H
EALTHC
AREF
OUNDATIONcalifornia
Health Care Almanac
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
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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,
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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,
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department of
managed HealtH care
(dmHc)
california
department of insurance
(cdi)
number of health insurance carriers regulated, 2009
1,249
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)
2,321.6 million
(~59% population)
2.4 million
(~7% population)
Share of individual market enrollment, 2008
448%
52%
Share of group market enrollment, 2008
491%
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.
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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,
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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,
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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,
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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,
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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,
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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.
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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,
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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.
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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,
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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.
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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.
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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,
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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,
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net cHange
individual
group
medicare
public
otHer
number perCentaetna
—
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,
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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,
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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,
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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,
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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,
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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,
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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,
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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,
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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.
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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,
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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,
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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,
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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,
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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.
<< re turn to ContentS
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 FOUNDATIONfor 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
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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.
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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
1blue 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
2California 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.
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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
3on 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.
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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 alsoincluded 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.
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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.
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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)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
1dec
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