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(1)

H

EALTH

C

ARE

F

OUNDATION

california

Health Care Almanac

(2)

Health insurance carriers form the backbone of California’s market-based health care system, serving about two-thirds

of the state’s population. in addition to covering the privately insured, these companies also serve large portions of the

publicly insured, through Medi-Cal, Healthy families, Medicare, and other programs.

in California, oversight of health insurance is primarily the responsibility of two entities: the department of Managed

Health Care (dMHC) and the California department of insurance (Cdi). dMHC regulates health plans — health

maintenance organizations (HMos) and certain preferred provider organizations (PPos) — while Cdi has jurisdiction over

traditional fee-for-service health insurers and most PPos. different statutes and regulations govern carriers under the two

bodies. larger companies typically operate a carrier under each regulator, selling products under a common brand name.

drawing on comparable information from both regulators when available, this report gives an overview of market share,

enrollment, financial performance, consumer satisfaction, and pay-for-performance participation for California’s health

plans and insurers.

Key findings include:

five carriers accounted for three-fourths of the $100.8 billion health insurance revenues in California in 2009.

Since 2007, enrollment in both dMHC- and Cdi-regulated plans has fallen. the onset of recession may have been

a factor in the decline.

individual enrollment fell by 32 percent and group enrollment fell by 8 percent in the largest dMHC-regulated plans

during 2008 and 2009. these losses were partially offset by increases in public programs.

Cdi-regulated plans are becoming increasingly important sources of revenue and revenue growth, as illustrated

by anthem and Blue Shield. evidence points to an ongoing migration from carriers’ dMHC-regulated products to

their Cdi-regulated ones, which are generally slimmer, especially in the individual market where economic pressures

are strongest.

despite enrollment losses, most plans were profitable in 2009. all of the largest dMHC plans operated in the black,

as did almost all of the largest Cdi-regulated insurers.

over half of all Medi-Cal and more than one-third of Medicare beneficiaries are enrolled in managed care plans.

large majorities of HMo and PPo members rate their plan highly in terms of getting appointments quickly,

finding a doctor, and getting the care they need.

c o n t e n t s

overview . . . 3

financials . . . 9

enrollment . . . .17

Customer Satisfaction . . . .27

Pay for Performance . . . .32

data resources . . . .33

appendices . . . .34

(3)

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Employer

49%

9% self-insured

Medi-Cal

17%

8% enrolled in managed care

Medicare

9%

3% enrolled in managed care

Uninsured

19%

Other Public*

1%

Individual

6%

about two-thirds of

Californians have coverage

through health insurance

carriers. this includes

55 percent with

employer-based or individual private

insurance, as well as

11 percent who are enrolled

in medicare and medi-Cal

managed care plans.

*other public includes department of defense and Veterans administration coverage such as tri-Care.

notes: SCHip and individuals eligible for medicare and medi-Cal are included in medi-Cal. for the 9 percent of Californians covered by self-insured employers, carriers provide administrative services only. numbers may not add to 100 percent due to rounding.

Source: Kaiser family foundation, State Health facts, based on Census bureau’s Current population Survey, annual Social and economic Supplements, 2008 and 2009.

Health Insurance Coverage, by Source,

(4)

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Health

Net

10%

Aetna

4%

Anthem

Blue Cross

15%

Kaiser*

32%

PacifiCare

7%

Blue

Shield

10%

All Others

20%

United

2%

*Kaiser figures adjusted to reflect only California business.

†all others includes Connecticut General (CiGna), SCan, l.a. Care, Caloptima, Contra Costa Health plan, Care1st.

notes: Share computation based on: 1) total revenues from dmHC-regulated carriers; and 2) Cdi California direct premium revenues reported by Cdi for the “accident and Health” line of business. figures may not add to 100 percent due to rounding. unitedHealthcare, pacifiCare life and Health insurance Company, and pacifiCare of California are members of the same holding company.

Sources: department of managed Health Care (dmHC), Health plan financial Summary data; California department of insurance (Cdi): California Life and Annuity Market Share Report for Calendar Year 2009, exhibit 4d, and table no. 1b — Health California direct premiums Written, 2009.

Health insurance was a

$100.8 billion business

in California in 2009. five

players dominated the

state’s health insurance

market, accounting for

some three-fourths of

all revenues.

total:

$100.8 billion

dmHC: $83.5 billion

(distribution on page 7)

Cdi: $17.3 billion

(distribution on page 8)

All Health Insurance Carriers,

(5)

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department of

managed HealtH care

(dmHc)

california

department of insurance

(cdi)

number of health insurance carriers regulated, 2009

1,2

49

285

California revenues* regulated, 2009

1,2

$83.5 billion

$17.3 billion

Share of business represented by the largest 8 companies

(largest as determined by revenues)

87%

66%

total enrollees reported, 2009 (dmHC), 2008 (Cdi)

2,3

21.6 million

(~59% population)

2.4 million

(~7% population)

Share of individual market enrollment, 2008

4

48%

52%

Share of group market enrollment, 2008

4

91%

9%

primary types of health insurance products regulated

Hmos, two ppos,

vision, dental

medicare supplements,

most ppos, indemnity,

medicare part d standalone,

dental, stop-loss

*reflects total revenues for dmHC-regulated carriers and California premiums written for Cdi-regulated carriers for the “accident and Health” line of business.

notes: Certain anthem blue Cross and blue Shield ppo products are regulated by dmHC; others are regulated under Cdi. for additional details, see Making Sense of Managed Care Regulation in California, California HealthCare foundation, november 2001 (www.chcf.org). number of carriers under dmHC reflects full service plans enrollment at fiscal year-end 2009. Six additional dmHC plans did not have enrollment at this time: San miguel Health plan, premier, talbert Health plan, Choice physicians network, Golden State, Humana (all but talbert and San miguel had enrollees by the end of the first quarter 2010). also excluded from the count: the dmHC-licensed medical discount plan, association Health Care management, inc., dba family Care (enrollment 20,232 at december 31, 2009).

Sources: 1. Cdi reports: California Life and Annuity Market Share Report for Calendar Year 2009, exhibit 4d; table no. 1 — life California direct premiums Written, 2009; table no. 1b — Health California direct premiums Written, 2009.

2. dmHC, Health plan financial Summary data, full Service Health plans, 2009. 3. Cdi office of Communications, 2008 figure is the most recent available.

4. California Health benefits review board, table 1 — Health Care Coverage of Californians, 2008.

Health insurance carriers

are regulated either by the

department of managed

Health Care (dmHC) or

the California department

of insurance (Cdi). the

dmHC, which has more

comprehensive benefit

requirements, regulates

Hmos, while the Cdi

oversees most ppos and

traditional fee-for-service

plans.

(6)

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0

5

10

15

20

25

2009

2008

2007

2006

2005

2004

2003

1.2

23.0

1.4

22.6

2.1

22.3

2.2

22.0

2.8

22.2

2.4

21.8

N/A

21.6

CDI

DMHC

enrollment growtH

cdi

14.1%

49.2%

3.0%

26.7%

–12.0%

n/a

dmHc

–1.7%

–1.3%

–1.4%

1.0%

–2.1%

–0.7%

notes: percentage growth may not compute precisely from rounded figures shown. dmHC enrollment totals are estimated to be consistently overstated by some 600,000 to 1 million medi-Cal enrollees each year (800,000 in 2009) because some plans contract enrollment out to other plans. Cdi enrollment data for 2009 were not available.

Sources: California department of insurance (Cdi) public affairs office; department of managed Health Care (dmHC) Health plan financial Statement Summary data.

in 2008, enrollment in

both dmHC and Cdi plans

declined. the onset of the

recession at the end of 2007

may have been a factor in

the decline.

in millions

Health Insurance Carrier Enrollment Trends,

(7)

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PacifiCare

8%

($7.1)

Health Net

11%

($8.8)

Blue Shield

10%

($8.5)

Anthem

Blue Cross

13%

($11.1)

Kaiser*

39%

($32.5)

All Others

13%

($10.6)

SCAN

2%

($1.7)

L.A. Care

1%

($1.2)

Aetna

2%

($1.9)

in millions

total:

$83.5 billion

Kaiser had by far the largest

total revenues, consistent

with an enrollment nearly

twice that of the next-largest

dmHC-regulated carrier.

other factors, including

the possibility of more

comprehensive benefits,

may also contribute to its

revenue share.

*Kaiser figures adjusted to reflect only California business.

†all others consists of 41 plans, including Heritage, Caloptima, Cigna, Care1st, inland empire, Caremore, molina, primecare, and Central California alliance. See appendix d for more detail. notes: in addition to enrollment, other factors influencing revenue for health plans include comprehensiveness and price of products sold, enrollment levels in medicare advantage, and whether copays are also plan revenues, as in the case of staff model Hmos. figures may not add to 100 percent due to rounding.

Source: department of managed Health Care (dmHC) Health plan financial Summary data.

DMHC-Regulated Health Plans,

(8)

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Blue

Shield

7%

($1,230)

Aetna

10%

($1,659)

Anthem

Blue Cross

25%

($4,283)

United*

10%

($1,673)

All Others

34%

($5,875)

Health Net

6%

($1,087)

Metropolitan

4%

($636)

CT General

(CIGNA)

3%

($591)

PacifiCare*

2%

($267)

‡not shown.

in millions

total:

$17.3 billion

*unitedHealthcare and pacifiCare belong to the same parent company, united Health Group.

†all others comprises 278 smaller carriers (as determined by their presence in California), including Guardian life, american family life, unum life, and Humana, each writing less than $500 million in premiums in California.

note: figures may not add to 100 percent due to rounding.

Source: Cdi reports: California Life and Annuity Market Share Report for Calendar Year 2009, exhibit 4d; financial reports, table no. 1b — Health California direct premiums Written, 2009.

anthem blue Cross is the

dominant Cdi-regulated

insurer, with over twice the

premium revenue of any

competitor. blue Shield,

aetna, and anthem have

increased their share of

the market in the last two

years.

With the top plans

accounting for about

two-thirds of the revenue, the

Cdi-regulated market is less

concentrated than dmHC’s.

CDI-Regulated Health Insurers,

(9)

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-4

-2

0

2

4

6

8

10

L.A. Care

Blue Shield

Health Net

Aetna

Anthem Blue Cross

PacifiCare

Kaiser

5.8%

–2.1%

4.9%

4.2%

3.2%

4.5%

6.1%

2.6%

4.0%

6.3%

6.4%

2.5%

2.3%

1.3%

2.0%

9.0%

2.1%

1.7%

–1.3%

– 0.3%

0.7%

2007

2008

2009

in 2009, all large plans

posted positive net income,

all below 5 percent. earnings

margins improved for five of

the seven largest plans.

notes: net income is an after-tax figure. Kaiser data reflect multi-state business. all figures reflect fiscal year end results. largest plans were selected on the basis of enrollment at december, 2009. Source: department of managed Health Care (dmHC) Health plan financial Summary data.

Net Income/Loss as a Percent of Total Revenue,

(10)

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-10

-5

0

5

10

15

20

25

30

Blue Shield

Anthem Blue Cross

Health Net

Aetna

United

Connecticut General (CIGNA)

PacifiCare

18.8%

25.5%

25.1%

9.8%

<0.1%

8.7%

7.6%

5.7%

5.5%

9.9%

6.6%

5.4%

2.4%

1.0%

4.5%

10.9%

5.0%

4.0%

4.7%

0.4%

–5.1%

2007

2008

2009

*pacifiCare’s 2009 royalty income of $133 million from Secure Horizons and pacifiCare service marks exceeded its net income of $121 million. pacificare has been been owned by united’s parent since december 2005.

margins declined for most

Cdi-regulated insurers

from 2008 to 2009, with

one company, blue Shield,

posting a loss. pacifiCare’s

earnings resulted from

significant non-premium

revenues.*

notes: net income is an after tax-figure; margin computed as line 35/line 9, Summary of operations. anthem blue Cross and blue Shield figures represent California business only; results for other insurers include business in multiple states.

Source: California department of insurance (Cdi), insurers’ annual Statements, 2007–2009.

Net Income/Loss as a Percent of Total Revenue,

(11)

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CDI

DMHC

Anthem Blue Cross

Blue Shield

0

4

8

12

16

2009

2008

2007

2006

2005

2004

2003

2009

2008

2007

2006

2005

2004

2003

1.8

10.6

2.3

11.4

2.8

11.5

3.4

11.7

3.8

11.2

4.3

11.1

1.4

10.1

<0.1

6.1

0.1

6.8

0.2

7.5

0.3

7.9

0.5

8.1

0.8

8.1

1.2

8.5

cdi as a percent of total revenue

12%

15%

17%

20%

22%

26%

28%

1%

1%

3%

4%

6%

9%

13%

in billions

Revenue for Selected Carriers,

DMHC and CDI, 2003 to 2009

notes: Carriers under Cdi refers to blue Shield of California life and Health insurance Company and anthem blue Cross life and Health insurance Company. Carriers under dmHC refers to California physicians’ Service, dba blue Shield of California and blue Cross of California, dba anthem blue Cross. revenues reflect California accident and health premiums written for Cdi-regulated insurers and total revenues for dmHC-Cdi-regulated plans. percentage growth may not compute precisely from rounded figures shown.

Source: department of managed Health Care, Health plan financial Summary data; California department of insurance, California Life and Annuity Market Share Report, 2003–2009, exhibit 4d.

Cdi-regulated plans are

becoming increasingly

important sources of

revenue and revenue

growth, as illustrated by

anthem and blue Shield.

evidence points to an

ongoing migration from

carriers’ dmHC-regulated

products to their

Cdi-regulated ones, which are

generally slimmer, especially

in the individual market

where economic pressures

are strongest.

(12)

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CDI

DMHC

-40

-30

-20

-10

0

10

20

30

40

50

60

PacifiCare

Anthem Blue Cross

Health Net

Blue Shield

L.A. Care

Kaiser

Aetna

-40

-30

-20

-10

0

10

20

30

40

50

60

PacifiCare

Connecticut General (CIGNA)

Health Net

Anthem Blue Cross

United

Aetna

Blue Shield

21%

7%

23%

10%

–1%

12%

3%

2%

11%

3%

<1%

5%

13%

10%

3%

2%

–4%

–1%

8%

–5%

–7%

59%

60%

61%

24%

24%

23%

40%

12%

17%

20%

13%

12%

21%

6%

4%

32%

15%

–13%

–24%

–37%

–34%

2007

2008

2009

notes: figures reflect total revenue for dmHC-regulated carriers. for Cdi-regulated carriers, revenues reflect accident and Health direct premiums written in California (Schedule t). all figures shown represent revenue growth in California, except Kaiser, whose figures include multi-state activity. largest plans were selected on the basis of enrollment at december, 2009. Sources: department of managed Health Care (dmHC), Health plan financial Summary data; California department of insurance (Cdi), insurers’ annual Statements.

Generally, revenue growth

has been faster under

Cdi-regulated plans. for some

carriers, revenues under

dmHC regulation have

been shrinking. pacifiCare’s

revenue has contracted

under both regulators.

Revenue Growth/Contraction,

(13)

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0

20

40

60

80

100

CT General

(CIGNA)

United

PacifiCare

Kaiser

Health Net

Blue Shield

Anthem

Blue Cross

Aetna

N/A

N/A

78%

84%

87%

88%

85%

88%

88%

81%

79%

94%

83%

97%

85%

86%

DMHC

CDI

notes: Medical care costs as a share of premium are referred to as “loss ratios.” the loss ratio for accident and health business, as computed in Cdi annual statements: incurred claims and cost containment expenses plus increase in contract reserves divided by premiums earned (schedule H, line (5+6)/line 2; five-Year Historical data; anthem figure only from accident and Health Policy experience exhibit). “Medical loss ratio” as computed under dMHC: total medical and hospital expenses divided by operating revenues; line 24 divided by the sum of lines 1 to 7 from report #2 of dMHC financial reporting form. loss ratios for Kaiser and for three Cdi-regulated insurers (Health net, PacifiCare, and aetna) reflect multi-state activity. see Appendix F for loss ratios from 2003 to 2008 Ytd. figures aggregate across lines of business, such as group and individual.

sources: department of Managed Health Care (dMHC), Health Plan financial summary data; California department of insurance (Cdi), insurers’ annual statements.

Medical care costs as

a percent of premium

revenues vary. they are

influenced by factors such

as risk levels, health plan

profitability, tax status,

administrative efficiency,

and medical practice

patterns. Most of the

large dMHC-regulated

plans spend more of their

premium dollar on medical

care than do large

Cdi-regulated plans.

(14)

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0

20

40

60

80

100

Blue Shield

Anthem Blue Cross

Blue Shield

Anthem Blue Cross

Blue Shield

Anthem Blue Cross

67%

67%

72%

70%

70%

69%

69%

76%

80%

68%

82%

96%

74%

77%

82%

69%

81%

95%

2007

2008

2009

Individual

Small Group

All Groups

anthem blue Cross and

blue Shield spent less of the

premium dollar on medical

care for individual coverage

than small group insurance.

loss ratios have climbed for

most of these insurers and

product lines in 2009.

note: loss ratios are for comprehensive medical insurance: incurred claims plus change in contract reserves divided by premiums earned. Source: California department of insurance (Cdi), insurers’ annual Statements (accident and Health policy experience exhibit).

Loss Ratios for Selected Individual and Group Products,

(15)

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0

6

12

18

24

30

Aetna*

CT General (CIGNA)*

United*

PacifiCare*

Health Net*

Anthem Blue Cross

Blue Shield

L.A. Care

Kaiser

PacifiCare

Aetna

Health Net

Anthem Blue Cross

Blue Shield

11.3%

10.2%

10.0%

9.6%

6.6%

4.2%

4.1%

21.7%

14.5%

13.9%

13.3%

8.9%

8.0%

6.4%

DMHC

CDI

*figures reflect multi-state business.

notes: administrative percentages reflect the share of revenues spent on administrative expenses. “administrative ratio” as reported by dmHC: total administration expenses / total revenue. “insurance expense percent” as reported on Cdi filing, five Year Historical data (line 60 for all carriers except anthem; line 8/line 5 for anthem’s Health filing version of the document). Sources: department of managed Health Care (dmHC), Health plan financial Summary data; California department of insurance (Cdi), insurers’ annual Statements.

the administrative ratio

is the share of revenues

spent on activities such

as contracting with

providers, processing

claims, marketing, and

commissions. Higher ratios

can reflect inefficiencies

or a small premium base

over which to spread

administrative costs.

(16)

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PacifiCare*

United*

Anthem

Blue Cross

Health

Net*

CT General

(CIGNA)*

Aetna*

Aetna

Anthem

Blue Cross

PacifiCare

Health

Net

0.9%

0.9%

1.3%

2.7%

3.1%

16.4%

2.7%

4.0%

4.7%

5.2%

DMHC

CDI

*figures reflect multi-state business.

notes: Cdi-regulated insurers: blue Shield paid no dividend. dmHC-regulated plans: nonprofits Kaiser and blue Shield paid no dividends in 2009.

Source: department of managed Health Care (dmHC), Health plan financial reporting forms; California department of insurance (Cdi), insurers’ annual Statements.

in 2009, dividends to

stockholders in California’s

major carriers ranged from

zero to 16 percent.

(17)

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0

1

2

3

4

5

6

7

8

2010

2009

2008

2007

2006

2005

2004

2003

Kaiser

All Others

Anthem Blue Cross

Blue Shield

Health Net

PacifiCare

L.A. Care

Aetna

+206k (+3%)

+255k (+6%)

–1.2 million

(–25%)

–100k (–4%)

–76k (–3%)

–611k (–36%)

+15k (+2%)

+78k (+21%)

All Plans

–1.4 million (–6%)

RECESSION ERA

total enrollment

(in millionS)

cHange since 2003

notes: plans shown are full-service dmHC plans with over 450,000 enrollees as of year-end 2009. pacifiCare reports merger-related activities have led to enrollment transfers to unitedHealthcare; pacifiCare enrollment declined 17 percent in 2009 and 32 percent since year-end 2007. largest plans were selected on the basis of enrollment at december, 2009.

Sources: department of managed Health Care (dmHC), Health plan financial Summary data. national bureau of economic research.

enrollment in

dmHC-regulated plans has dropped

6 percent since the end of

2003 — a loss of 1.4 million

enrollees. the largest seven

dmHC plans lost 9 percent

of their enrollment in

this period, while smaller

plans, which include many

county-based plans serving

medi-Cal, grew. enrollment

losses may be attributed

to recession, post-merger

activity, and migration to

Cdi-regulated plans.

Enrollment Trends in DMHC-Regulated Plans,

(18)

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2008

2009

-800000

-700000

-600000

-500000

-400000

-300000

-200000

-100000

0

100000

Other

Medi-Cal

and Other Public

Medicare

Group

Individual

–185,461

–340,035

88,012

48,490

–130,113

–633,671

41,518

68,583

–13,836

9,415

1.2

8.5

overall cHange

(year-end 2007 to year-end 2009)

– 32%

– 8%

+ 9%

+ 4%

– 4%

notes: Some, but not all of these losses were offset by gains in the Cdi sector (see page 20 of this publication). other factors, such as a shift to self-insurance and “administrative services only” from carriers can also affect the accounting of enrollment. other public includes Healthy families, Healthy Kids, and aim. the seven largest plans reflected here are: aetna, anthem blue Cross, blue Shield, Health net, Kaiser, l.a. Care, and pacifiCare. largest plans were selected on the basis of enrollment at december, 2009.

Source: department of managed Health Care (dmHC), Health plan financial Summary data and report #4.

the seven largest plans

lost 1.3 million commercial

enrollees during 2008 and

2009, while enrollment

in medicare and public

plans grew slightly.

the commercial losses

represented 32 percent

of individual enrollment

and 8 percent of group

enrollment.

Enrollment Gains/Losses,

(19)

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net cHange

individual

group

medicare

public

otHer

number perCent

aetna

67,855

1,774

13,907

83,536

22%

anthem blue Cross

–164,886

– 225,231

– 8,740

– 210,662

– 609,519 – 15%

blue Shield

– 92,518

55,558

84,536

15,873

– 62,339

1,110

0%

Health net

– 15,257

– 143,003

25,790

164,396

31,327

63,253

3%

Kaiser

– 35,550

– 258,716

44,090

69,021

47,554

– 133,601

– 2%

l.a. Care

380

78,445

– 34,870

43,955

6%

pacifiCare

– 7,363

– 470,169

– 18,300

– 495,832 – 32%

Total, Plans Shown

– 315,574

– 973,706

129,530

117,073

– 4,421 – 1,047,098

– 6%

notes: other includes plan-to-plan enrollment; Group includes small group, point of service, and administrative services only. (administrative services only accounted for 11 percent of anthem blue Cross’ and 24 percent of blue Shield’s dmHC group enrollment in 2009.) largest plans were selected on the basis of enrollment at december, 2009.

Source: department of managed Health Care (dmHC), Health plan financial Summary data and report #4.

most enrollment gains

were concentrated in the

public sector. anthem and

blue Shield accounted

for the bulk of individual

enrollment losses, and

pacifiCare accounted for

almost half of the losses in

group enrollment.

Source of Enrollment Gains/Losses,

(20)

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Group

Individual

Anthem Blue Cross

Blue Shield

0

280000

560000

840000

1120000

1400000

2009

2008

2007

2009

2008

2007

594,848

86,875

507,973

1,280,982

697,015

583,967

1,307,898

671,398

671,398

230,758

86,875

143,883

372,531

196,318

176,213

513,605

280,147

233,458

1.2

8.5

notes: reflects comprehensive major medical insurance enrollment; excludes administrative services only and administrative services contract enrollment of 2.84, 3.16, and 3.68 million for 2007, 2008, and 2009 respectively (anthem blue Cross). blue Shield reported no aSo enrollment under Cdi regulation.

Source: California department of insurance (Cdi), insurers’ annual Statements, “accident and Health policy experience exhibit for Year.”

individual purchasers

have been a major factor

in enrollment growth of

Cdi-regulated insurers.

individuals now account for

45 percent of blue Shield

and 51 percent of anthem.

under Cdi-regulation,

carriers can offer slimmer

products to the

price-sensitive individual market.

Enrollment Trends in Selected CDI-Regulated Insurers,

(21)

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Group

Individual

-300000

-250000

-200000

-150000

-100000

-50000

0

Kaiser

Blue Shield

Anthem

–254,764

–36,359

–253,351

–35,550

–169,673

–2,943

note: enrollment refers to comprehensive major medical insurance.

Sources: department of managed Health Care (dmHC), Health plan financial Summary data and report #4; California department of insurance (Cdi), insurers’ annual Statements, “accident and Health policy experience exhibit for Year.”

in California’s commercial

sector, growth in Cdi

products has not offset

losses in the

dmHC-regulated products.

anthem, blue Shield, and

Kaiser experienced net

commercial enrollment

losses across Cdi- and

dmHC-regulated insurance.

Commercial Enrollment Shifts,

(22)

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Fee-for-Service

65%

Medicare

Advantage

35%

Other Contracts

<1%

Fee-for-Service

76%

Medicare

Advantage

24%

Other Contracts

1%

California Medicare Eligibles

Total: 4.6 million

U.S. Medicare Eligibles

Total: 46 million

notes: under medicare advantage, health plans provide all medicare benefits in exchange for a capitated payment. other Contracts include “cost” contracts, which do not involve capitation, and paCe, the program of all inclusive Care for the elderly, an alternative to nursing home care. figures exclude pilot projects. Some fee-for-Service (ffS) beneficiaries also have medicare supplemental insurance. figures may not add to 100 percent due to rounding.

Source: Centers for medicare and medicaid Services, medicare advantage State/County penetration and medicare advantage enrollment by State/County/Contract, december 2009.

almost two-thirds of

California’s medicare

beneficiaries have

fee-for-service coverage, and over

one-third have medicare

advantage. California’s

35 percent participation

rate in medicare advantage

is higher than the national

average of 24 percent.

Medicare Advantage vs. Medicare Fee-for-Service,

(23)

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Health Net

8%

SCAN

7%

Kaiser

45%

United

21%

All

Others*

10%

Anthem

Blue Cross

4%

Aetna

3%

Blue Shield

3%

total enrollment:

1.62 million

*all others includes Caremore Health plan, inter Valley Health plan, Care 1st, Caloptima (orange County Health authority), Citizens Choice, Humana, Health plan of San mateo, Chinese Community Health plan, and 42 other carriers.

†united’s medicare advantage products are marketed under the name Secure Horizons by unitedHealthcare and encompass the former pacifiCare medicare advantage enrollment. note: figures may not add to 100 percent due to rounding.

Source: Centers for medicare and medicaid Services, medicare advantage enrollment by State/County/Contract, december 2009.

Kaiser and united together

cover two-thirds of all

medicare advantage

members in the state.

Medicare Advantage Enrollment,

(24)

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Fee-for-Service

47%

Health Net

9%

Anthem

Blue Cross

6%

L.A. Care

11%

Other

Managed

Care

12%

CalOptima

5%

Inland Empire

5%

Molina

2%

Central Coast Alliance

for Health

2%

*not shown.

total medi-cal:

7.21 million

managed care:

3.85 million

(53% of benefiCiarieS)

over half of all medi-Cal

beneficiaries are enrolled

in managed care. the

total pool of medi-Cal

beneficiaries rose 6 percent

in 2009.*

notes: Some medi-Cal managed care plans contract their enrollees out to other managed care plans. figures here reflect contracts between plans and the state. figures may not total 100 percent due to rounding. other managed Care is detailed on Slide 25.

Source: California department of Health Care Services, medi-Cal managed Care enrollment report, december 2009 (www.dhcs.ca.gov) and research and analytical Studies Section beneficiary data files, accessed June 2010 (www.dhcs.ca.gov).

Medi-Cal Fee-for-Service vs. Managed Care Enrollment,

(25)

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0

100000

200000

300000

400000

500000

600000

700000

800000

All Other Plans

Contra Costa Health Plan*

Health Plan of San Mateo*

Health Plan of San Joaquin*

CenCal*

Community Health Group

Alameda Alliance*

Santa Clara Family Health Plan*

Kern Family Health Care*

Partnership

Molina

Central California Alliance for Health*

CalOptima*

Inland Empire Health Plan

Anthem Blue Cross

Health Net

L.A. Care*

787,589

680,853

426,807

364,005

349,350

172,063

171,097

148,724

101,450

94,738

92,522

89,509

88,685

71,043

57,627

54,891

100,569

20%

18%

11%

9%

9%

4%

4%

4%

3%

2%

2%

2%

2%

2%

1%

1%

3%

*County plans. San francisco Health plan (included in all other plans) is also a county health plan.

notes: all other plans consists of Kaiser, 40,206; San francisco Health plan, 36,009; Western Health advantage, 13,451; Care1st, 10,049; positive Healthcare, 716; family mosaic project, 138. (family mosaic project is a specialty health plan operated by San francisco’s department of public Health, serving emotionally disturbed children at risk of out-of-home placement, and is not a dmHC licensee.) Some medi-Cal managed care plans contract their enrollees out to other managed care plans. figures here reflect contracts between plans and the state. Source: California department of Health Care Services, medi-Cal managed Care enrollment reports (www.dhcs.ca.gov).

County-level plans play a

major role in medi-Cal’s

expanding managed care

program, covering nearly

60 percent of the managed

care enrollees. the state

contracted for medi-Cal

managed care in 26 of

California’s 58 counties

in 2009.

Medi-Cal Managed Care Market Share and Enrollment,

(26)

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Anthem

Blue Cross

HMO

13%

Kaiser

18%

Health Net

16%

Anthem

Blue Cross

EPO

11%

Other

17%

CalOptima*

5%

Community

Health Group*

3%

Blue Shield HMO

6%

Inland Empire*

7%

Molina

5%

total enrollment:

882,432

*County plans. Some of those included under other are also county plans

notes: other includes Kern family Health Care, blue Shield epo (exclusive provider organization), Care1st, alameda alliance, San francisco Health plan, CenCal, l.a. Care, Health plan of San mateo, Contra Costa Health plan, and Ventura County Health plan. Healthy families is California’s vehicle for the State Children’s Health insurance program (SCHip) and, unlike medi-Cal, has no fee-for-service component.

Source: mrmib report: Healthy families program Current enrollment distribution by County and Health plan, January 5, 2010 (www.mrmib.ca.gov).

although some county

plans have sizable

enrollments, California’s

major commercial carriers

insure the majority of

Healthy families members.

together, Health net,

anthem, Kaiser, and blue

Shield cover 64 percent of

Healthy families enrollees.

Healthy Families Enrollment,

(27)

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0

10

20

30

40

50

60

70

80

Kaiser

South

Kaiser

North

PacifiCare

Aetna

CIGNA

HMO

Health Net

Anthem

HMO

Blue Shield

HMO

69%

68%

67%

70%

72%

73%

73%

73%

notes: percent of plan members who rated their health care 8, 9, or 10 on a scale of 10. differences of 4 percentage points or more should be considered meaningful. When there were an insufficient number of responses, no bar is shown.

Source: office of the patient advocate, 2009 surveys.

the majority of Hmo

members rated the care

in their plans highly.

(28)

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0

20

40

60

80

100

Anthem PPO

Aetna

Health Net

United

Health Net

Kaiser North

CIGNA HMO

Blue Shield HMO

Aetna

PacifiCare

Anthem HMO

80%

81%

81%

81%

81%

84%

85%

84%

85%

85%

86%

HMO

PPO

notes: percent of members who rated their plan 8, 9, or 10 on a scale of 10 on how quickly and easily they got care and service from their doctors and office staff. differences of 4 percentage points or more should be considered meaningful.

Source: office of the patient advocate, 2009 surveys.

more than three-fourths of

enrollees rated their plan

highly on access to care.

Getting Appointments and Care Quickly,

(29)

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0

20

40

60

80

100

Aetna

Anthem PPO

United

Health Net

Health Net

PacifiCare

Aetna

Kaiser North

Blue Shield HMO

Anthem HMO

69%

72%

73%

75%

76%

77%

74%

76%

77%

78%

HMO

PPO

notes: percent of members who rated their plan 8, 9, or 10 on a scale of 10 on how easy it was to find a personal doctor they are happy with. differences of 4 percentage points or more should be considered meaningful.

Source: office of the patient advocate, 2009 surveys.

many ppo and Hmo

enrollees rated their plans

similarly in terms of making

it easy to find a personal

doctor they are happy with.

Ease in Finding a Doctor They Are Happy With,

(30)

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0

20

40

60

80

100

United

Aetna

AnthemPPO

CIGNA PPO

Health Net

CIGNA HMO

PacifiCare

Kaiser North

Health Net

Aetna

Blue Shield HMO

Kaiser South

AnthemHMO

78%

80%

81%

82%

83%

83%

84%

84%

82%

86%

87%

88%

90%

HMO

PPO

notes: percent of members who rated their plan 8, 9, or 10 on a scale of 10 on helping them get the care they need. differences of 4 percentage points or more should be considered meaningful.

Source: office of the patient advocate, 2009 surveys.

the large majority of

enrollees rated their plan

highly for helping them

get the care they need.

Getting the Care They Need,

(31)

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0

1

2

3

4

5

PacifiCare

Kaiser

Health Net

Blue Shield

Anthem

Blue Cross

Aetna

138

935

799

368

1,809

219

Claims/Financial

Benefits/Coverage

Coordination of Care

Access

Attitude/Service of Health Plan

Attitude/Service of Provider

Enrollment

TOTAL NUMBER

OF COMPLAINTS*

Complaints Per 10k Members

*Companies with less than 500,000 enrollees were not charted. total complaints for smaller plans was 129, including inland empire (3), l.a. Care (3), and CiGna (42). note: largest plans were selected on the basis of enrollment at december, 2009.

Source: department of managed Health Care (dmHC), 2009 Complaint Results by Category and Health Plan.

the complaint process

provides another measure

of satisfaction. of the

large commercial plans,

Health net had the lowest

complaint rate.

Complaints Filed with DMHC,

(32)

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$0

$1

$2

$3

$4

$5

Anthem

Blue Cross

Blue Shield

Health Net

Aetna

United/

PacifiCare

CIGNA

Non-IHA Measures

IHA Measures

$1.02

$1.63

$1.70

$2.00

$2.27

$4.53

$0

$10

$20

$30

$40

$50

$60

$70

$80

total payment (in millions)

$3.0

$15.5

$7.4

$27.6

$29.5

$60.3

per member per montH

total payment

(in dollarS)

(in millionS)

notes: Kaiser Health plan participates in the clinical reporting of iHa measures, but not in the financial payouts. Source: integrated HealthCare association, transparency report on 2009 Health plan payouts.

major Hmos are using

performance measurement

and financial incentives to

enhance clinical quality,

patient experience, and

information technology.

plans make two types

of incentive payments:

those based on uniform

measurements adopted by

the integrated HealthCare

association (iHa), and those

based on plan-selected

criteria.

(33)

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California HealthCare foundation

1438 Webster Street, Suite 400

oakland, Ca 94612

510.238.1040

www.chcf.org

CA L I FOR N I A HEALTHCARE FOUNDATION

for more information

note: all links current as of September 16, 2010.

reGulatorS

california department of insurance (cdi)

insurance Company profiles, including financial Statements

www.insurance.ca.gov

insurance Company financial reports, 2009

www.insurance.ca.gov

table no. 1 – life California direct premiums Written, 2009

www.insurance.ca.gov

table no. 1b – Health California direct premiums Written, 2009

www.insurance.ca.gov

life and annuity market Share reports, 2003–2009

www.insurance.ca.gov

california department of managed Health care (dmHc)

Health plan information, including financial Statements

www.hmohelp.ca.gov

Health plan financial Statements

www.hmohelp.ca.gov

licensed plans list

www.hmohelp.ca.gov

Health plan financial Summary report

wpso.dmhc.ca.gov

independent medical review and Complaint results, 2009

www.hmohelp.ca.gov

centers for medicare and medicaid services

monthly medicare advantage enrollment,

by State/County/Contract

www.cms.gov

medicare advantage State/County penetration report

www.cms.gov

otHer State reSourCeS

california department of Health care services (dHcs)

medi-Cal beneficiary data files

www.dhcs.ca.gov

medi-Cal enrollment, by managed Care plan, 2009

www.dhcs.ca.gov

california Health benefits review board (cHbrp)

table 1: Health insurance Coverage of Californians, 2008

www.chbrp.org

california major risk medical insurance board (mrmib).

information for Healthy families, aid to infants and mothers

(aim), major risk medical insurance program (mrmip), 2010

www.mrmib.ca.gov

monthly board meetings minutes

(link to monthly enrollment for Healthy Families, AIM, and MRMIP)

www.mrmib.ca.gov

california office of the patient advocate

Health plan report Cards

opa.ca.gov

priVate reSourCeS

integrated Healthcare association (iHa)

financial transparency reports: pay for performance payouts

www.iha.org

Kaiser family foundation

State Health facts

www.statehealthfacts.org

(34)

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company grouping

under department of managed HealtH care

under california department of insurance

aetna

aetna Health of California, inc.

aetna life insurance Company

anthem blue Cross

blue Cross of California, dba anthem blue Cross

anthem blue Cross life and Health insurance Company

blue Shield

California physicians’ Service, dba blue Shield of California

blue Shield of California life and Health insurance Company

Careamerica life insurance Company*

CiGna

CiGna HealthCare of California

GemCare Health plan, inc.

Great-West Health plan, inc.

Connecticut General life insurance Company*

Health net

Health net of California, inc.

Health net life insurance Company

Kaiser

Kaiser foundation Health plan, inc. *

Kaiser permanente insurance Company*

unitedHealthcare

pacifiCare of California

pacifiCare life and Health insurance Company

unitedHealthcare insurance Company*

*multi-state activities are included in California regulatory filings.

†denotes entities paired under their company brand name in snapshot slides comparing or combining dmHC and Cdi carriers. note: largest plans were selected on the basis of enrollment at december, 2009.

Source: California department of insurance (Cdi): California life & annuity market Share report, 2009; annual Statements for the year ending 2009, Schedule Y.

(35)

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enrollment distribution

HealtH plan name

official HealtH plan name

administrative

office location

licensed

date

(enrollment)

siZe

medi-Cal, aim,

HealtHY familieS mediCare

plan

type

status

tax

aetna

aetna Health of California, inc.

Walnut Creek

8/6/81

455,470

0%

6%

b

p

alameda alliance

alameda alliance for Health

alameda

9/19/95

107,894

94%

2%

C

np

anthem blue Cross

1

blue Cross of California

thousand oaks

1/7/93

3,552,695

28%

7%

b

p

arcadian

arcadian Health plan, inc.

oakland

5/29/08

28,958

n/a

n/a

m

p

arta

arta medicare Health plan, inc.

San diego

3/17/06

426

0%

100%

m

n/a

blue Shield

2

California physicians' Service

San francisco

7/27/78

2,601,504

2%

5%

b

np

Caloptima

orange County Health authority

orange

6/28/00

400,504

97%

3%

C/b

np

Care1st

Care1st Health plan

monterey park

11/1/95

308,975

68%

4%

o

np

Caremore

Caremore Health plan

Cerritos

11/1/02

33,860

0%

100%

m

p

CenCal

Santa barbara San luis obispo regional Health authority

Goleta

6/22/00

98,785

97%

0%

C

np

Central California alliance for Health Santa Cruz-monterey-merced managed medical Care Community Scotts Valley

6/20/00

194,711

99%

0%

C

np

Central Health plan

Central Health plan of California, inc.

Covina

10/27/04

4,953

0%

100%

m

p

Chinese Community Health plan

Chinese Community Health plan

San francisco

7/31/87

13,765

0%

55%

o

p

CiGna

CiGna HealthCare of California, inc.

Glendale

3/23/79

212,965

0%

0%

o

p

CiGna pacific (previously Great-West)

CiGna HealthCare pacific, inc.

Glendale

3/22/96

13,086

0%

0%

o

p

Citizens Choice

Honored Citizens Choice Health plan, inc.

Cerritos

5/25/04

8,279

0%

100%

m

n/a

Community Health Group

Community Health Group

Chula Vista

8/30/85

115,685

99%

1%

C

np

Community Health plan

County of los angeles department of Health Services

alhambra

12/30/85

186,721

81%

0%

C

np

Contra Costa Health plan

Contra Costa County medical Services

martinez

4/6/78

81,847

72%

1%

C

np

easy Choice

easy Choice Health plan, inc.

newport beach

6/11/07

5,337

0%

100%

m

p

GemCare

GemCare Health plan, inc.

Glendale

3/22/96

6,467

0%

100%

m

n/a

Health net

Health net of California, inc.

Woodland Hills

2/7/97

2,161,960

45%

6%

b

p

Health plan of San Joaquin

San Joaquin County Health Commission

french Camp

1/30/96

101,066

88%

0%

C

np

Health plan of San mateo

San mateo Health Commission

South San francisco

7/31/98

76,162

81%

10%

C

np

1. includes 240,571 (7 percent of total) enrolled in administrative services only (aSo) contracts.

2. includes 564,836 (22 percent of total) enrolled in aSo contracts.

Key to plan types: b (big): 400,000 or more enrollees; m (medicare): 70 percent or more enrollees in medicare; C (medi-Cal): 70 percent or more enrollees in medi-Cal, Healthy families, aim; o (other): all others. plan types determined based on status at december 31, 2009. Status based on enrollment reports, disclosures, and footnotes filed in health plan financial reports to dmHC. Key to tax status: p: for profit; np: nonprofit or public health agency. not sHown: Six plans with no enrollment at december 31, 2009 (plan type and march 31, 2010 enrollment shown in parentheses): Choice physicians network (m: 3,544), Golden State (m: 252), Humana (m: 514), premier (m), San miguel Health plan (m), and talbert Health plans (o). also not shown: the sole dmHC-licensed medical discount plan, association Health Care management, inc., dba family Care (enrollment 20,232 at december 31, 2009). Source: department of managed Health Care (dmHC), annual financial reports of full service health plans and List of All Licensed Plans (6/14/2010); supplemental information on tax status from the California association of Health plans 2009 annual report.

(36)

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enrollment distribution

HealtH plan name

official HealtH plan name

administrative

office location

licensed

date

(enrollment)

siZe

medi-Cal, aim,

HealtHY familieS mediCare

plan

type

status

tax

Heritage*

Heritage provider network, inc.

northridge

n/a

455,846

3%

16%

b

p

inland empire

inland empire Health plan

San bernardino

7/22/96

430,871

98%

1%

C/b

np

inter Valley

inter Valley Health plan

pomona

5/25/79

12,208

0%

100%

m

np

Kaiser

Kaiser foundation Health plan, inc.

oakland

11/4/77

6,659,879

5%

11%

b

np

Kern family Health Care

Kern Health Systems

bakersfield

5/6/96

101,450

100%

0%

C

np

l.a. Care

local initiative Health authority for los angeles County

los angeles

4/1/97

816,496

97%

0%

C/b

np

md Care

md Care, inc.

los alamitos

7/6/07

7,245

0%

100%

m

n/a

medcore

medcore Hp

Stockton

6/26/02

2,098

m

n/a

molina

molina Healthcare of California

long beach

3/14/97

350,624

C

p

monarch

monarch Health plan

irvine

4/18/07

7,729

m

n/a

on lok

3

on lok Senior Health Services

San francisco

1/20/99

1,010

m/C

np

pacifiCare

pacifiCare of California

Cypress

5/15/78

1,070,639

0%

30%

b

p

partnership

partnership Healthplan of California

fairfield

11/4/05

156,413

96%

3%

C

np

positive Healthcare

aidS Healthcare foundation

long beach

12/1/05

1,404

51%

49%

o

n/a

primecare*

primeCare medical network, inc.

ontario

10/16/98

177,777

o

p

San francisco

San francisco Community Health authority

San francisco

5/23/05

57,561

75%

0%

C

np

Santa Clara family Health plan

Santa Clara County Health authority

Campbell

12/20/96

122,678

90%

3%

C

np

SCan

Scan Health plan

long beach

11/30/84

111,114

6%

94%

m

np

Scripps*

Scripps Health plan Services, inc.

San diego

4/7/99

35,854

o

n/a

Sharp

Sharp Health plan

San diego

9/18/92

47,406

o

np

Simnsa

Sistemas medicos nacionales, S.a.de C.V.

tijuana, mexico

1/31/00

20,283

o

p

universal Care

universal Care

Signal Hill

10/15/85

15,841

C

p

Valley Health plan

Santa Clara County

San Jose

9/13/85

71,426

C

np

Ventura County Health plan

County of Ventura

Ventura

6/6/96

13,491

27%

0%

o

np

Western

Western Health advantage

Sacramento

1/14/97

83,068

16%

2%

o

p

3. on lok operates under medicare and medicaid waivers as a prototype “program of all-inclusive Care for the elderly” (paCe), providing complete care to a nursing-home-certified population that remains in the community.

*limited license Knox-Keene act plan. permitted to assume full-risk for physician and hospital services, but contracts with other health plans for enrollment.

Key to plan types: b (big): 400,000 or more enrollees; m (medicare): 70 percent or more enrollees in medicare; C (medi-Cal): 70 percent or more enrollees in medi-Cal, Healthy families, aim; o (other): all others. plan types determined based on status at december 31, 2009. Status based on enrollment reports, disclosures, and footnotes filed in health plan financial reports to dmHC. Key to tax status: p: for profit; np: nonprofit or public health agency. not sHown: Six plans with no enrollment at december 31, 2009 (plan type and march 31, 2010 enrollment shown in parentheses): Choice physicians network (m: 3,544), Golden State (m: 252), Humana (m: 514), premier (m), San miguel Health plan (m), and talbert Health plans (o). also not shown: the sole dmHC-licensed medical discount plan, association Health Care management, inc., dba family Care (enrollment 20,232 at december 31, 2009). Source: department of managed Health Care (dmHC), annual financial reports of full service health plans and List of All Licensed Plans (6/14/2010); supplemental information on tax status from the California association of Health plans 2009 annual report.

(37)

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official HealtH plan name

name used in publication

(in millionS)

siZe

aetna life insurance Company

aetna

$1,659

anthem blue Cross life and Health Company

anthem blue Cross

$4,283

blue Shield of California life & Health insurance Company

blue Shield

$1,230

Connecticut General life insurance Company

§

Connecticut General (CiGna)

$591

Health net life insurance Company

Health net

$1,087

metropolitan life insurance Company

metropolitan

$636

pacifiCare life and Health insurance Company

pacifiCare

$267

unitedHealthcare insurance Company

united

$1,673

* Cdi-regulated companies selling accident and health insurance, with California direct accident and health premiums greater than $400 million, 2009. pacifiCare also

included due to its affiliation with unitedHealthcare. State-specific enrollment is not available for companies with multi-state filings. products include comprehensive major medical insurance, in addition to other products, such as dental, medicare supplement, part d — standalone, and stop-loss.

†in millions of dollars of California accident and health premiums. §Wholly owned subsidiary of CiGna.

Source: California department of insurance (Cdi) insurers’ annual Statements, Schedule t; accident and Health policy experience exhibit.

(38)

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HealtH Plan name

Fiscal

Year

end

rePort

tYPe

statement

date

net income

/loss

(in millions)

total

revenue

(in millions)

tangible

net equitY

(in millions)

net income

(as sHare of revenue)

medical

loss

ratio

admin.

cost

ratio

tangible

net equitY

to required

current

assets:

current

liabilities

Plan

tYPe

enrollees

(at statement date)

aetna

dec

a

12/31/09

48.2

1918.4

131.6

2.5%

88.1%

9.6%

311.5%

0.60

B

455,470

alameda alliance

June

a

6/30/09

– 3.8

187.8

17.7

– 2.0%

93.1%

9.1%

178.0%

1.37

C

103,756

anthem Blue Cross

dec

a

12/31/09

450.5

11126.7

1340.4

4.0%

83.3%

10.2%

433.8%

1.36

B

3,552,695

arcadian

dec

a

12/31/09

15.8

281.5

41.7

5.6%

78.2%

15.1%

316.4%

1.02

m

28,958

arta

dec

a

12/31/09

– 0.4

7.6

1.1

– 5.7%

87.4%

22.0%

108.4%

1.81

m

426

Blue shield

dec

a

12/31/09

148.5

8525.4

2861.2

1.7%

87.6%

11.3%

1,223.5%

0.48

B

2,601,504

Caloptima

June

a

6/30/09

– 17.5

1087.6

131.3

– 1.6%

98.1%

4.3%

346.9%

0.97

C/B

378,977

Caloptima

June

Ytd

12/31/09

– 1.3

600.1

130.0

– 0.2%

87.9%

8.2%

324.5%

0.96

C/B

400,504

Care1st

dec

a

12/31/09

11.6

676.6

64.2

1.7%

89.1%

9.5%

305.0%

1.37

o

308,975

Caremore

dec

a

12/31/09

47.6

485.7

49.1

9.8%

72.6%

11.1%

302.4%

1.31

m

33,860

CenCal

June

a

6/30/09

5.0

271.1

20.6

1.9%

99.1%

6.6%

134.2%

1.39

C

94,737

CenCal

June

Ytd

12/31/09

0.2

146.5

19.8

– 0.5%

95.6%

7.6%

125.4%

1.45

C

98,785

Central California alliance for Health

dec

a

12/31/09

4.9

389.6

89.5

1.3%

91.6%

5.3%

452.3%

1.82

C

194,711

Central Health Plan

dec

a

12/31/09

– 0.1

42.7

2.1

– 0.3%

89.7%

12.7%

127.3%

1.19

m

4,953

Chinese Community Health Plan

dec

a

12/31/09

1.4

103.7

14.1

1.3%

88.5%

12.5%

705.0%

1.40

o

13,765

CiGna

dec

a

12/31/09

– 12.0

802.0

42.1

– 1.5%

97.4%

5.5%

159.6%

1.41

o

212,965

CiGna Pacific (previously Great-West)

dec

a

12/31/09

10.7

89.5

19.0

12.0%

71.7%

13.2%

552.4%

1.91

o

13,086

Citizens Choice

dec

a

12/31/09

0.4

88.0

3.3

0.5%

86.0%

13.6%

105.4%

1.07

m

8,279

Community Health Group

dec

a

12/31/09

3.5

165.6

18.5

2.1%

91.6%

6.5%

199.6%

1.57

C

115,685

Community Health Plan

June

a

6/30/09

23.6

265.0

17.3

8.9%

81.2%

10.5%

418.3%

1.74

C

180,003

Community Health Plan

June

Ytd

12/31/09

5.8

141.2

15.4

4.1%

86.0%

10.4%

358.9%

1.67

C

186,721

Contra Costa Health Plan

June

a

6/30/09

0.2

210.8

4.6

0.1%

121.9%

5.6%

112.2%

1.71

o

82,298

Contra Costa Health Plan

June

Ytd

12/31/09

1.4

118.4

6.1

1.2%

123.8%

6.6%

134.2%

1.18

o

81,847

*most recent annual and selected year-to-date data for plans with fiscal year-end other than december.

KeY to rePort tYPes: a: annual, a-est.: estimated annual (4th quarter Ytd), Q: quarterly, Ytd: year-to-date. KeY to Plan tYPes: B (Big): 400,000 or more enrollees; m (medicare): 70 percent or more enrollees in medicare; C (medi-Cal): 70 percent or more enrollees in medi-Cal, Healthy families, aim; o (other): all others. Plan types determined based on status at december 31, 2009. status based on enrollment reports, disclosures, and footnotes filed in health plan financial reports to dmHC.

notes: tangible net equity (tne) is a measure of the physical worth of a company and excludes the value of intangible assets. six new plans, not shown, had no enrollees at december 2009 (plan type in parentheses): Choice (m), Golden state (m), Humana (m), Premier (m), san miguel Health Plan (m), and talbert (o). also not shown, association Health Care management, dba family Care, a medical discount plan. l.a. Care and Caloptima qualify as both medi-Cal oriented and big plans. on lok qualifies as both a medicare and a medi-Cal oriented plan.

(39)

<< re turn to Contents

HealtH Plan name

Fiscal

Year

end

rePort

tYPe

statement

date

net income

/loss

(in millions)

total

revenue

(in millions)

tangible

net equitY

(in millions)

net income

(as sHare of revenue)

medical

loss

ratio

admin.

cost

ratio

tangible

net equitY

to required

current

assets:

current

liabilities

Plan

tYPe

enrollees

(at statement date)

easy Choice

dec

a

12/31/09

– 1.8

44.1

1.7

– 4.0%

86.3%

17.7%

146.9%

1.24

m

5,337

GemCare

dec

a

12/31/09

– 0.7

69.8

3.4

– 1.0%

92.2%

9.1%

112.8%

1.45

m

6,467

Health net

dec

a

12/31/09

172.2

8824.8

1170.4

2.0%

87.9%

10.0%

570.5%

1.93

B

2,161,960

Health Plan of san Joaquin

June

a

6/30/09

2.1

129.0

36.3

1.6%

91.3%

8.5%

547.0%

2.37

C

99,524

Health Plan of san Joaquin

June

Ytd

12/31/09

1.4

79.4

37.7

1.8%

91.5%

7.4%

515.8%

2.02

C

101,066

Health Plan of san mateo

dec

a

12/31/09

15.0

306.1

57.5

4.9%

89.6%

6.5%

372.8%

2.00

C

76,162

Heritage

dec

a

12/31/09

0.2

1166.8

47.5

0.0%

91.9%

9.7%

160.1%

1.25

B

455,846

inland empire

June

a

6/30/09

4.7

515.3

34.3

0.9%

92.4%

6.8%

176.8%

1.40

C/B

400,493

inland empire

June

Ytd

12/31/09

4.7

312.7

39.0

1.5%

89.0%

5.7%

172.7%

1.39

C/B

430,871

inter valley

mar

a

3/31/09

4.6

130.7

16.0

3.5%

85.7%

11.1%

613.0%

3.64

m

12,258

inter valley

mar

Ytd

12/31/09

2.1

106.0

18.1

2.0%

86.2%

11.8%

649.2%

3.20

m

12,208

Kaiser

1

dec

a

12/31/09

2108.6

42792.8

11787.0

4.9%

93.5%

4.2%

1,106.5%

0.93

B

6,659,879

Kern family Health Care

dec

a

12/31/09

2.0

152.0

71.0

1.3%

89.6%

8.7%

756.3%

2.56

C

101,450

l.a. Care

sept

a

9/30/09

7.9

1171.4

125.2

0.7%

97.2%

4.1%

980.2%

1.48

C/B

800,340

md Care

dec

a

12/31/09

– 5.1

79.0

– 0.4

– 6.4%

88.9%

17.8%

– 12.9%

0.66

m

7,245

medcore

dec

a

12/31/09

0.0

30.8

0.8

– 0.1%

110.8%

12.3%

60.4%

1.59

m

2,098

molina

dec

a

12/31/09

– 19.4

465.6

27.2

– 4.2%

93.7%

9.6%

164.1%

1.36

C

350,624

monarch

dec

a

12/31/09

0.4

69.0

3.3

0.5%

97.0%

2.3%

119.3%

1.37

m

7,729

on lok

June

a

6/30/09

– 4.2

78.0

64.0

– 5.4%

90.5%

8.8%

2,380.7%

3.65

m/C

1,029

on lok

June

Ytd

12/31/09

7.2

47.4

71.3

15.2%

89.9%

6.8%

2,471.9%

3.28

o

1,010

PacifiCare

dec

a

12/31/09

320.0

7050.1

828.0

4.5%

86.3%

6.6%

916.9%

1.81

B

1,070,639

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