % of
Premium
Amount % of
Premium
(1) Number of Covered Lives, Dec. 31 32,149   36,832   35,486  
(2) Member Months During Year 390,803   431,782   417,365  
(3) Number of Contracts issued during year 7,438   6,216   6,350  
(4) Number of contracts issued during year covering policyholders that were uninsured for the prior 90 days 2,204   1,645   511  
(5) Premiums Earned $126,033,420 100% $133,160,108 100% $139,665,678 100%
(6) Claims Incurred $102,317,208 81% $114,814,188 86% $108,243,858 78%
(7) Increase in Policy Reserves -$1,472,644 -1% $998,171 1% -$5,915,240 -4%
(8) Administrative Expenses $22,210,102 18% $21,578,583 16% $23,312,436 17%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)] $2,978,754 2% -$4,230,834 -3% $14,024,625 10%
(10a) Premium per Member Month [(5)/(2)] $322   $324   $335  
(10b) Premium Trend [(10a)/(10a prior year)-1] 0%   -3%   9%  
(11a) Claims per Member Month [(6)/(2)] $262   $279   $259  
(11b) Claims Trend [(11a)/(11a prior year)-1] -6%   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: December 16, 2013