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

2013 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. 2013 Enrollees as of December 31, 2013
  Totals Large Group Small Group Individual
Insurers 2013 Change
%
2013 Change
%
2013 Change
%
2013 Change
%
Aetna Health Inc + Aetna Life Ins Co 31,705 -22% 14,025 -20% 17,625 -23% 55 25%
Anthem Health Plans of ME Inc 189,367 -3% 137,626 3% 33,390 -26% 18,351 10%
Connecticut General Life Ins Co + CIGNA Health & Life Ins Co 27,840 -18% 27,824 -18% 14 100% 2 -67%
Harvard Pilgrim Health Care Inc. and HPHC 62,737 35% 29,878 28% 29,997 54% 2,862 -21%
Mega Life & Health Ins Co 10,991 -15% 0 0% 877 -22% 10,114 -14%
Nationwide Life Ins Co 1,483 -46% 1,483 -46% 0 0% 0 0%  
United Healthcare Ins Co 3,068 9% 2,523 13% 5457 -7% 0 0%
Total 327,191 -6% 213,359 -6% 82,448 -7% 31,384 -2%

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. 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. 2013 Premium Earned
  Totals Large Group Small Group Individual
Insurers 12/31/2013 Change
%
12/31/2013 Change
%
12/31/2013 Change
%
12/31/2013 Change
%
Aetna Health Inc + Aetna Life Ins Co $140,035,672 -26% $69,775,934 -24% $69,811,867 -27% $447,871 115%
Anthem Health Plans of ME Inc $944,599,007 -2% $707,728,862 2% $179,718,804 -14% $57,151,341 -1%
Connecticut General Life Ins Co + CIGNA Health & Life Ins Co $166,315,848 15% $166,110,629 15% $178,311 187% $26,908 -17%
Harvard Pilgrim Health Care Inc. and HPHC $284,340,734 24% $136,020,546 20% $123,184,756 49% $25,135,432 -24%
Mega Life & Health Ins Co $32,048,734 -8% $0 0% $2,392,181 -15% $29,656,147 -5%
Nationwide Life Ins Co $4,876,032 17% $4,876,032 17% $0 0% $0 0%
United Healthcare Ins Co $16,392,755 9% $13,432,698 11% $2,960,057 0% $0 0%
All Other Companies $7,495,526 25% $5,020,425 89% $1,442 -100% $2,473,659 -16%
Totals: $1,596,103,902 0% $1,102,965,126 3% $378,247,418 -4% $114,891,358 -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. 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

 

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. 2013 Premium Per Member Month
  Large Group Small Group Individual
  2013 Change
%
2013 Change
%
2013 Change
%
Aetna (Aetna Health Inc + Aetna Life Ins Co) $410 -4% $348 9% $720 61%
Anthem Health Plans of ME Inc $444 3% $411 6% $264 -10%
Connecticut General Life Ins Co + CIGNA Health & Life $503 10% $734 9% $549 22%
Harvard Pilgrim Health Care Inc. & HPHC $402 -4% $361 -10% $643 0%
Mega Life & Health Ins Co $0 0% $202 4% $234 4%
Nationwide Life Ins Co $314 151% $0 0% $0 0%
United Healthcare Ins Co $461 2% $536 23% $0 0%
Total $445 3% $379 2% $300 -7%

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. 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. 2013 Dollar Amount Spent on Claims and Percentage of Premium
  Totals Large Group Small Group Individual
Insurers 2013 Claims 2013 Claims % of
Premium
2013 Claims % of
Premium
2013 Claims % of
Premium
Aetna Health & Aetna Life $112,764,195 $53,345,488 76% $58,685,782 84% $732,925 164%
Anthem $808,145,523 $629,266,615 89% $141,967,970 79% $36,910,938 65%
Connecticut General & CIGNA Health and Life $126,889,734 $126,681,996 76% $121,053 68% $86,685 322%
Harvard Pilgrim & HPHC $232,337,756 $111,644,641 82% $98,503,519 80% $22,189,596 88%
MEGA $21,809,427 $0 0% $1,998,997 84% $19,810,430 67%
Nationwide Life Ins Co $3,341,863 $3,341,863 69% $0 0% $0 0%
United Healthcare $12,159,710 $10,208,610 76% $1,951,100 66% $0 0%
All Other Insurers $5,668,840 $4,044,462 81% $0 0% $1,624,378 66%
Total $1,323,117,048 $938,533,675 85% $303,228,421 80% $81,354,952 71%

Notes: 1. Small Group and Individual include the DirigoChoice product. This product is sold through Harvard Pilgrim. 2. 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. 2013 Claims Per Member Month
  Large Group Small Group Individual
  2013 % Change 2013 % Change 2013 % Change
Aetna Health + Aetna Life $313 -6% $293 12% $1,178 -45%
Anthem Health Plans of ME Inc $395 4% $325 2% $170 -27%
Connecticut General & CIGNA Health & Life $383 10% $498 -33% $1,769 1465%
Harvard Pilgrim & HPHC $330 -5% $289 -1% $567 -1%
Mega Life & Health Ins Co $0 0% $169 -29% $156 -8%
Nationwide Life Ins Co $215 89% $0 0% $0 0%
United Healthcare Ins Co $350 0% $353 22% $0 0%
Total $379 4% $304 2% $212 -19%

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. 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. 2013 Amount for Administrative Expenses and Percentage of Premiums Paid for Administrative Expenses
  Totals Large Group Small Group Individual
  2013 2013 % of
Premium
2013 % of
Premium
2013 % of
Premium
Aetna Health & Aetna Life $39,902,296 $21,645,372 31% $18,181,281 26% $75,643 17%
Anthem $89,004,487 $55,771,229 8% $23,613,098 13% $9,620,160 17%
Connecticut General & CIGNA Health and Life $14,060,264 $14,040,653 8% $11,945 7% $7,666 28%
Harvard Pilgrim & HPHC $50,566,889 $22,243,741 16% $24,489,981 20% $3,833,167 15%
MEGA $8,676,792 $0 0% $456,369 19% $8,220,423 28%
Nationwide Life Ins Co $1,239,672 $1,239,672 25% $0 0% $0 0%
United Healthcare $3,316,935 $2,648,683 20% $668,252 23% $0 0%
All other Companies $1,484,631 $845,398 N/A $31,258 N/A $607,975 N/A
Total $208,251,966 $118,434,748 11% $67,452,184 18% $22,365,034 19%

Notes: 1. Small Group and Individual include the DirigoChoice product. This product is sold through Harvard Pilgrim. 2. 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. 2013 Underwriting Gain/Loss
  Totals Large Group Small Group Individual
  2013 % of
Premium
2013 % of
Premium
2013 % of
Premium
2013 % of
Premium
Aetna Health & Aetna Life -$14,667,102 -10% -$5,214,926 -7% -$8,800,882 -13% -$651,294 -145%
Anthem Health Plans of ME Inc. $47,448,997 5% $22,691,018 3% $14,137,736 8% $10,620,243 19%
Connecticut General & CIGNA Health & Life $25,365,850 15% $25,387,980 15% $45,313 25% -$67,443 -251%
Harvard Pilgrim & HPHC $1,436,090 1% $2,132,164 2% $191,257 0% -$887,331 -4%
Mega Life & Health Insurance Co. $2,077,140 6% $0 0% $174,549 7% $1,902,591 6%
Nationwide Life Ins Co -$391,179 -8% -$391,179 -8% $0 0% $0 0%
United Healthcare Insurance Co. $732,354 4% 421,443 3% $310,911 11% $0 0%
All other Companies $-486,336 N/A -$742,835 N/A -$29,729 N/A $286,228 N/A
Total $61,515,814 4% $44,283,665 4% $6,029,155 2% $11,202,994 10%

Notes: 1. Small Group and Individual include the DirigoChoice product. This product is sold through Harvard Pilgrim. 2. 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: June 23, 2014