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2013 STATEMENT OF REVENUE AND EXPENSES - 004 HMO Maine, a Line of Business of Anthem Health Plans of Maine, Inc. Quarter 1

  LINE Uncovered Current Year to Date Total Current Year to Date Total Prior Year to Date Prior Year Ended December 31
01 Member months XXX 212,902 259,761 970,585
02 Net premium income (including $0 non-health premium income) XXX 82,975,853 78,418,792 332,005,200
03 Change in unearned premium reserves and reserve for rate credits XXX (9,165,645) (2,676,796) (20,467,241)
04 Fee-for-service (net of $0 medical expenses) XXX 0 0 0
05 Risk revenue XXX 0 0 0
06 Aggregate write-ins for other health care related revenues XXX 0 0 0
07 Aggregate write-ins for other non-health revenues XXX 0 0 0
08 Total revenues XXX 73,810,208 75,741,996 311,537,959
09 Hospital/medical benefits (medical and hospital)   51,482,351 54,445,560 228,046,690
10 Other professional services (medical and hospital)   329 275 2,531
11 Outside referrals (medical and hospital)   0 0 0
12 Emergency room and out-of-area (medical and hospital)   3,458,975 3634355 13,561,441
13 Prescription drugs (hospital and medical)   10,881,319 11,107,129 42,612,704
14 Aggregate write-ins for other hospital and medical (hospital and medical) 0 0 0 0
15 Incentive pool, withhold adjustments and bonus amounts (hospital and medical)   2,336 0 0
16 Subtotal (hospital and medical) 0 65,825,310 69,187,319 284,223,366
17 Net reinsurance recoveries (less)   0 0 0
18 Total hospital and medical (less) 0 65,825,310 69,187,319 284,223,366
19 Non-health claims (net) (less)   0 0 0
20 Claims adjustment expenses, including $261,716 cost containment expenses (less)   1,770,363 785,797 3,883,077
21 General administrative expenses (less)   3,428,797 1,922,206 7,520,654
22 Increase in reserves for life and accident and health contracts (including $0 increase in reserves for life only) (less)   0 0 0
23 Total underwriting deductions 0 71,024,470 71,895,322 295,627,097
24 Net underwriting gain or (loss) XXX 2,785,738 3,846,674 15,910,862
25 Net investment income earned   791,523 949,957 3,268,671
26 Net realized capital gains (losses) less capital gains tax of $   0 0 0
27 Net investment gains or (losses) 0 791,523 949,957 3,268,671
28 Net gain or (loss) from agents' or premium balances charged off [(amount recovered $0 (amount charged off $0)] 0 0 0 0
29 Aggregate write-ins for other income or expenses 0 0 0 0
30 Net income or (loss) after capital gains tax and before all other federal income taxes XXX 3,577,261 4,796,631 19,179,533
31 Federal and foreign income taxes incurred XXX 1,252,041 1,678,821 6,712,837
32 Net income (loss) XXX 2,325,220 3,117,810 12,466,696
  Details of Write-Ins        
0601   XXX      
0602   XXX      
0603   XXX      
0698 Summary of remaining write-ins for Line 6 from overflow page XXX 0 0 0
0699 Totals (Lines 0601 through 0603 plus 0698)(Line 6 above) XXX 0 0 0
0701   XXX      
0702   XXX      
0703   XXX      
0798 Summary of remaining write-ins for Line 7 from overflow page XXX 0 0 0
0799 Totals (Lines 0701 through 0703 plus 0798)(Line 7 above) XXX 0 0 0
1401          
1402          
1403          
1498 Summary of remaining write-ins for Line 14 from overflow page 0 0 0 0
1499 Totals (Lines 1401 through 1403)(Line 14 above) 0 0 0 0
2901          
2902          
2903          
2998 Summary of remaining write-ins for Line 29 from overflow page 0 0 0 0
2999 Totals (Lines 2901 through 2903 plus 2998)(Line 29 above) 0 0 0 0

Current Year To Date Member Months reported in column 2 and Prior Year Ended December 31 Member Months reported in Column 4 include Stop Loss members. Prior Year to Date Member Months reported in column 3 does not include Stop Loss members.

Last Updated: May 16, 2014