2011 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). Grand totals are shown for each market segment. 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 group are presented together in one table. The “All Other Companies” table for each market segment provides aggregate data for companies with less than $2 million in direct written medical expense premium in the State of Maine. These “All Other Companies” tables do not include enrollment and per member per month data because these companies are not required to report it. 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 2011: 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 2011 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 2010 for coverage in January 2011 are included in 2011 premiums earned but premiums paid in December 2011 for coverage in January 2012 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 2010 for services provided in December 2010 are included in 2010 claims incurred but claims paid in January 2012 for services provided in December 2011 are included in 2011 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 or different 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/consumer/rule945reports.htm.

Large Group
Aetna (Aetna Health Inc + Aetna Life Ins Co)
Insurer	2011		2010		2009
	Amount	% of Premium	Amount	% of Premium	Amount	% of Premium
(1) Number of Covered Lives, Dec. 31	17,889		17,598		28,881
(2) Member Months During Year	209,348		229,463		384,849
(3) Number of Contracts issued during year	11		16		9
(4) Number of contracts issued during year covering policyholders that were uninsured for the prior 90 days	NA		NA		NA
(5) Premiums Earned	$85,739,529	100%	$94,236,142	100%	$151,435,959	100%
(6) Claims Incurred	$70,920,629	83%	$78,658,937	83%	$124,670,678	82%
(7) Increase in Policy Reserves	$0	0%	$0	0%	$0	0%
(8) Administrative Expenses	$22,025,885	26%	$12,716,658	13%	$24,458,560	16%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)]	($7,206,985)	-8%	$2,860,547	3%	$2,306,721	2%
(10a) Premium per Member Month [(5)/(2)]	$410		$411		$393
(10b) Premium Trend [(10a)/(10a prior year)-1]	0%		4%		2%
(11a) Claims per Member Month [(6)/(2)]	$339		$343		$324
(11b) Claims Trend [(11a)/(11a prior year)-1]	-1%		6%		8%
Source: Rule Chapter 945 Long Form Large Group Totals

 

Large Group
Anthem Health Plans of ME Inc
Insurer	2011		2010		2009
	Amount	% of Premium	Amount	% of Premium	Amount	% of Premium
(1) Number of Covered Lives, Dec. 31	139,402		137,497		135,852
(2) Member Months During Year	1,671,071		1,658,211		1,637,612
(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	$690,275,486	100%	$673,974,416	100%	$654,851,523	100%
(6) Claims Incurred	$605,470,861	88%	$597,704,671	89%	$588,409,990	90%
(7) Increase in Policy Reserves	$0	0%	0	0%	0	0%
(8) Administrative Expenses	$49,413,194	7%	$48,505,094	7%	$49,881,655	8%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)]	$35,391,431	5%	$27,764,651	4%	$16,559,878	3%
(10a) Premium per Member Month [(5)/(2)]	$413		$406		$400
(10b) Premium Trend [(10a)/(10a prior year)-1]	2%		2%		5%
(11a) Claims per Member Month [(6)/(2)]	$362		$360		$359
(11b) Claims Trend [(11a)/(11a prior year)-1]	1%		0%		7%
Source: Rule Chapter 945 Long Form Large Group Totals

 

Large Group
Connecticut General Life Ins Co
Insurer	2011		2010		2009
	Amount	% of Premium	Amount	% of Premium	Amount	% of Premium
(1) Number of Covered Lives, Dec. 31	27,475		26,726		23,359
(2) Member Months During Year	334,446		320,504		291,203
(3) Number of Contracts issued during year	41		60		36
(4) Number of contracts issued during year covering policyholders that were uninsured for the prior 90 days	NA		NA		NA
(5) Premiums Earned	$157,263,147	100%	$143,487,477	100%	$140,559,200	100%
(6) Claims Incurred	$121,153,521	77%	$113,714,738	79%	$100,260,740	71%
(7) Increase in Policy Reserves	$0	0%	$0	0%	$0	0%
(8) Administrative Expenses	$12,740,624	8%	$9,769,038	7%	$10,873,167	8%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)]	$23,369,002	15%	$20,003,701	14%	$29,425,292	21%
(10a) Premium per Member Month [(5)/(2)]	$470		$448		$483
(10b) Premium Trend [(10a)/(10a prior year)-1]	5%		-7%		25%
(11a) Claims per Member Month [(6)/(2)]	$362		$355		$344
(11b) Claims Trend [(11a)/(11a prior year)-1]	2%		3%		9%
Source: Rule Chapter 945 Long Form Large Group Totals

 

Large Group
Harvard Pilgrim (Includes Harvard Pilgrim Health Care Inc. & HPHC Insurance Company
Insurer	2011		2010		2009
	Amount	% of Premium	Amount	% of Premium	Amount	% of Premium
(1) Number of Covered Lives, Dec. 31	22,127		22,672		19,838
(2) Member Months During Year	277,744		266,289		218,037
(3) Number of Contracts issued during year	237		196		81
(4) Number of contracts issued during year covering policyholders that were uninsured for the prior 90 days	NA		NA		NA
(5) Premiums Earned	$112,837,016	100%	$101,640,051	100%	$76,835,035	100%
(6) Claims Incurred	$96,512,207	86%	$89,807,234	88%	$68,921,549	90%
(7) Increase in Policy Reserves	0	0%	$0	0%	$0	0%
(8) Administrative Expenses	$16,710,926	15%	$17,030,539	17%	$12,178,562	16%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)]	($386,117)	0%	($5,197,722)	-5%	($4,265,076)	-6%
(10a) Premium per Member Month [(5)/(2)]	$406		$382		$352
(10b) Premium Trend [(10a)/(10a prior year)-1]	6%		8%		4%
(11a) Claims per Member Month [(6)/(2)]	$347		$337		$316
(11b) Claims Trend [(11a)/(11a prior year)-1]	3%		7%		6%
Source: Rule Chapter 945 Long Form Large Group Totals

Large Group
Nationwide Life Ins Co
Insurer	2011		2010		2009
	Amount	% of Premium	Amount	% of Premium	Amount	% of Premium
(1) Number of Covered Lives, Dec. 31	5400		1,249		0
(2) Member Months During Year	23,086		2,860		0
(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	$4,614,934	100%	$2,971,914	100%	$0	0%
(6) Claims Incurred	$849,383	18%	$1,065,174	36%	$0	0%
(7) Increase in Policy Reserves	$1,232,891	27%	$207,201	7%	$0	0%
(8) Administrative Expenses	$1,422,844	31%	$1,310,036	44%	$0	0%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)]	$1,109,816	24%	$389,503	13%	$0	0%
(10a) Premium per Member Month [(5)/(2)]	$200		$1,039		$0
(10b) Premium Trend [(10a)/(10a prior year)-1]	-81%				0%
(11a) Claims per Member Month [(6)/(2)]	$37		$372		$0
(11b) Claims Trend [(11a)/(11a prior year)-1]	-90%		0%		0%
Source: Rule Chapter 945 Long Form Large Group Totals

 

Large Group
United Healthcare Ins Co
Insurer	2011		2010		2009
	Amount	% of Premium	Amount	% of Premium	Amount	% of Premium
(1) Number of Covered Lives, Dec. 31	1,995		1,529		1,410
(2) Member Months During Year	24,146		17,374		17,808
(3) Number of Contracts issued during year	0		0		12
(4) Number of contracts issued during year covering policyholders that were uninsured for the prior 90 days	NA		NA		NA
(5) Premiums Earned	$10,906,618	100%	$8,745,782	100%	$7,432,717	100%
(6) Claims Incurred	$8,623,315	79%	$6,914,692	79%	$5,967,397	80%
(7) Increase in Policy Reserves	$134,699	1%	$108,172	1%	$91,846	1%
(8) Administrative Expenses	$2,499,049	23%	$1,554,618	18%	$1,174,780	16%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)]	($350,445)	-3%	$168,300	2%	$198,694	3%
(10a) Premium per Member Month [(5)/(2)]	$452		$503		$417
(10b) Premium Trend [(10a)/(10a prior year)-1]	-10%		21%		-8%
(11a) Claims per Member Month [(6)/(2)]	$357		$398		$335
(11b) Claims Trend [(11a)/(11a prior year)-1]	-10%		19%		-9%
Source: Rule Chapter 945 Long Form Large Group Totals

 

Large Group
All Other Companies
Insurer	2011		2010		2009
	Amount	% of Premium	Amount	% of Premium	Amount	% of Premium
(1) Number of Covered Lives, Dec. 31
(2) Member Months During Year
(3) Number of Contracts issued during year
(4) Number of contracts issued during year covering policyholders that were uninsured for the prior 90 days
(5) Premiums Earned	$4,743,687	100%	$5,633,287	100%	$8,099,190	100%
(6) Claims Incurred	$3,250,413	69%	$3,349,668	59%	$5,226,243	65%
(7) Increase in Policy Reserves	$119,432	3%	($73,140)	-1%	($66,666)	-1%
(8) Administrative Expenses	$572,319	12%	$430,686	8%	$938,382	12%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)]	$801,522	17%	$1,926,072	34%	$2,001,231	25%
(10a) Premium per Member Month [(5)/(2)]
(10b) Premium Trend [(10a)/(10a prior year)-1]
(11a) Claims per Member Month [(6)/(2)]
(11b) Claims Trend [(11a)/(11a prior year)-1]
Source: Rule Chapter 945 Long Form Large Group Totals for companies who are not displayed in the tables above. In addition, this table includes aggregate data for companies reporting on Rule Chapter 945 Short Form for Large Groups. Note: Some of the lines are left blank because companies reporting on the Short form are not required to complete them.

 

Large Group Grand Totals
Insurer	2011		2010		2009
	Amount	% of Premium	Amount	% of Premium	Amount	% of Premium
(1) Number of Covered Lives, Dec. 31	208,888		207,271		209,902
(2) Member Months During Year	2,516,755		2,494,701		2,558,169
(3) Number of Contracts issued during year	289		272		138
(4) Number of contracts issued during year covering policyholders that were uninsured for the prior 90 days	NA		NA		NA
(5) Premiums Earned	$1,066,380,416	100%	$1,030,689,069	100%	$1,039,213,624	100%
(6) Claims Incurred	$906,780,329	85%	$891,215,114	86%	$893,456,598	86%
(7) Increase in Policy Reserves	$1,487,022	0%	$242,233	0%	$25,180	0%
(8) Administrative Expenses	$105,384,841	10%	$91,316,670	9%	$99,505,107	10%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)]	$52,728,224	5%	$47,915,053	5%	$46,226,739	4%
(10a) Premium per Member Month [(5)/(2)]	$420		$413		$406
(10b) Premium Trend [(10a)/(10a prior year)-1]	2%		2%		5%
(11a) Claims per Member Month [(6)/(2)]	$357		$357		$349
(11b) Claims Trend [(11a)/(11a prior year)-1]	0%		2%		7%
Source: Rule Chapter 945 Aggregate Totals for Long Form Large Group and Short Form Large Group Note: The Covered Lives total and the Contracts Issued total does not include companies reporting less than $2 million in premium. These companies are not required to report those figures.

 

Small Group
Aetna (Aetna Health Inc + Aetna Life Ins Co)
Insurer	2011		2010		2009
	Amount	% of Premium	Amount	% of Premium	Amount	% of Premium
(1) Number of Covered Lives, Dec. 31	26,397		31,752		38,487
(2) Member Months During Year	322,921		428,716		447,233
(3) Number of Contracts issued during year	354		381		843
(4) Number of contracts issued during year covering policyholders that were uninsured for the prior 90 days	94		97		0
(5) Premiums Earned	$94,993,008	100%	$129,776,069	100%	$129,348,436	100%
(6) Claims Incurred	$82,555,166	87%	$114,272,664	88%	$111,212,840	86%
(7) Increase in Policy Reserves	$0	0%	$0	0%	($573,223)	0%
(8) Administrative Expenses	$36,181,508	38%	$12,136,571	9%	$15,955,070	12%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)]	($23,743,666)	-25%	$3,366,835	3%	$2,753,749	2%
(10a) Premium per Member Month [(5)/(2)]	$294		$303		$289
(10b) Premium Trend [(10a)/(10a prior year)-1]	-3%		5%		-3%
(11a) Claims per Member Month [(6)/(2)]	$256		$267		$249
(11b) Claims Trend [(11a)/(11a prior year)-1]	-4%		7%		11%
Source: Rule Chapter 945 Long Form Small Group and Dirigo Small Group Totals.

 

Small Group
Anthem Health Plans of ME Inc
Insurer	2011		2010		2009
	Amount	% of Premium	Amount	% of Premium	Amount	% of Premium
(1) Number of Covered Lives, Dec. 31	47,614		50,765		47,383
(2) Member Months During Year	573,108		583,112		584,390
(3) Number of Contracts issued during year	2,954		2,968		3,237
(4) Number of contracts issued during year covering policyholders that were uninsured for the prior 90 days	440		387		418
(5) Premiums Earned	$214,557,142	100%	$210,933,205	100%	$207,912,903	100%
(6) Claims Incurred	$176,996,063	82%	$170,897,672	81%	$177,106,931	85%
(7) Increase in Policy Reserves	$0	0%	$0	0%	$0	0%
(8) Administrative Expenses	$27,017,058	13%	$26,023,964	12%	$26,740,599	13%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)]	$10,544,021	5%	$14,011,569	7%	$4,065,373	2%
(10a) Premium per Member Month [(5)/(2)]	$374		$362		$356
(10b) Premium Trend [(10a)/(10a prior year)-1]	3%		2%		3%
(11a) Claims per Member Month [(6)/(2)]	$309		$293		$303
(11b) Claims Trend [(11a)/(11a prior year)-1]	5%		-3%		7%
Source: Rule Chapter 945 Long Form Small Group and Dirigo Small Group Totals.

 

Small Group
Connecticut General Life Ins Co
Insurer	2011		2010		2009
	Amount	% of Premium	Amount	% of Premium	Amount	% of Premium
(1) Number of Covered Lives, Dec. 31	14		27		9
(2) Member Months During Year	292		348		135
(3) Number of Contracts issued during year	1		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	$146,770	100%	$143,631	100%	$112,650	100%
(6) Claims Incurred	$74,379	51%	$91,504	64%	$168,412	150%
(7) Increase in Policy Reserves	$0	0%	$0	0%	$0	0%
(8) Administrative Expenses	$11,790	8%	$9,485	7%	$8,878	8%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)]	$60,601	41%	$42,642	30%	($64,640)	-57%
(10a) Premium per Member Month [(5)/(2)]	$503		$413		$834
(10b) Premium Trend [(10a)/(10a prior year)-1]	22%		-51%
(11a) Claims per Member Month [(6)/(2)]	$255		$263		$1,247
(11b) Claims Trend [(11a)/(11a prior year)-1]	-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	2011		2010		2009
	Amount	% of Premium	Amount	% of Premium	Amount	% of Premium
(1) Number of Covered Lives, Dec. 31	17,021		13,324		11,205
(2) Member Months During Year	185,740		138,004		131,618
(3) Number of Contracts issued during year	1,437		2,158		1,617
(4) Number of contracts issued during year covering policyholders that were uninsured for the prior 90 days	22		11		0
(5) Premiums Earned	$74,791,858	100%	$57,841,244	100%	$51,954,592	100%
(6) Claims Incurred	$62,889,374	84%	$46,546,338	80%	$46,670,374	90%
(7) Increase in Policy Reserves	$0	0%	$0	0%	$0	0%
(8) Administrative Expenses	$9,425,936	13%	$8,452,290	15%	$6,563,694	13%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)]	$2,476,548	3%	$2,842,615	5%	($1,279,476)	-2%
(10a) Premium per Member Month [(5)/(2)]	$403		$419		$395
(10b) Premium Trend [(10a)/(10a prior year)-1]	-4%		6%		7%
(11a) Claims per Member Month [(6)/(2)]	$339		$337		$355
(11b) Claims Trend [(11a)/(11a prior year)-1]	0%		-5%		11%
Source: Rule Chapter 945 Long Form Small Group and Dirigo Small Group Totals.

 

Small Group
Mega Life & Health Ins Co
Insurer	2011		2010		2009
	Amount	% of Premium	Amount	% of Premium	Amount	% of Premium
(1) Number of Covered Lives, Dec. 31	1,351		1,560		1,759
(2) Member Months During Year	17,072		18,625		22,559
(3) Number of Contracts issued during year	1		3		0
(4) Number of contracts issued during year covering policyholders that were uninsured for the prior 90 days	0		0		0
(5) Premiums Earned	$3,086,969	100%	$3,639,783	100%	$4,393,110	100%
(6) Claims Incurred	$2,931,468	95%	$2,558,030	70%	$3,365,547	77%
(7) Increase in Policy Reserves	($30,016)	-1%	($502,267)	-14%	$239,987	5%
(8) Administrative Expenses	962,452	31%	$855,444	24%	$1,073,683	24%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)]	($776,935)	-25%	$728,576	20%	($286,107)	-7%
(10a) Premium per Member Month [(5)/(2)]	$181		$195		$195
(10b) Premium Trend [(10a)/(10a prior year)-1]	-7%		0%		-3%
(11a) Claims per Member Month [(6)/(2)]	$172		$137		$149
(11b) Claims Trend [(11a)/(11a prior year)-1]	25%		-8%		20%
Source: Rule Chapter 945 Long Form Small Group and Dirigo Small Group Totals.

 

Small Group
United Healthcare Ins Co
Insurer	2011		2010		2009
	Amount	% of Premium	Amount	% of Premium	Amount	% of Premium
(1) Number of Covered Lives, Dec. 31	554		284		300
(2) Member Months During Year	6,370		3,380		3,930
(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	$2,800,817	100%	$1,401,495	100%	$1,120,941	100%
(6) Claims Incurred	$1,876,789	67%	$867,018	62%	$757,518	68%
(7) Increase in Policy Reserves	$27,767	1%	$11,870	1%	$12,412	1%
(8) Administrative Expenses	$760,441	27%	$308,329	22%	$269,026	24%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)]	$135,820	5%	$214,277	15%	$81,985	7%
(10a) Premium per Member Month [(5)/(2)]	$440		$415		$285
(10b) Premium Trend [(10a)/(10a prior year)-1]	6%		45%		2%
(11a) Claims per Member Month [(6)/(2)]	$295		$257		$193
(11b) Claims Trend [(11a)/(11a prior year)-1]	15%		33%		3%
Source: Rule Chapter 945 Long Form Small Group and Dirigo Small Group Totals.

 

Small Group
All Other Companies
Insurer	2011		2010		2009
	Amount	% of Premium	Amount	% of Premium	Amount	% of Premium
(1) Number of Covered Lives, Dec. 31
(2) Member Months During Year
(3) Number of Contracts issued during year
(4) Number of contracts issued during year covering policyholders that were uninsured for the prior 90 days
(5) Premiums Earned	$1,746,406	100%	$2,598,417	100%	$1,725,253	100%
(6) Claims Incurred	$958,288	55%	$1,148,963	44%	$1,159,866	67%
(7) Increase in Policy Reserves	($15,613)	-3%	$15,271	1%	($23,142)	-1%
(8) Administrative Expenses	$572,665	33%	$564,082	22%	$456,319	26%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)]	$231,065	13%	$870,100	33%	$132,210	8%
(10a) Premium per Member Month [(5)/(2)]
(10b) Premium Trend [(10a)/(10a prior year)-1]
(11a) Claims per Member Month [(6)/(2)]
(11b) Claims Trend [(11a)/(11a prior year)-1]
Source: Rule Chapter 945 Long Form Small Group and Dirigo Small Group Totals for companies who are not displayed in the tables above. In addition, this table includes aggregate data for companies reporting on Rule Chapter 945 Short Form for Large Groups. Note: Some of the lines are left blank because companies reporting on the Short form are not required to complete them.

 

Small Group Grand Totals
Insurer	2011		2010		2009
	Amount	% of Premium	Amount	% of Premium	Amount	% of Premium
(1) Number of Covered Lives, Dec. 31	93,018		97,712		99,143
(2) Member Months During Year	1,105,503		1,172,184		1,189,865
(3) Number of Contracts issued during year	4,747		5,511		5,698
(4) Number of contracts issued during year covering policyholders that were uninsured for the prior 90 days	556		495		418
(5) Premiums Earned	$390,376,564	100%	$406,333,843	100%	$396,567,885	100%
(6) Claims Incurred	$327,323,239	84%	$336,382,190	83%	$340,441,488	86%
(7) Increase in Policy Reserves	($2,249)	0%	($475,126)	0%	($343,965)	0%
(8) Administrative Expenses	$74,359,184	19%	$48,350,164	12%	$51,067,268	13%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)]	($11,072,546)	-1%	$22,076,615	5%	$5,403,094	1%
(10a) Premium per Member Month [(5)/(2)]	$353		$347		$333
(10b) Premium Trend [(10a)/(10a prior year)-1]	2%		4%		-3%
(11a) Claims per Member Month [(6)/(2)]	$296		$287		$286
(11b) Claims Trend [(11a)/(11a prior year)-1]	3%		0%		3%
Source: Rule Chapter 945 Aggregate Long Form Small Group and Dirigo Small Group Totals. Note: The Covered Lives total, the Contracts Issued total, and the total number of contracts issued during the year covering policyholders that were uninsured for the prior 90 days does not include companies reporting less than $2 million in premium. These companies are not required to report those figures.

 

Individual
Aetna (Aetna Health Inc + Aetna Life Ins Co)
Insurer	2011		2010		2009
	Amount	% of Premium	Amount	% of Premium	Amount	% of Premium
(1) Number of Covered Lives, Dec. 31	38		45		52
(2) Member Months During Year	456		602		621
(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	3		0		0
(5) Premiums Earned	$171,649		$244,370	100%	$203,870	100%
(6) Claims Incurred	$750,259		$380,630	156%	$570,104	280%
(7) Increase in Policy Reserves	$122,888		$36,118	15%	$0	0%
(8) Administrative Expenses	$29,012		$61,932	25%	$30,628	15%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)]	($730,510)		($234,310)	-96%	($396,862)	-195%
(10a) Premium per Member Month [(5)/(2)]	$376		$406		$328
(10b) Premium Trend [(10a)/(10a prior year)-1]	-7%		24%		48%
(11a) Claims per Member Month [(6)/(2)]	$1,645		$632		$918
(11b) Claims Trend [(11a)/(11a prior year)-1]	160%		-31%		50%
Source: Rule Chapter 945 Long Form Individual and Dirigo Individual Totals.

 

Individual
Anthem Health Plans of ME Inc
Insurer	2011		2010		2009
	Amount	% of Premium	Amount	% of Premium	Amount	% of Premium
(1) Number of Covered Lives, Dec. 31	16,233		17,503		19,298
(2) Member Months During Year	201,259		220,711		243,617
(3) Number of Contracts issued during year	653		794		939
(4) Number of contracts issued during year covering policyholders that were uninsured for the prior 90 days	239		239		290
(5) Premiums Earned	$62,558,074	100%	$62,088,316	100%	$64,365,540	100%
(6) Claims Incurred	$56,232,983	90%	$54,400,212	88%	$60,428,948	94%
(7) Increase in Policy Reserves	$0	0%	($6,347,696)	-10%	$6,347,696	10%
(8) Administrative Expenses	$6,874,232	11%	$6,720,874	11%	$6,974,880	11%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)]	($549,141)	-1%	$7,314,926	12%	($9,385,984)	-15%
(10a) Premium per Member Month [(5)/(2)]	$311		$281		$264
(10b) Premium Trend [(10a)/(10a prior year)-1]	10%		6%		4%
(11a) Claims per Member Month [(6)/(2)]	$279		$246		$248
(11b) Claims Trend [(11a)/(11a prior year)-1]	13%		-1%		15%
Source: Rule Chapter 945 Long Form Individual and Dirigo Individual Totals.

 

Individual
Connecticut General Life Ins Co
Insurer	2011		2010		2009
	Amount	% of Premium	Amount	% of Premium	Amount	% of Premium
(1) Number of Covered Lives, Dec. 31	4		6		0
(2) Member Months During Year	44		72		0
(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	$40,462	100%	$40,030	100%	$0
(6) Claims Incurred	$26,665	66%	$46,957	117%	$0
(7) Increase in Policy Reserves	$0	0%	$0	0%	$0
(8) Administrative Expenses	$3,069	8%	$2,734	7%	$0
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)]	$10,728	27%	($9,661)	-24%	$0
(10a) Premium per Member Month [(5)/(2)]	$920		$556
(10b) Premium Trend [(10a)/(10a prior year)-1]	65%
(11a) Claims per Member Month [(6)/(2)]	$606		$652
(11b) Claims Trend [(11a)/(11a prior year)-1]	-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	2011		2010		2009
	Amount	% of Premium	Amount	% of Premium	Amount	% of Premium
(1) Number of Covered Lives, Dec. 31	4,924		4,963		6,088
(2) Member Months During Year	60,070		62,186		81,631
(3) Number of Contracts issued during year	3,224		3,293		3,895
(4) Number of contracts issued during year covering policyholders that were uninsured for the prior 90 days	0		0
(5) Premiums Earned	$37,611,012	100%	$38,262,645	100%	$47,821,277	100%
(6) Claims Incurred	$34,890,338	93%	$31,432,220	82%	$38,387,454	80%
(7) Increase in Policy Reserves	0	0%	$0	0%	$0	0%
(8) Administrative Expenses	$5,396,131	14%	$3,239,048	8%	$3,148,997	7%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)]	($2,675,457)	-7%	$3,591,377	9%	$6,284,826	13%
(10a) Premium per Member Month [(5)/(2)]	$626		$615		$586
(10b) Premium Trend [(10a)/(10a prior year)-1]	2%		5%		13%
(11a) Claims per Member Month [(6)/(2)]	$581		$505		$470
(11b) Claims Trend [(11a)/(11a prior year)-1]	15%		7%		0%
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	2011		2010		2009
	Amount	% of Premium	Amount	% of Premium	Amount	% of Premium
(1) Number of Covered Lives, Dec. 31	12,513		12,969		12,607
(2) Member Months During Year	149,241		133,794		139,755
(3) Number of Contracts issued during year	2,339		2,263		3,440
(4) Number of contracts issued during year covering policyholders that were uninsured for the prior 90 days	1403		272		0
(5) Premiums Earned	$32,778,911	100%	$30,384,463	100%	$25,818,266	100%
(6) Claims Incurred	$22,913,942	70%	$18,616,519	61%	$16,652,464	64%
(7) Increase in Policy Reserves	$875,283	3%	$224,829	1%	$629,368	2%
(8) Administrative Expenses	$9,276,139	28%	$8,741,654	29%	$10,162,300	39%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)]	($286,453)	-1%	$2,801,461	9%	($1,625,866)	-6%
(10a) Premium per Member Month [(5)/(2)]	$220		$227		$185
(10b) Premium Trend [(10a)/(10a prior year)-1]	-3%		23%		6%
(11a) Claims per Member Month [(6)/(2)]	$154		$139		$119
(11b) Claims Trend [(11a)/(11a prior year)-1]	10%		17%		10%
Source: Rule Chapter 945 Long Form Individual and Dirigo Individual Totals.

 

Individual
All other companies
Insurer	2011		2010		2009
	Amount	% of Premium	Amount	% of Premium	Amount	% of Premium
(1) Number of Covered Lives, Dec. 31
(2) Member Months During Year
(3) Number of Contracts issued during year
(4) Number of contracts issued during year covering policyholders that were uninsured for the prior 90 days
(5) Premiums Earned	$5,100,162	100%	$8,645,854	100%	$4,345,395	100%
(6) Claims Incurred	$2,499,369	49%	$3,367,320	39%	$3,547,684	82%
(7) Increase in Policy Reserves	($26,633)	-1%	$171,509	2%	$40,541	1%
(8) Administrative Expenses	$982,138	19%	$4,546,195	53%	$835,376	19%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)]	$1,645,288	32%	$560,831	6%	($80,067)	-2%
(10a) Premium per Member Month [(5)/(2)]
(10b) Premium Trend [(10a)/(10a prior year)-1]
(11a) Claims per Member Month [(6)/(2)]
(11b) Claims Trend [(11a)/(11a prior year)-1]
Source: Rule Chapter 945 Long Form Individual and Dirigo Individual for companies who are not displayed in the tables above. In addition, this table includes aggregate data for companies reporting on Rule Chapter 945 Short Form for Individual and Dirigo Individual.

 

Individual Grand Totals
Insurer	2011		2010		2009
	Amount	% of Premium	Amount	% of Premium	Amount	% of Premium
(1) Number of Covered Lives, Dec. 31	36,832		35,486		38,055
(2) Member Months During Year	431,782		417,365		465,725
(3) Number of Contracts issued during year	6,216		6,350		8,274
(4) Number of contracts issued during year covering policyholders that were uninsured for the prior 90 days	1645		511		290
(5) Premiums Earned	$133,160,108	100%	$139,665,678	100%	$142,590,961	100%
(6) Claims Incurred	$114,814,188	86%	$108,243,858	78%	$119,604,001	84%
(7) Increase in Policy Reserves	$998,171	1%	($5,915,240)	-4%	$7,017,605	5%
(8) Administrative Expenses	$21,578,583	16%	$23,312,436	17%	$21,152,181	15%
(9) Underwriting Gain or (Loss) [(5)-(6)-(7)-(8)]	($4,230,834)	-3%	$14,024,625	10%	($5,182,825)	-4%
(10a) Premium per Member Month [(5)/(2)]	$324		$335		$306
(10b) Premium Trend [(10a)/(10a prior year)-1]	-3%		9%		3%
(11a) Claims per Member Month [(6)/(2)]	$279		$259		$257
(11b) Claims Trend [(11a)/(11a prior year)-1]	8%		1%		4%
Source: Rule Chapter 945 Long Form Individual and Dirigo Individual Totals and Rule Chapter 945 Short Form Individual and Dirigo Individual Totals for Premiums Earned, Claims Incurred, Increase in Policy Reserves, Administrative Expenses, and Underwriting Gain or Loss. Note: The Covered Lives, the Contracts Issued, and the Number of Contracts Covering Previously Uninsured totals do not include companies reporting less than $2 million in premium. These companies are not required to report those figures.

 

 

 

 

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