2008 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. 2008 Enrollees as of December 31, 2008
	Totals		Large Group		Small Group		Individual
Insurers	2008	Change %	2008	Change %	2008	Change %	2008	Change %
Aetna Health Inc + Aetna Life Ins Co	71,837	10%	33,666	3%	38,126	17%	45	-35%
Anthem Health Plans of ME Inc	211,450	-11%	138,456	-4%	51,704	-19%	21,290	-30%
Cigna Healthcare of Me Inc + Connecticut General Life Ins Co	27,763	-7%	27,750	-7%	0	0%	13	-13%
Harvard Pilgrim Health Care Inc. and HPHC	34,487	46%	15,575	14%	11,091	10%	7,821	130250%
Mega Life & Health Ins Co	13,400	9%	0	0%	2,115	-17%	11,285	16%
United Healthcare Ins Co	2.252	-6%	1,754	-3%	498	-13%	0	0%
Total	361,189	-3%	217,201	-2%	103,534	-6%	40,454	0%

Note: Small Group and Individual include the DirigoChoice product. This product was sold through Anthem in 2007 and moved to Harvard Pilgrim in 2008. This accounts for the decrease in Individual for Anthem and the large increase for Harvard Pilgrim.

Percent of Enrollees by Company

Premiums

Premiums are the dollars paid by employers and employees and by individuals for insurance coverage.

Table 2. 2008 Premium
	Totals		Large Group		Small Group		Individual
Insurers	12/31/2008	Change %	12/31/2008	Change %	12/31/2008	Change %	12/31/2008	Change %
Aetna Health Inc + Aetna Life Ins Co	$278,628,101	17%	$154,913,707	14%	$123,583,562	22%	$130,832	25%
Anthem Health Plans of ME Inc	$928,388,393	-8%	$635,899,126	3%	$225,316,648	-20%	$67,172,619	-38%
Cigna Healthcare of Me Inc + Connecticut General Life Ins Co	$143,006,708	13%	$142,942,246	13%	$0	0%	$64,462	-17%
Harvard Pilgrim Health Care Inc. and HPHC	$151,925,919	74%	$46,007,999	-8%	$50,838,450	38%	$55,079,470	32372%
Mega Life & Health Ins Co	$27,025,064	14%	$0	0%	$5,475,463	-25%	$21,549,601	31%
United Healthcare Ins Co	$11,152,427	39%	$9,428,899	37%	$1,723,528	48%	$0	0%
All Other Companies	$9,248,451	-23%	$3,858,380	-34%	$1,572,883	-8%	$3,817,188	-14%
Totals:	$1,549,375,063	3%	$993,050,356	6%	$408,510,534	-5%	$147,814,172	14%

Note: Small Group and Individual include the DirigoChoice product. This product was sold through Anthem in 2007 and moved to Harvard Pilgrim in 2008. This accounts for the decrease in Small Group and Individual for Anthem and the increase for Harvard Pilgrim.

Premiums by Market Segment

Average Monthly Premium per Person

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. 2008 Average Monthly Premium per Person
	Large Group		Small Group		Individual
	2008	Change %	2008	Change %	2008	Change %
Aetna (Aetna Health Inc + Aetna Life Ins Co)	$387	9%	$282	-4%	$221	65%
Anthem Health Plans of ME Inc	$379	5%	$347	9%	$254	-19%
CIGNA (Cigna Healthcare of Me Inc + Connecticut General Life Ins Co)	$421	26%	$0	0%	$366	-13%
Harvard Pilgrim Health Care Inc.	$258	-19%	$370	12%	$519	-54%
Mega Life & Health Ins Co	$0	0%	$202	-8%	$174	4%
United Healthcare Ins Co	$452	31%	$279	-16%	$0	0%
Total	$380	8%	$324	5%	$299	6%

Note: The average premium is calculated by dividing the premium in Table 2 by the number of member months.

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 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 below the table shows the percentage of premiums paid for claims by market segment.

Table 4. 2008 Dollar Amount Spent on Claims and Percentage of Premium
	Totals	Large Group		Small Group		Individual
Insurers	2008 Claims	2008 Claims	% of Premium	2008 Claims	% of Premium	2008 Claims	% of Premium
Aetna	$218,836,364	$120,162,405	78%	$98,312,205	80%	$361,754	277%
Anthem	$802,806,193	$561,612,832	88%	$184,386,716	82%	$56,806,645	85%
CIGNA	$106,463,045	$106,420,444	74%	$0	0%	$42,601	66%
Harvard	$146,772,149	$53,107,244	115%	$43,811,855	86%	$49,853,050	91%
Mega	$16,740,513	$0	0%	$3,374,753	62%	$13,365,760	62%
United Healthcare	$8,793,931	$7,636,442	81%	$1,157,489	67%	$0	0%
All Other Insurers	$7,457,755	$3,690,585	96%	$1,026,661	65%	$2,740,510	72%
Total	$1,307,869,950	$852,629,952	86%	$332,069,679	81%	$123,170,320	83%

2008 Percent of Premium Paid for Claims

Average Monthly Claims per Person

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. 2008 Average Monthly Claims per Person
	Large Group		Small Group		Individual
	2008	% Change	2008	% Change	2008	% Change
Aetna (Aetna Health Inc + Aetna Life Ins Co)	$300	6%	$224	-5%	$610	97%
Anthem Health Plans of ME Inc	$335	7%	$284	13%	$215	-22%
CIGNA (Cigna Healthcare of Me Inc + Connecticut General Life Ins Co)	$313	11%	$0	0%	$242	-62%
Harvard Pilgrim Health Care Inc.	$298	8%	$319	6%	$470	-86%
Mega Life & Health Ins Co	$0	0%	$124	2%	$108	21%
United Healthcare Ins Co	$366	32%	$187	-29%	$0	0%
Total	$326	8%	$264	7%	$249	6%

Note: The average monthly claims are calculated by dividing the dollar amount spent on claims in Table 4 by the number of member months.

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. 2008 Amount for Administrative Expenses and Percentage of Premiums Paid for Administrative Expenses
	Totals	Large Group		Small Group		Individual
	2008	2008	% of Prem	2008	% of Prem	2008	% of Prem
Aetna	$38,291,349	$21,515,816	14%	$16,755,125	14%	$20,408	16%
Anthem	$76,704,024	$40,852,804	6%	$29,112,559	13%	$6,738,661	10%
CIGNA	$10,380,226	$10,380,226	7%	$0	0%	$0	0%
Harvard	$20,329,346	$8,518,459	19%	$6,592,694	13%	$5,218,193	9%
Mega	$11,456,216	$0	0%	$2,320,873	42%	$9,135,343	42%
United Healthcare	$1,914,550	$1,500,903	16%	$413,647	24%	$0	0%
All other Companies	$1,824,421	$474,199	12%	$490,322	31%	$859,900	23%
Total	$160,900,130	$83,242,406	8%	$55,685,219	14%	$21,972,505	15%

2008 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. 2008 Underwriting Gain/Loss
	Totals		Large Group		Small Group		Individual
	2008	% of Premium	2008	% of Premium	2008	% of Premium	2008	% of Premium
Aetna	$20,947,563	8%	$13,235,486	9%	$7,943,009	6%	-$230,932	-177%
Anthem Health Plans of ME Inc.	$48,898,302	5%	$33,449,188	5%	$11,818,516	5%	$3,630,598	5%
CIGNA	$26,163,437	18%	$26,141,576	18%	$0	0%	$21,861	34%
Harvard Pilgrim Health Care Inc.	-$15,175,576	-10%	-$15,617,704	-34%	$433,901	1%	$8,227	0%
Mega Life & Health Insurance Co.	-$2,407,729	-9%	$0	0%	$21,198	0%	-$2,428,927	-11%
United Healthcare Insurance Co.	$311,677	3%	$177,441	2%	$134,236	8%	$0	0%
All other Companies	$215,018	2%	-$159,105	-4%	$221,717	14%	$152,406	4%
Total	$78,952,692	5%	$57,226,882	6%	$20,572,777	5%	$1,153,233	1%

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/consumer/rule945reports.htm.

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