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  • 20 Accident and HealthPolicy Experience Report

    201

  • Accounting & ReportingInformation about statutory accounting principles and the procedures necessary for fi ling fi nancial annual statements and conducting risk-based capital calculations.

    Consumer InformationImportant answers to common questions about auto, home, health and life insurance — as well as buyer’s guides on annuities, long-term care insurance and Medicare supplement plans.

    Financial Regulation Useful handbooks, compliance guides and reports on fi nancial analysis, company licensing, state audit requirements and receiverships.

    LegalComprehensive collection of NAIC model laws, regulations and guidelines; state laws on insurance topics; and other regulatory guidance on antifraud and consumer privacy.

    Market RegulationRegulatory and industry guidance on market-related issues, including antifraud, product fi ling requirements, producer licensing and market analysis.

    NAIC ActivitiesNAIC member directories, in-depth reporting of state regulatory activities and offi cial historical records of NAIC national meetings and other activities.

    For more information about NAIC publications, view our online catalog at:

    http://store.naic.org

    Special StudiesStudies, reports, handbooks and regulatory research conducted by NAIC members on a variety of insurance-related topics.

    Statistical ReportsValuable and in-demand insurance industry-wide statistical data for various lines of business, including auto, home, health and life insurance.

    Supplementary ProductsGuidance manuals, handbooks, surveys and research on a wide variety of issues.

    Capital Markets & Investment AnalysisInformation regarding portfolio values and procedures for complying with NAIC reporting requirements.

    White Papers Relevant studies, guidance and NAIC policy positions on a variety of insurance topics.

    © 2015 National Association of Insurance Commissioners. All rights reserved.

    ISBN:

    Printed in the United States of America

    No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any storage or retrieval system, without written permission from the NAIC.

    NAIC Executive Offi ce444 North Capitol Street, NWSuite 700Washington, DC 20001 202.471.3990

    NAIC Central Offi ce1100 Walnut StreetSuite 1500Kansas City, MO 64106816.842.3600

    NAIC Capital Markets& Investment Analysis Offi ceOne New York Plaza, Suite 4210New York, NY 10004212.398.9000

    The NAIC is the authoritative source for insurance industry information. Our expert solutions support the efforts of regulators, insurers and researchers by providing detailed and comprehensive insurance information. The NAIC offers a wide range of publications in the following categories:

  • 2014 Accident and Health Policy Experience Report

    TABLE OF CONTENTS

    INTRODUCTION..........................................................................................................................1 Report Format ..................................................................................................................................1 Aggregation and Calculation of Data ..............................................................................................3 Definitions........................................................................................................................................3 Qualifications ...................................................................................................................................4 Accident and Health Policy Experience 2010-2014 ........................................................................5 Figure 1: Grand Total of Number of Policies or Certificates 2010-2014 ........................................7 Figure 2: Grand Total of Number of Covered Lives 2010-2014 .....................................................9 AGGREGATED ANNUAL STATEMENT DATA ..................................................................11 2014 Annual Statement Page (Health Blank) 2014 Report Page Supp 8-9 Individual Business .......................................................................................... 13-14 Supp 10 Group, Other, and Grand Total Business ...............................................................15 Supp 11 Summary Page .......................................................................................................16 Annual Statement Data by Statement Type ...................................................................................17 INDIVIDUAL BUSINESS...........................................................................................................35 Market Share for the Top 125 Insurers ..........................................................................................37 Top 25 Groups by Company ..........................................................................................................43 Market Share by Statement Type ...................................................................................................59 Market Share by Line of Business .................................................................................................73 GROUP BUSINESS ...................................................................................................................129 Market Share for the Top 125 Insurers ........................................................................................131 Top 25 Groups by Company ........................................................................................................137 Market Share by Statement Type .................................................................................................151 Market Share by Line of Business ...............................................................................................165 OTHER BUSINESS ...................................................................................................................227 Market Share for the Top 125 Insurers ........................................................................................229 Top 25 Groups by Company ........................................................................................................235 Market Share by Statement Type .................................................................................................243 Market Share by Line of Business ...............................................................................................253 GRAND TOTAL (INDIVIDUAL, GROUP, AND OTHER) BUSINESS .............................261 Market Share for the Top 125 Insurers ........................................................................................263 Top 25 Groups by Company ........................................................................................................269 Market Share by Statement Type .................................................................................................287 TECHNICAL NOTES ...............................................................................................................301 COMPANY INDEX ...................................................................................................................305

    © 2015 National Association of Insurance Commissioners

  • © 2015 National Association of Insurance Commissioners

  • 2014 Accident and Health Policy Experience Report

    INTRODUCTION

    The Accident and Health Policy Experience Report was originally created in 2010 using 2009 data, with the intention of meeting the growing demand for information on health insurance. The Accident and Health Policy Experience Report includes aggregated data from the Accident and Health Policy Experience Exhibit, market share data based on this exhibit, and more. The health insurance market is expansive, with a variety of different types of health insurers. Employer-provided health insurance that is self-insured may be regulated by the federal government. Not all health insurers are required to file with the state insurance departments. For example, while many health insurance writers in California file with the California Department of Insurance, some companies are required to file with the California Department of Managed Health Care. It is the peculiarities of the health insurance market that warrant caution be taken when analyzing the numbers within this report. Because the NAIC receives most filings from companies required to file with the state insurance departments, the data are not a complete depiction of the health market as a whole. Some life insurance companies and fraternal insurance companies provide accident and health coverage, as well as expected life coverages. Property/casualty companies may also provide accident and health coverage in addition to other lines of business. Some companies write primarily accident and health insurance, even if they are licensed as life, fraternal, or property/casualty entities. Therefore, the Accident and Health Policy Experience Exhibit appears in all major NAIC financial annual statement blanks (property/casualty, health, life, and fraternal). The exhibit as it currently exists was added to the NAIC financial annual statement blanks that were used for reporting 2006 year-end data. The exhibit includes a breakout for individual and group business.

    Report Format

    This report contains the following sections:

    Aggregated Annual Statement Financial Data This section reflects data reported in the Accident and Health Policy Experience Exhibit. The aggregated data is broken out by each financial annual statement type (property/casualty, health, life, and fraternal). The data is not available at the state level at this time. Individual Business This section contains breakouts of Individual Business market share data. The market share is based on premiums earned as reported in the Accident and Health Policy Experience Exhibit. Insurance groups are made up of insurance companies that are related by common ownership. The market share reports show data by group for those insurers that are a member of a group. This allows the report to contain a more complete view of the market share information. The market share data is broken out by statement type and by line of business.

    © 2015 National Association of Insurance Commissioners1

  • The Individual Business breakouts are: • Market Share for the Top 125 Insurers – This includes total market share, across

    all business types, for the top 125 groups. • Top 25 Groups by Company – Individual company data is shown for each of the

    top 25 groups. • Market Share Data by Statement Type – The data is broken out by business type.

    It includes breakouts of separate market share data in each statement type, including property/casualty, health, life, and fraternal.

    • Market Share Data by Line of Business – This consists of data broken out by line of business. It includes a total market share of the top 125 groups. Breakouts are provided for the aggregate of all lines of business, as well as by line of business (e.g., comprehensive major medical).

    Group Business This section contains breakouts of Group Business market share data. The Group Business breakouts are:

    • Market Share for the Top 125 Insurers • Top 25 Groups by Company • Market Share Data by Statement Type • Market Share Data by Line of Business

    Other Business This section contains breakouts of Other Business market share data The Other Business breakouts are:

    • Market Share for the Top 125 Insurers • Top 25 Groups by Company • Market Share Data by Statement Type • Market Share Data by Line of Business

    Grand Total (Individual, Group, and Other) Business The final section contains breakouts of Grand Total (Individual, Group, and Other) Business market share data. The data in this section is not broken out by the separate Lines of Business included within the Grand Total. The Grand Total breakouts are:

    • Market Share for the Top 125 Insurers • Top 25 Groups by Company • Market Share Data by Statement Type

    © 2015 National Association of Insurance Commissioners2

  • Company Index An index listing the insurer groups and the individual companies included in the insurance groups reported in this publication has been added at the end of the report. Insurers continuously merge, change names, and buy and sell companies; however, the index gives a “snapshot” view of group structures as filed with the NAIC by the date this report was generated.

    Comments on this report are encouraged so that the report will continue to evolve to meet the needs of its users. These data are maintained in NAIC databases and are available for additional application development. These data are also available for purchase by the public in both hardcopy and electronic formats.

    Aggregation and Calculation of Data This report utilizes the term “aggregated” to describe data developed by summing the financial annual statements of individual companies. In order to represent more completely the data as reported on the financial annual statements, all data are aggregated directly from the numbers reported to the NAIC.

    Definitions The health insurance industry is broad, and not all terminology carries the same definition. To avoid ambiguity and to help ensure this report is not misunderstood, some definitions have been provided. For more definitions within the Accident and Health Policy Experience Exhibit, please use the NAIC Annual and Quarterly Statement Instructions (for property/casualty, health, life, or fraternal). Group Business – Health insurance where the policy is issued to employers, associations, trusts, or other groups covering employees, members and/or their dependents, to whom a certificate of coverage may be provided. Individual Business – Health insurance where the policy is issued to an individual and covers the individual and/or their dependents. This includes conversions from group policies.

    Comprehensive/Major Medical – Policies that provide fully insured indemnity, health maintenance organization (HMO), preferred provider organization (PPO), or fee for service coverage for hospital, medical, and surgical expenses. This category excludes short-term medical insurance; the Federal Employees Health Benefit Program and non-comprehensive coverage (such as basic hospital only, medical only, hospital confinement indemnity, surgical, outpatient indemnity, specified disease, intensive care, and organ and tissue transplant coverage); and any other coverage described in the other categories of this exhibit.

    © 2015 National Association of Insurance Commissioners3

  • Qualifications The accuracy of the reports included in this publication depends on the accuracy of the information contained in each Accident and Health Policy Experience Exhibit filed by insurers. Even though the data elements used to prepare the reports are extracted from exhibits filed with the NAIC, the NAIC cannot verify or guarantee the accuracy of every data element. While the NAIC exercises a great deal of care in capturing data from the financial annual statements and producing various reports, as with any statistical project of a significant magnitude, errors can occur. Consequently, the NAIC makes no representations or warranties with respect to the accuracy of the data and statistics in this report. Please send any questions regarding this report to [email protected]. Links to this report and other NAIC reports can be found on the NAIC website at: NAIC Publications.

    © 2015 National Association of Insurance Commissioners4

    mailto:[email protected]://www.naic.org/prod_serv_statistical.htm#accident_health

  • ACCIDENT AND HEALTH POLICY EXPERIENCE COUNTRYWIDE

    2010-2014*

    INCURRED CLAIMS CHANGE IN CONTRACT LOSS PREMIUMS EARNED AMOUNT RESERVES RATIO

    Grand Total Individual Business

    2010 $ 231,406,329,551 $ 189,209,391,179 $ 9,103,850,750 85.7% 2011 $ 248,150,598,691 $ 203,692,230,630 $ 6,811,541,165 84.8% 2012 $ 275,331,003,590 $ 229,077,321,934 $ 7,963,114,454 86.1% 2013 $ 300,898,264,568 $ 252,350,066,953 $ 7,553,211,253 86.4% 2014 $ 360,636,224,687 $ 306,109,705,129 $ 7,992,483,052 87.1%

    2010-2014 $ 283,284,484,217.40 $ 236,087,743,165.00 $ 7,884,840,134.80 86.1%

    Grand Total Group Business 2010 $ 308,772,423,410 $ 254,193,201,219 $ 2,259,412,505 83.1% 2011 $ 318,544,030,034 $ 260,285,262,066 $ 1,644,917,354 82.2% 2012 $ 319,265,016,462 $ 264,195,307,535 $ 2,091,570,032 83.4% 2013 $ 320,528,048,857 $ 264,137,467,703 $ 2,051,840,442 83.0% 2014 $ 316,229,440,369 $ 257,868,663,588 $ 1,903,725,622 82.1%

    2010-2014 $ 316,667,791,826.40 $ 260,135,980,422.20 $ 1,990,293,191.00 82.8%

    Grand Total Other Business

    2010 $ 8,948,454,269 $ 6,190,695,093 $ 1,385,160 69.2% 2011 $ 9,762,385,463 $ 6,763,710,823 $ 12,062,558 69.4% 2012 $ 9,785,579,698 $ 6,838,329,920 $ 2,236,096 69.9% 2013 $ 11,698,910,267 $ 8,232,126,487 $ 4,025,501 70.4% 2014 $ 13,374,504,961 $ 9,549,465,202 $ (1,512,106) 71.4%

    2010-2014 $ 10,713,966,931.60 $ 7,514,865,505.00 $ 3,639,441.80 70.2%

    Grand Total (Individual, Group, and Other) 2010 $ 549,127,207,230 $ 449,593,287,491 $ 11,364,648,415 83.9% 2011 $ 576,457,014,188 $ 470,741,203,519 $ 8,468,521,077 83.1% 2012 $ 604,381,599,750 $ 500,110,959,389 $ 10,056,920,582 84.4% 2013 $ 633,125,223,692 $ 524,719,661,143 $ 9,609,077,196 84.4% 2014 $ 690,240,170,017 $ 573,527,833,919 $ 9,894,696,568 84.5%

    2010-2014 $ 610,666,242,975.40 $ 503,738,589,092.20 $ 9,878,772,767.60 84.1%

    * Results may vary from prior-year reports due to new or revised filings. Loss Ratio = (Incurred Claims Amount + Change in Contract Reserves) / Premiums Earned

    © 2015 National Association of Insurance Commissioners5

  • © 2015 National Association of Insurance Commissioners6

  • -

    50

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    350

    400

    450

    2010 2011 2012 2013 2014Total Per Year 285,835,165 329,045,144 342,371,076 365,950,059 387,885,909

    Mill

    ions

    Years

    Number of Policies or CertificatesGrand Total (Individual, Group, and Other) Business

    © 2015 National Association of Insurance Commissioners7

  • © 2015 National Association of Insurance Commissioners8

  • -

    100

    200

    300

    400

    500

    600

    700

    800

    900

    2010 2011 2012 2013 2014Total Per Year 653,279,438 673,360,197 688,324,821 755,364,415 805,501,558

    Mill

    ions

    Years

    Number of Covered LivesGrand Total (Individual, Group, and Other) Business

    © 2015 National Association of Insurance Commissioners9

  • © 2015 National Association of Insurance Commissioners10

  • Accident and Health Policy Experience Report

    Aggregated Annual Statement Data

    © 2015 National Association of Insurance Commissioners11

  • © 2015 National Association of Insurance Commissioners12

  • ACCIDENT AND HEALTH POLICY EXPERIENCE REPORT FOR 2014Aggregated Totals for All Statement Types

    Premiums

    countrywide

    Earned Claims AmountIncurred

    Contract ReservesChange in

    Loss Ratio ¹or Certificates

    Number of Policies

    as of Dec 31 as of Dec 31Covered Lives

    Number ofMemberMonths

    A. INDIVIDUAL BUSINESS 1. Comprehensive Major Medical

    $16,565,047,208 1.1 With contract reserves $15,539,026,502 )$(17,455,415 3,168,151 4,903,007 57,670,88993.70%$27,826,330,002 1.2 Without contract reserves $28,186,001,519 $38,355,582 5,298,984 8,144,869 93,284,501101.43%$44,391,377,211 1.3 Subtotal $43,725,028,019 $20,900,167 8,467,135 13,047,876 150,955,39098.55%

    2. Short-Term Medical$2,979,625 2.1 With contract reserves $2,418,080 )$(40,808 4,912 7,389 79,39779.78%

    $128,125,177 2.2 Without contract reserves $98,256,060 $0 107,071 136,961 1,239,44876.69%$131,104,802 2.3 Subtotal $100,674,140 )$(40,808 111,983 144,350 1,318,84576.76%

    3. Other Medical (Non-Comprehensive)$1,065,036,304 3.1 With contract reserves $495,951,287 $58,608,207 2,678,853 4,433,887 51,214,13752.07%

    $131,812,043 3.2 Without contract reserves $81,714,531 )$(30,325 85,417 113,572 1,331,13261.97%$1,196,848,346 3.3 Subtotal $577,665,818 $58,577,882 2,764,270 4,547,459 52,545,26953.16%

    4. Specified/Named Disease$3,499,560,109 4.1 With contract reserves $1,833,966,462 $532,706,167 7,506,847 13,650,973 155,670,07067.63%

    $16,592,493 4.2 Without contract reserves $8,392,497 )$(52,850 82,478 107,348 1,209,66350.26%$3,516,152,602 4.3 Subtotal $1,842,358,957 $532,653,317 7,589,325 13,758,321 156,879,73367.55%

    5. Limited Benefit$661,596,751 5.1 With contract reserves $549,263,298 $28,760,372 305,825 405,930 4,299,96987.37%

    $2,613,204,260 5.2 Without contract reserves $2,424,849,753 )$(82 513,788 662,274 7,392,61392.79%$3,274,801,011 5.3 Subtotal $2,974,113,051 $28,760,290 819,613 1,068,204 11,692,58291.70%

    6. Student$57,765 6.1 With contract reserves $15,929 $0 362 362 4,36827.58%

    $87,700,390 6.2 Without contract reserves $78,119,827 $0 338,426 338,818 3,946,23289.08%$87,758,155 6.3 Subtotal $78,135,756 $0 338,788 339,180 3,950,60089.04%

    7. Accident Only or AD&D$2,360,905,453 7.1 With contract reserves $889,065,946 $84,004,406 9,659,944 14,614,250 158,516,10141.22%

    $137,064,724 7.2 Without contract reserves $32,229,732 )$(23,723 2,357,415 2,793,362 28,449,14923.50%$2,497,970,176 7.3 Subtotal $921,295,677 $83,980,683 12,017,359 17,407,612 186,965,25040.24%

    8. Disability Income - Short-Term$2,135,097,727 8.1 With contract reserves $977,666,289 $46,413,781 3,318,546 3,427,107 39,196,59847.96%

    $135,463,677 8.2 Without contract reserves $52,982,390 )$(35,855 245,482 247,163 2,973,95739.09%$2,270,561,405 8.3 Subtotal $1,030,648,679 $46,377,926 3,564,028 3,674,270 42,170,55547.43%

    ¹ Loss Ratio = (Incurred Claims Amount + Change in Contract Reserves) / Premiums Earned

    © 2015 National Association of Insurance Commissioners13

  • ACCIDENT AND HEALTH POLICY EXPERIENCE REPORT FOR 2014aggregated totals for All Statement Types

    Premiums

    countrywide

    Earned Claims AmountIncurred

    Contract ReservesChange in

    Loss Ratio ¹or Certificates

    Number of Policies

    as of Dec 31 as of Dec 31Covered Lives

    Number ofMemberMonths

    A. INDIVIDUAL BUSINESS (Continued) 9. Disability Income - Long-Term

    $4,677,232,242 9.1 With contract reserves $4,337,514,988 )$(223,282,392 3,107,010 3,057,132 37,367,47487.96%$34,839,979 9.2 Without contract reserves $4,511,992 )$(132,242 24,848 32,157 275,42212.57%

    $4,712,072,219 9.3 Subtotal $4,342,026,979 )$(223,414,634 3,131,858 3,089,289 37,642,89687.41% 10. Long-Term Care

    $13,563,001,327 10.1 With contract reserves $9,407,999,354 $7,534,774,931 4,351,493 4,933,470 62,336,117124.92%$375,949,485 10.2 Without contract reserves $187,954,601 $30,238,837 34,324 34,325 446,36758.04%

    $13,938,950,811 10.3 Subtotal $9,595,953,955 $7,565,013,768 4,385,817 4,967,795 62,782,484123.12% 11. Medicare Supplement (Medigap)

    $9,514,707,563 11.1 With contract reserves $7,348,494,495 )$(151,162,666 4,864,634 4,862,941 55,158,78775.64%$8,897,286,427 11.2 Without contract reserves $6,666,439,053 $242,877 4,062,625 4,067,087 46,697,90074.93%

    $18,411,993,991 11.3 Subtotal $14,014,933,551 )$(150,919,789 8,927,259 8,930,028 101,856,68675.30% 12. Dental

    $1,067,148,583 12.1 With contract reserves $753,581,449 $9,034,920 3,548,690 4,095,775 39,103,89471.46%$1,052,210,059 12.2 Without contract reserves $719,020,512 )$(6,557 2,319,909 3,564,753 40,793,91868.33%$2,119,358,642 12.3 Subtotal $1,472,601,961 $9,028,363 5,868,599 7,660,528 79,897,81269.91%

    13. State Children's Health Insurance Program$336,193,132 13.1 With contract reserves $250,276,489 $1,441,545 180,540 180,540 2,277,86374.87%

    $2,599,241,479 13.2 Without contract reserves $2,141,401,722 $372,097 1,145,115 1,178,052 16,603,42782.40%$2,935,434,611 13.3 Subtotal $2,391,678,211 $1,813,642 1,325,655 1,358,592 18,881,29081.54%

    14. Medicare$13,933,490,892 14.1 With contract reserves $12,221,378,549 $62,168,301 1,286,582 1,299,812 15,902,48588.16%

    $116,597,651,355 14.2 Without contract reserves $99,707,973,028 $5,831,088 10,103,975 11,130,672 126,236,20885.52%$130,531,142,247 14.3 Subtotal $111,929,351,577 $67,999,389 11,390,557 12,430,484 142,138,69385.80%

    15. Medicaid$14,822,199,845 15.1 With contract reserves $12,980,511,640 $869,754 3,783,372 3,771,937 42,825,92487.58%$95,597,269,762 15.2 Without contract reserves $81,613,863,245 )$(2,415,023 24,139,868 24,368,810 261,912,73685.37%

    $110,419,469,607 15.3 Subtotal $94,594,374,885 )$(1,545,269 27,923,240 28,140,747 304,738,66085.67% 16. Medicare Part D - Stand-Alone

    $966,495,419 16.1 With contract reserves $892,525,178 )$(40,999,949 938,283 938,283 11,538,95588.10%$17,488,881,278 16.2 Without contract reserves $14,372,612,113 $0 16,842,617 17,638,457 210,874,56982.18%$18,455,376,697 16.3 Subtotal $15,265,137,291 )$(40,999,949 17,780,900 18,576,740 222,413,52482.49%

    17. Other Individual Business$666,577,612 17.1 With contract reserves $388,353,877 )$(5,699,823 1,303,550 2,035,039 10,985,87557.41%

    $1,079,274,547 17.2 Without contract reserves $865,372,750 )$(2,104 454,891 714,801 4,517,59480.18%$1,745,852,158 17.3 Subtotal $1,253,726,627 )$(5,701,927 1,758,441 2,749,840 15,503,46971.49%

    18. Total Individual Business$85,837,327,552 18.1 With contract reserves $68,868,009,804 $7,920,141,333 50,007,594 66,617,834 744,148,90389.46%

    $274,798,897,135 18.2 Without contract reserves $237,241,695,325 $72,341,720 68,157,232 75,273,480 848,184,83586.36%$360,636,224,687 19. Grand total individual $306,109,705,129 $7,992,483,052 118,164,826 141,891,314 1,592,333,73887.10%

    ¹ Loss Ratio = (Incurred Claims Amount + Change in Contract Reserves) / Premiums Earned

    © 2015 National Association of Insurance Commissioners14

  • ACCIDENT AND HEALTH POLICY EXPERIENCE REPORT FOR 2014Aggregated Totals for All Statement Types

    Premiums

    countrywide

    Earned Claims AmountIncurred

    Contract ReservesChange in

    Loss Ratio ¹or Certificates

    Number of Policies

    as of Dec 31 as of Dec 31Covered Lives

    Number ofMemberMonths

    B. GROUP BUSINESSComprehensive Major Medical 1. Single Employer 1.1 Small employer 7,502,702 13,685,860 171,611,344$64,708,047,253 $51,606,939,451 ($1,885,636) 79.75% 1.2 Other Employer 12,541,237 26,718,963 320,059,918$118,159,431,686 $97,309,095,350 $10,681,015 82.36% 1.3 Single employer subtotal 20,043,939 40,404,823 491,671,262$182,867,478,945 $148,916,034,796 $8,795,379 81.44% 2. Multiple employer assns and trusts 846,019 1,668,178 20,663,485$8,614,302,784 $7,226,703,920 $14,353,595 84.06% 3. Other associations and discretionary trusts 801,572 1,408,366 18,499,610$4,495,612,638 $3,692,275,732 $5,242,464 82.25% 4. Other comprehensive major medical 1,468,950 2,884,067 35,002,634$8,323,731,732 $7,688,538,485 ($2,456,872) 92.34% 5. Comprehensive/major medical subtotal 23,160,480 46,365,434 565,836,991$204,301,126,098 $167,523,552,935 $25,934,566 82.01%

    Other Medical (Non-Comprehensive) 6. Specified/named disease 3,149,860 5,282,934 59,321,940$988,759,618 $410,663,331 $68,116,862 48.42% 7. Limited benefit 12,468,355 46,336,724 571,880,265$4,012,714,451 $2,978,955,850 ($3,286,045) 74.16% 8. Student 2,530,270 3,803,041 42,138,784$1,925,394,700 $1,522,207,761 $284,702 79.07% 9. Accident only or AD&D 98,827,637 182,781,007 1,907,380,002$3,689,739,970 $1,544,293,694 $1,432,658 41.89% 10. Disability income - short-term 8,830,187 21,640,553 200,090,455$4,626,995,583 $3,187,696,638 $4,320,176 68.99% 11. Disability income - long-term 13,774,161 42,975,161 372,273,522$11,214,458,926 $9,776,924,644 ($2,645,657) 87.16% 12. Long-term care 1,244,708 2,578,041 27,962,434$2,273,110,476 $1,170,805,118 $1,770,383,322 129.39% 13. Medicare supplement 3,093,070 3,127,717 37,272,390$6,389,526,808 $5,047,933,497 $22,947,121 79.36% 14. Federal Employees Health Benefit Plans 3,189,994 7,376,501 88,420,876$35,092,409,726 $32,019,886,636 $4,014,688 91.26% 15. Tricare 5 10 720$32,043,299 $30,539,404 ($818,942) 92.75% 16. Dental 20,384,339 59,016,456 584,632,563$21,642,371,752 $16,193,162,098 $32,131,261 74.97% 17. Medicare 1,080,304 1,217,645 14,334,521$12,986,742,949 $11,511,401,970 $1,955,947 88.65% 18. Medicare Part D - Stand-Alone 737,063 960,984 12,020,057$1,287,440,125 $1,032,396,598 $0 80.19% 19. Other group care 9,843,603 40,184,439 232,658,334$5,766,605,886 $3,918,243,414 ($21,045,041) 67.58% 20. Grand total group business 202,314,035 463,646,647 4,716,223,852$316,229,440,369 $257,868,663,588 $1,903,725,622 82.15%

    C. OTHER BUSINESS 1. Credit (Individual and Group) 9,699,621 10,224,447 123,833,277$1,025,662,921 $374,459,150 ($3,574,476) 36.16% 2. Stop Loss/Excess Loss 18,710,236 53,805,213 661,715,150$12,348,842,039 $9,175,006,053 $2,062,370 74.32% 3. Administrative Services Only 17,904,501 58,702,932 701,168,452XXX XXX XXX XXX 4. Administrative Services Contracts 21,092,690 77,231,005 899,367,103XXX XXX XXX XXX 5. Grand Total Other Business 67,407,048 199,963,597 2,386,083,982$13,374,504,961 $9,549,465,202 ($1,512,106) 71.39%

    D. TOTAL BUSINESS 1. Total Non U.S. Policy Forms 32,007,376 46,332,535 407,807,275$10,569,816,003 $5,844,855,132 $1,134,834,820 66.03% 2. Grand Total Individual, Group & Other Business 419,893,286 851,834,093 9,102,448,847$700,809,986,026 $579,372,689,050 $11,029,531,391 84.25%

    ¹ Loss Ratio = (Incurred Claims Amount + Change in Contract Reserves) / Premiums Earned

    © 2015 National Association of Insurance Commissioners15

  • ACCIDENT AND HEALTH POLICY EXPERIENCE REPORT FOR 2014Aggregated Totals for All Statement Types

    Premiums

    countrywide

    Earned Claims AmountIncurred

    Contract ReservesChange in

    Loss Ratio ¹

    Part 1 - Individual PoliciesSummary

    $359,608,029,18201. U.S. forms direct business $304,588,432,424 $7,972,172,232 86.92%$10,303,175,45302. Other forms direct business $5,788,450,117 $1,135,400,404 67.20%

    $369,911,204,63403. Total direct business $310,376,882,541 $9,107,572,636 86.37%$13,113,147,47604. Reinsurance assumed $10,586,177,845 $3,134,122,483 104.63%$24,018,580,51005. Less reinsurance ceded $22,980,211,782 $5,407,191,091 118.19%

    $359,005,771,60706. Total $297,982,844,528 $6,834,504,030 84.91%

    Part 2 - Group PoliciesSummary

    $327,708,076,57201. U.S. forms direct business $267,043,088,561 $1,920,724,633 82.07%$720,474,53202. Other forms direct business $438,295,694 )$(361,149 60.78%

    $328,428,551,10403. Total direct business $267,481,384,255 $1,920,363,484 82.03%$16,241,411,15804. Reinsurance assumed $12,712,125,023 )$(6,627,019 78.23%$26,030,801,42405. Less reinsurance ceded $21,419,672,033 $423,089,591 83.91%

    $318,639,117,60206. Total $258,773,904,777 $1,490,646,876 81.68%

    Part 3 - Credit Policies (Individual and Group)Summary

    $1,875,948,67501. U.S. forms direct business $1,039,256,447 )$(2,138,883 55.28%$158,335,07002. Other forms direct business $17,690,880 $0 11.17%

    $2,034,283,74603. Total direct business $1,056,947,327 )$(2,138,883 51.85%$122,919,82804. Reinsurance assumed $16,195,563 )$(3,447,217 10.37%$477,585,92105. Less reinsurance ceded $79,433,897 )$(3,561,714 15.89%

    $1,679,617,65306. Total $993,708,992 )$(2,024,385 59.04%

    Part 4 - All Individual, Group and Credit PoliciesSummary

    $689,413,808,07201. U.S. forms direct business $572,887,269,126 $9,890,760,573 84.53%$11,059,149,43702. Other forms direct business $6,153,408,398 $1,135,039,255 65.90%

    $700,472,957,50903. Total direct business $579,040,677,524 $11,025,799,828 84.24%$29,477,478,46204. Reinsurance assumed $23,314,498,430 $3,124,048,248 89.69%$50,529,449,12605. Less reinsurance ceded $44,482,041,734 $5,826,718,969 99.56%

    $679,420,943,60406. Total $557,873,197,679 $8,323,129,106 83.34%

    ¹ Loss Ratio = (Incurred Claims Amount + Change in Contract Reserves) / Premiums Earned

    © 2015 National Association of Insurance Commissioners16

  • Annual Statement Data by Statement Type

    © 2015 National Association of Insurance Commissioners17

  • © 2015 National Association of Insurance Commissioners18

  • ACCIDENT AND HEALTH POLICY EXPERIENCE REPORT FOR 2014Aggregated Totals for Life, Accident & Health

    Premiums

    countrywide

    Earned Claims AmountIncurred

    Contract ReservesChange in

    Loss Ratio ¹or Certificates

    Number of Policies

    as of Dec 31 as of Dec 31Covered Lives

    Number ofMemberMonths

    A. INDIVIDUAL BUSINESS 1. Comprehensive Major Medical

    $2,387,864,591 1.1 With contract reserves $2,143,582,625 $50,749,491 372,441 600,743 7,734,46491.90%$1,939,898,341 1.2 Without contract reserves $2,157,095,420 )$(161,885 323,832 590,188 7,147,126111.19%$4,327,762,933 1.3 Subtotal $4,300,678,043 $50,587,606 696,273 1,190,931 14,881,590100.54%

    2. Short-Term Medical$927,067 2.1 With contract reserves $228,269 )$(41,704 2,919 3,559 40,71720.12%

    $76,112,163 2.2 Without contract reserves $45,286,819 $0 58,817 71,495 736,14959.50%$77,039,230 2.3 Subtotal $45,515,088 )$(41,704 61,736 75,054 776,86659.03%

    3. Other Medical (Non-Comprehensive)$975,003,083 3.1 With contract reserves $447,124,515 $58,503,114 2,304,275 3,995,326 45,953,58151.86%

    $95,662,545 3.2 Without contract reserves $48,060,539 )$(19,770 71,725 94,342 1,164,87250.22%$1,070,665,627 3.3 Subtotal $495,185,055 $58,483,344 2,376,000 4,089,668 47,118,45351.71%

    4. Specified/Named Disease$3,484,535,006 4.1 With contract reserves $1,829,188,487 $530,754,555 7,459,597 13,593,784 154,964,42167.73%

    $14,544,455 4.2 Without contract reserves $6,299,544 )$(72,559 61,974 80,153 952,87842.81%$3,499,079,461 4.3 Subtotal $1,835,488,029 $530,681,996 7,521,571 13,673,937 155,917,29967.62%

    5. Limited Benefit$125,157,265 5.1 With contract reserves $50,700,894 $28,582,656 249,497 349,452 3,725,80663.35%

    $27,012,023 5.2 Without contract reserves $12,778,336 )$(82 137,629 215,000 2,334,88947.31%$152,169,288 5.3 Subtotal $63,479,230 $28,582,574 387,126 564,452 6,060,69560.50%

    6. Student$57,765 6.1 With contract reserves $15,929 $0 362 362 4,36827.58%

    $19,430,980 6.2 Without contract reserves $10,929,893 $0 303,692 303,692 3,509,24956.25%$19,488,745 6.3 Subtotal $10,945,822 $0 304,054 304,054 3,513,61756.16%

    7. Accident Only or AD&D$2,339,037,067 7.1 With contract reserves $880,576,518 $83,510,759 9,532,521 14,482,209 157,046,18941.22%

    $108,919,984 7.2 Without contract reserves $24,482,109 )$(67,644 1,659,732 1,938,423 20,951,75122.42%$2,447,957,050 7.3 Subtotal $905,058,626 $83,443,115 11,192,253 16,420,632 177,997,94040.38%

    8. Disability Income - Short-Term$2,123,373,188 8.1 With contract reserves $969,775,676 $46,276,919 3,298,349 3,407,943 38,954,17547.85%

    $46,542,485 8.2 Without contract reserves $16,662,334 $81,931 31,181 32,508 345,00035.98%$2,169,915,674 8.3 Subtotal $986,438,010 $46,358,850 3,329,530 3,440,451 39,299,17547.60%

    ¹ Loss Ratio = (Incurred Claims Amount + Change in Contract Reserves) / Premiums Earned

    © 2015 National Association of Insurance Commissioners19

  • ACCIDENT AND HEALTH POLICY EXPERIENCE REPORT FOR 2014Aggregated Totals for Life, Accident & Health

    Premiums

    countrywide

    Earned Claims AmountIncurred

    Contract ReservesChange in

    Loss Ratio ¹or Certificates

    Number of Policies

    as of Dec 31 as of Dec 31Covered Lives

    Number ofMemberMonths

    A. INDIVIDUAL BUSINESS (Continued) 9. Disability Income - Long-Term

    $4,615,309,663 9.1 With contract reserves $4,298,659,640 )$(223,285,596 2,986,519 2,936,157 35,913,09588.30%$18,000,766 9.2 Without contract reserves $3,835,992 )$(132,242 14,373 21,682 145,98220.58%

    $4,633,310,428 9.3 Subtotal $4,302,495,632 )$(223,417,838 3,000,892 2,957,839 36,059,07788.04% 10. Long-Term Care

    $12,698,149,834 10.1 With contract reserves $8,184,149,895 $6,776,427,077 3,841,278 4,406,515 55,940,925117.82%$44,334,123 10.2 Without contract reserves )$(117,030,874 $30,315,074 20,337 20,338 244,786(195.60)%

    $12,742,483,956 10.3 Subtotal $8,067,119,021 $6,806,742,151 3,861,615 4,426,853 56,185,711116.73% 11. Medicare Supplement (Medigap)

    $6,593,455,546 11.1 With contract reserves $4,915,846,074 $33,886,098 3,539,216 3,504,316 36,078,71575.07%$3,444,858,223 11.2 Without contract reserves $2,512,303,169 $202,536 1,659,412 1,661,913 18,080,30672.93%

    $10,038,313,770 11.3 Subtotal $7,428,149,245 $34,088,634 5,198,628 5,166,229 54,159,02074.34% 12. Dental

    $294,710,669 12.1 With contract reserves $135,611,074 $9,581,669 628,074 964,222 9,999,43449.27%$249,120,291 12.2 Without contract reserves $227,587,907 )$(4,953 556,148 778,478 8,677,34791.35%$543,830,960 12.3 Subtotal $363,198,981 $9,576,716 1,184,222 1,742,700 18,676,78168.55%

    13. State Children's Health Insurance Program$0 13.1 With contract reserves $0 $0 0 0 0N/A

    $283,244,906 13.2 Without contract reserves $217,182,363 $0 84,857 84,857 1,368,19276.68%$283,244,906 13.3 Subtotal $217,182,363 $0 84,857 84,857 1,368,19276.68%

    14. Medicare$432,001,403 14.1 With contract reserves $361,170,308 $161,536 45,916 45,917 555,05483.64%

    $15,590,269,206 14.2 Without contract reserves $13,012,068,749 $0 1,536,047 1,536,059 13,765,18783.46%$16,022,270,609 14.3 Subtotal $13,373,239,057 $161,536 1,581,963 1,581,976 14,320,24183.47%

    15. Medicaid$0 15.1 With contract reserves $0 $0 0 0 0N/A

    $905,479,873 15.2 Without contract reserves $747,682,988 $0 52,301 52,301 600,03482.57%$905,479,873 15.3 Subtotal $747,682,988 $0 52,301 52,301 600,03482.57%

    16. Medicare Part D - Stand-Alone$882,271,988 16.1 With contract reserves $813,358,719 )$(39,647,537 870,448 870,448 10,722,74787.70%

    $6,763,116,731 16.2 Without contract reserves $5,463,945,146 $0 5,890,954 6,684,939 79,988,06380.79%$7,645,388,719 16.3 Subtotal $6,277,303,865 )$(39,647,537 6,761,402 7,555,387 90,710,81081.59%

    17. Other Individual Business$256,821,022 17.1 With contract reserves $164,076,677 )$(4,850,596 613,106 344,903 3,824,19062.00%

    $22,102,628 17.2 Without contract reserves $13,584,906 )$(2,104 61,354 84,648 913,23161.45%$278,923,649 17.3 Subtotal $177,661,583 )$(4,852,700 674,460 429,551 4,737,42161.96%

    18. Total Individual Business$37,208,675,153 18.1 With contract reserves $25,194,065,294 $7,350,608,442 35,744,518 49,505,856 561,457,88187.47%$29,648,649,720 18.2 Without contract reserves $24,402,755,338 $30,138,302 12,524,364 14,251,015 160,925,04182.41%$66,857,324,872 19. Grand total individual $49,596,820,630 $7,380,746,744 48,268,882 63,756,871 722,382,92285.22%

    ¹ Loss Ratio = (Incurred Claims Amount + Change in Contract Reserves) / Premiums Earned

    © 2015 National Association of Insurance Commissioners20

  • ACCIDENT AND HEALTH POLICY EXPERIENCE REPORT FOR 2014Aggregated Totals for Life, Accident & Health

    Premiums

    countrywide

    Earned Claims AmountIncurred

    Contract ReservesChange in

    Loss Ratio ¹or Certificates

    Number of Policies

    as of Dec 31 as of Dec 31Covered Lives

    Number ofMemberMonths

    B. GROUP BUSINESSComprehensive Major Medical 1. Single Employer 1.1 Small employer 1,285,643 2,377,742 28,495,408$10,640,710,430 76.52%$8,141,476,587 $949,553 1.2 Other Employer 2,631,022 6,984,344 83,732,308$25,718,340,248 81.16%$20,870,785,774 $2,342,255 1.3 Single employer subtotal 3,916,665 9,362,086 112,227,716$36,359,050,678 79.80%$29,012,262,359 $3,291,808 2. Multiple employer assns and trusts 39,070 77,544 1,206,982$434,653,740 79.13%$343,939,133 $844 3. Other associations and discretionary trusts 556,737 937,847 12,663,628$3,147,673,045 81.73%$2,566,535,612 $6,001,311 4. Other comprehensive major medical 117,034 322,768 3,808,405$280,875,855 77.51%$220,164,557 ($2,456,872) 5. Comprehensive/major medical subtotal 4,629,506 10,700,245 129,906,731$40,222,253,317 79.93%$32,142,901,663 $6,837,091

    Other Medical (Non-Comprehensive) 6. Specified/named disease 3,072,698 5,113,053 57,324,723$966,343,877 48.13%$396,645,294 $68,429,403 7. Limited benefit 9,838,690 20,842,927 269,324,680$1,998,597,268 67.70%$1,356,678,458 ($3,596,509) 8. Student 1,510,788 1,565,645 16,726,872$1,454,132,591 78.38%$1,139,466,130 $284,702 9. Accident only or AD&D 57,849,808 117,348,588 1,151,943,671$3,205,047,604 41.66%$1,334,134,136 $1,070,218 10. Disability income - short-term 8,783,325 20,583,009 199,742,269$4,534,097,368 69.19%$3,135,633,046 $1,445,953 11. Disability income - long-term 13,726,991 42,927,552 371,939,492$11,203,872,406 87.07%$9,757,472,287 ($2,351,483) 12. Long-term care 1,005,045 2,338,372 25,054,841$2,091,656,101 125.85%$1,078,481,069 $1,553,790,797 13. Medicare supplement 2,620,029 2,650,560 31,573,107$5,120,207,622 79.70%$4,057,912,770 $22,844,515 14. Federal Employees Health Benefit Plans 121,570 259,725 2,955,141$628,400,289 84.43%$529,964,128 $580,688 15. Tricare 5 10 720$26,610 24.22%$12,639 ($6,195) 16. Dental 8,541,350 29,848,720 255,929,786$12,130,629,525 74.67%$9,025,517,697 $32,244,114 17. Medicare 227 227 2,689$1,594,465 53.65%$855,448 $0 18. Medicare Part D - Stand-Alone 251,572 452,653 6,442,581$317,814,926 70.77%$224,925,080 $0 19. Other group care 4,545,303 10,638,838 120,196,340$2,299,264,498 61.05%$1,421,774,802 ($18,124,048) 20. Grand total group business 116,496,907 265,270,124 2,639,063,641$86,173,938,471 78.06%$65,602,374,652 $1,663,449,250

    C. OTHER BUSINESS 1. Credit (Individual and Group) 6,040,111 6,564,937 79,502,548$851,657,049 41.35%$355,868,000 ($3,740,546) 2. Stop Loss/Excess Loss 12,348,881 38,759,749 482,681,177$8,301,218,103 71.95%$5,973,448,678 ($766,007) 3. Administrative Services Only 9,219,267 39,343,631 470,387,758XXX XXXXXX XXX 4. Administrative Services Contracts 111,442 2,088,053 23,706,600XXX XXXXXX XXX 5. Grand Total Other Business 27,719,701 86,756,370 1,056,278,083$9,152,875,153 69.10%$6,329,316,677 ($4,506,553)

    D. TOTAL BUSINESS 1. Total Non U.S. Policy Forms 29,341,707 39,951,139 340,318,801$10,496,778,573 66.27%$5,822,518,270 $1,133,641,221 2. Grand Total Individual, Group & Other Business 221,827,197 455,734,504 4,758,043,447$172,680,917,072 79.64%$127,351,030,227 $10,173,330,665

    ¹ Loss Ratio = (Incurred Claims Amount + Change in Contract Reserves) / Premiums Earned

    © 2015 National Association of Insurance Commissioners21

  • ACCIDENT AND HEALTH POLICY EXPERIENCE REPORT FOR 2014Aggregated Totals for Life, Accident & Health

    Premiums

    countrywide

    Earned Claims AmountIncurred

    Contract ReservesChange in

    Loss Ratio ¹

    Part 1 - Individual PoliciesSummary

    $66,809,989,75401. U.S. forms direct business $49,775,409,100 $7,375,329,185 85.54%$9,982,308,02402. Other forms direct business $5,534,467,731 $1,134,209,507 66.80%

    $76,792,297,77803. Total direct business $55,309,876,831 $8,509,538,692 83.11%$8,313,851,52404. Reinsurance assumed $6,965,918,047 $3,053,355,524 120.51%

    $17,176,420,63105. Less reinsurance ceded $13,489,484,127 $5,317,447,923 109.49%$67,929,728,67006. Total $48,786,310,749 $6,245,446,295 81.01%

    Part 2 - Group PoliciesSummary

    $94,584,939,17101. U.S. forms direct business $71,635,063,501 $1,671,289,359 77.50%$455,920,11202. Other forms direct business $304,809,619 )$(361,149 66.78%

    $95,040,859,28303. Total direct business $71,939,873,120 $1,670,928,210 77.45%$11,173,906,46404. Reinsurance assumed $8,987,260,073 )$(2,011,071 80.41%$17,531,297,23005. Less reinsurance ceded $14,482,778,835 $422,290,204 85.02%$88,683,468,51506. Total $66,444,354,358 $1,246,626,937 76.33%

    Part 3 - Credit Policies (Individual and Group)Summary

    $795,174,27701. U.S. forms direct business $296,405,299 )$(2,135,752 37.01%$129,325,17102. Other forms direct business $12,753,862 $0 9.86%$924,499,44803. Total direct business $309,159,161 )$(2,135,752 33.21%

    $85,687,86004. Reinsurance assumed $15,952,769 )$(3,447,217 14.59%$326,847,19505. Less reinsurance ceded $61,213,290 )$(3,561,714 17.64%$683,340,11506. Total $263,898,639 )$(2,021,254 38.32%

    Part 4 - All Individual, Group and Credit PoliciesSummary

    $162,253,586,33201. U.S. forms direct business $121,749,518,444 $9,044,485,383 80.61%$10,504,065,66302. Other forms direct business $5,809,005,971 $1,133,848,358 66.10%

    $172,757,651,99503. Total direct business $127,558,524,415 $10,178,333,741 79.73%$19,573,445,84604. Reinsurance assumed $15,969,130,887 $3,047,897,237 97.16%$35,034,565,05305. Less reinsurance ceded $28,033,476,253 $5,736,176,414 96.39%

    $157,296,532,78406. Total $115,494,179,047 $7,490,054,563 78.19%

    ¹ Loss Ratio = (Incurred Claims Amount + Change in Contract Reserves) / Premiums Earned

    © 2015 National Association of Insurance Commissioners22

  • ACCIDENT AND HEALTH POLICY EXPERIENCE REPORT FOR 2014Aggregated Totals for Health

    Premiums

    countrywide

    Earned Claims AmountIncurred

    Contract ReservesChange in

    Loss Ratio ¹or Certificates

    Number of Policies

    as of Dec 31 as of Dec 31Covered Lives

    Number ofMemberMonths

    A. INDIVIDUAL BUSINESS 1. Comprehensive Major Medical

    $14,170,812,489 1.1 With contract reserves $13,387,519,463 )$(68,949,487 2,793,984 4,299,641 49,905,43793.99%$25,877,730,614 1.2 Without contract reserves $26,017,548,084 $38,517,827 4,974,323 7,553,544 86,109,243100.69%$40,048,543,103 1.3 Subtotal $39,405,067,547 )$(30,431,660 7,768,307 11,853,185 136,014,68098.32%

    2. Short-Term Medical$2,050,793 2.1 With contract reserves $2,188,915 $0 1,972 3,804 38,628106.74%

    $51,509,743 2.2 Without contract reserves $52,608,484 $0 37,396 54,566 493,440102.13%$53,560,536 2.3 Subtotal $54,797,399 $0 39,368 58,370 532,068102.31%

    3. Other Medical (Non-Comprehensive)$4,158,631 3.1 With contract reserves $848,853 )$(186,277 8,209 8,731 108,90715.93%$9,852,960 3.2 Without contract reserves $17,126,119 $0 9,996 14,818 104,992173.82%

    $14,011,591 3.3 Subtotal $17,974,972 )$(186,277 18,205 23,549 213,899126.96% 4. Specified/Named Disease

    $7,742,134 4.1 With contract reserves $2,760,295 $634,048 14,513 24,087 299,15943.84%$1,189,398 4.2 Without contract reserves $1,941,199 $0 2,234 3,263 40,483163.21%$8,931,532 4.3 Subtotal $4,701,494 $634,048 16,747 27,350 339,64259.74%

    5. Limited Benefit$535,177,695 5.1 With contract reserves $498,223,773 $33,988 55,201 55,351 562,69793.10%

    $2,586,192,237 5.2 Without contract reserves $2,412,071,417 $0 376,159 447,274 5,057,72493.27%$3,121,369,932 5.3 Subtotal $2,910,295,190 $33,988 431,360 502,625 5,620,42193.24%

    6. Student$0 6.1 With contract reserves $0 $0 0 0 0N/A

    $68,269,410 6.2 Without contract reserves $67,189,934 $0 34,734 35,126 436,98398.42%$68,269,410 6.3 Subtotal $67,189,934 $0 34,734 35,126 436,98398.42%

    7. Accident Only or AD&D$1,146,703 7.1 With contract reserves $379,648 $19,816 12,447 14,343 191,51234.84%$6,901,890 7.2 Without contract reserves $939,471 $0 23,268 41,948 600,95013.61%$8,048,593 7.3 Subtotal $1,319,119 $19,816 35,715 56,291 792,46216.64%

    8. Disability Income - Short-Term$3,562,469 8.1 With contract reserves $1,754,876 $74,415 1,259 1,263 21,87451.35%

    $0 8.2 Without contract reserves $0 $0 0 0 0N/A$3,562,469 8.3 Subtotal $1,754,876 $74,415 1,259 1,263 21,87451.35%

    ¹ Loss Ratio = (Incurred Claims Amount + Change in Contract Reserves) / Premiums Earned

    © 2015 National Association of Insurance Commissioners23

  • ACCIDENT AND HEALTH POLICY EXPERIENCE REPORT FOR 2014Aggregated Totals for Health

    Premiums

    countrywide

    Earned Claims AmountIncurred

    Contract ReservesChange in

    Loss Ratio ¹or Certificates

    Number of Policies

    as of Dec 31 as of Dec 31Covered Lives

    Number ofMemberMonths

    A. INDIVIDUAL BUSINESS (Continued) 9. Disability Income - Long-Term

    $9,408,295 9.1 With contract reserves $9,766,477 $2,201,040 36,743 36,852 434,194127.20%$0 9.2 Without contract reserves $0 $0 0 0 0N/A

    $9,408,295 9.3 Subtotal $9,766,477 $2,201,040 36,743 36,852 434,194127.20% 10. Long-Term Care

    $38,060,605 10.1 With contract reserves $44,220,972 $13,239,082 24,204 24,488 287,374150.97%$331,462,979 10.2 Without contract reserves $304,556,830 )$(76,237 13,844 13,844 200,00991.86%$369,523,584 10.3 Subtotal $348,777,802 $13,162,845 38,048 38,332 487,38397.95%

    11. Medicare Supplement (Medigap)$2,332,491,487 11.1 With contract reserves $2,022,062,471 )$(202,453,961 1,088,050 1,118,572 13,324,75078.01%$5,412,035,909 11.2 Without contract reserves $4,127,948,801 $42,079 2,391,190 2,393,151 28,465,23476.27%$7,744,527,396 11.3 Subtotal $6,150,011,272 )$(202,411,882 3,479,240 3,511,723 41,789,98476.80%

    12. Dental$772,437,914 12.1 With contract reserves $617,970,375 )$(546,749 2,920,616 3,131,553 29,104,46079.93%$801,261,853 12.2 Without contract reserves $491,432,605 )$(1,604 1,761,675 2,784,189 32,114,48561.33%

    $1,573,699,767 12.3 Subtotal $1,109,402,980 )$(548,353 4,682,291 5,915,742 61,218,94570.46% 13. State Children's Health Insurance Program

    $336,193,132 13.1 With contract reserves $250,276,489 $1,441,545 180,540 180,540 2,277,86374.87%$2,315,996,573 13.2 Without contract reserves $1,924,219,359 $372,097 1,060,258 1,093,195 15,235,23583.10%$2,652,189,705 13.3 Subtotal $2,174,495,848 $1,813,642 1,240,798 1,273,735 17,513,09882.06%

    14. Medicare$13,501,479,630 14.1 With contract reserves $11,860,188,880 $62,006,765 1,240,638 1,253,867 15,347,09588.30%

    $101,007,382,149 14.2 Without contract reserves $86,695,904,279 $5,831,088 8,567,928 9,594,613 112,471,02185.84%$114,508,861,779 14.3 Subtotal $98,556,093,159 $67,837,853 9,808,566 10,848,480 127,818,11686.13%

    15. Medicaid$14,822,199,845 15.1 With contract reserves $12,980,511,640 $869,754 3,783,372 3,771,937 42,825,92487.58%$94,691,789,889 15.2 Without contract reserves $80,866,180,257 )$(2,415,023 24,087,567 24,316,509 261,312,70285.40%

    $109,513,989,734 15.3 Subtotal $93,846,691,897 )$(1,545,269 27,870,939 28,088,446 304,138,62685.69% 16. Medicare Part D - Stand-Alone

    $84,223,431 16.1 With contract reserves $79,166,459 )$(1,352,412 67,835 67,835 816,20892.39%$10,725,764,547 16.2 Without contract reserves $8,908,666,967 $0 10,951,663 10,953,518 130,886,50683.06%$10,809,987,978 16.3 Subtotal $8,987,833,426 )$(1,352,412 11,019,498 11,021,353 131,702,71483.13%

    17. Other Individual Business$367,188,696 17.1 With contract reserves $294,698,625 )$(561,985 648,067 658,094 4,446,77080.11%$967,221,092 17.2 Without contract reserves $815,992,912 $0 174,850 206,644 2,363,30884.36%

    $1,334,409,788 17.3 Subtotal $1,110,691,537 )$(561,985 822,917 864,738 6,810,07883.19% 18. Total Individual Business

    $46,988,333,949 18.1 With contract reserves $42,052,538,210 )$(193,530,418 12,877,650 14,650,958 159,992,85289.08%$244,854,561,244 18.2 Without contract reserves $212,704,326,720 $42,270,227 54,467,085 59,506,202 675,892,31586.89%$291,842,895,193 19. Grand total individual $254,756,864,930 )$(151,260,191 67,344,735 74,157,160 835,885,16787.24%

    ¹ Loss Ratio = (Incurred Claims Amount + Change in Contract Reserves) / Premiums Earned

    © 2015 National Association of Insurance Commissioners24

  • ACCIDENT AND HEALTH POLICY EXPERIENCE REPORT FOR 2014Aggregated Totals for Health

    Premiums

    countrywide

    Earned Claims AmountIncurred

    Contract ReservesChange in

    Loss Ratio ¹or Certificates

    Number of Policies

    as of Dec 31 as of Dec 31Covered Lives

    Number ofMemberMonths

    B. GROUP BUSINESSComprehensive Major Medical 1. Single Employer 1.1 Small employer 6,172,919 11,226,086 142,197,099($1,869,620)$43,110,448,353 80.38%$53,630,568,150 1.2 Other Employer 9,886,842 19,668,668 235,550,528$8,369,191$76,140,513,473 82.66%$92,121,460,461 1.3 Single employer subtotal 16,059,761 30,894,754 377,747,627$6,499,571$119,250,961,823 81.82%$145,752,028,617 2. Multiple employer assns and trusts 806,949 1,590,634 19,428,356$14,352,751$6,862,101,878 84.28%$8,159,378,587 3. Other associations and discretionary trusts 243,874 469,228 5,817,465$306,353$1,122,900,616 83.58%$1,343,871,969 4. Other comprehensive major medical 1,351,736 2,553,398 31,099,648$0$7,433,992,635 92.83%$8,008,094,395 5. Comprehensive/major medical subtotal 18,462,320 35,508,014 434,093,096$21,158,675$134,669,956,952 82.50%$163,263,373,568

    Other Medical (Non-Comprehensive) 6. Specified/named disease 48,660 97,091 1,128,557($312,541)$10,708,660 61.01%$17,040,465 7. Limited benefit 2,466,078 25,186,188 299,944,428($3,000)$1,535,217,756 82.71%$1,856,140,662 8. Student 189,695 979,415 11,944,652$0$301,607,772 84.92%$355,148,920 9. Accident only or AD&D 480,590 481,124 5,915,744$0$5,878,966 46.82%$12,556,808 10. Disability income - short-term 2,787 5,910 72,702$0$236,604 24.59%$962,169 11. Disability income - long-term 20 20 258($294,174)$1,502,776 108.24%$1,116,580 12. Long-term care 9,291 9,297 113,123$8,816,228$17,251,510 201.51%$12,936,000 13. Medicare supplement 473,038 477,057 5,697,885$120,300$989,874,358 78.01%$1,269,122,387 14. Federal Employees Health Benefit Plans 3,068,424 7,116,776 85,465,735$3,434,000$31,489,922,508 91.38%$34,464,009,437 15. Tricare 0 0 0($812,747)$30,526,765 92.81%$32,016,689 16. Dental 11,765,786 29,055,321 327,900,057($113,053)$7,124,991,093 75.62%$9,421,510,077 17. Medicare 1,080,077 1,217,418 14,331,832$1,955,947$11,510,546,522 88.66%$12,985,148,484 18. Medicare Part D - Stand-Alone 485,491 508,331 5,577,476$0$807,471,518 83.28%$969,625,199 19. Other group care 2,522,057 5,729,950 74,037,124$536,360$1,791,666,258 95.20%$1,882,562,845 20. Grand total group business 41,054,313 106,371,912 1,266,222,669$34,485,995$190,287,360,014 84.01%$226,543,270,289

    C. OTHER BUSINESS 1. Credit (Individual and Group) 1 1 403,811$0$2,932 33.16%$8,843 2. Stop Loss/Excess Loss 5,567,605 10,122,675 121,323,539$7,618$2,639,223,635 80.16%$3,292,444,272 3. Administrative Services Only 8,685,234 19,359,301 230,780,694XXXXXX XXXXXX 4. Administrative Services Contracts 20,981,248 75,142,952 875,660,503XXXXXX XXXXXX 5. Grand Total Other Business 35,234,088 104,624,929 1,228,168,547$7,618$2,639,226,567 80.16%$3,292,453,115

    D. TOTAL BUSINESS 1. Total Non U.S. Policy Forms 134,662 132,420 1,246,403$0$8,889 6.26%$141,982 2. Grand Total Individual, Group & Other Business 143,767,799 285,286,421 3,331,522,786($116,766,578)$447,683,460,402 85.79%$521,678,760,582

    ¹ Loss Ratio = (Incurred Claims Amount + Change in Contract Reserves) / Premiums Earned

    © 2015 National Association of Insurance Commissioners25

  • ACCIDENT AND HEALTH POLICY EXPERIENCE REPORT FOR 2014Aggregated Totals for Health

    Premiums

    countrywide

    Earned Claims AmountIncurred

    Contract ReservesChange in

    Loss Ratio ¹

    Part 1 - Individual PoliciesSummary

    $290,824,718,53801. U.S. forms direct business $253,029,815,489 )$(165,536,308 86.95%$228,169,47102. Other forms direct business $221,637,984 $0 97.14%

    $291,052,888,00903. Total direct business $253,251,453,473 )$(165,536,308 86.96%$2,884,395,90504. Reinsurance assumed $2,360,081,192 $48,104,646 83.49%$5,639,629,99905. Less reinsurance ceded $8,769,818,311 $61,905,170 156.60%

    $288,297,653,92206. Total $246,841,716,352 )$(179,336,832 85.56%

    Part 2 - Group PoliciesSummary

    $229,029,585,12201. U.S. forms direct business $192,956,803,248 $36,023,966 84.27%$16,671,29502. Other forms direct business $12,348,982 $0 74.07%

    $229,046,256,41703. Total direct business $192,969,152,230 $36,023,966 84.26%$2,569,830,41404. Reinsurance assumed $2,198,876,809 $8,423,331 85.89%$5,659,054,11605. Less reinsurance ceded $5,368,853,790 $9,410,452 95.04%

    $225,957,032,71506. Total $189,799,175,250 $35,036,845 84.01%

    Part 3 - Credit Policies (Individual and Group)Summary

    $908,491,67101. U.S. forms direct business $725,625,412 $0 79.87%$002. Other forms direct business $0 $0 N/A

    $908,491,67103. Total direct business $725,625,412 $0 79.87%$35,373,20704. Reinsurance assumed $0 $0 0.00%

    $7,509,35105. Less reinsurance ceded $6,010,266 $0 80.04%$936,355,52706. Total $719,615,146 $0 76.85%

    Part 4 - All Individual, Group and Credit PoliciesSummary

    $520,861,717,86801. U.S. forms direct business $446,838,092,248 )$(129,512,342 85.76%$244,840,76602. Other forms direct business $233,986,966 $0 95.57%

    $521,106,558,63403. Total direct business $447,072,079,214 )$(129,512,342 85.77%$5,489,599,52604. Reinsurance assumed $4,558,958,001 $56,527,977 84.08%

    $11,308,674,74005. Less reinsurance ceded $14,147,406,387 $71,315,622 125.73%$515,287,483,42006. Total $437,483,630,825 )$(144,299,987 84.87%

    ¹ Loss Ratio = (Incurred Claims Amount + Change in Contract Reserves) / Premiums Earned

    © 2015 National Association of Insurance Commissioners26

  • ACCIDENT AND HEALTH POLICY EXPERIENCE REPORT FOR 2014Aggregated Totals for Property/Casualty

    Premiums

    countrywide

    Earned Claims AmountIncurred

    Contract ReservesChange in

    Loss Ratio ¹or Certificates

    Number of Policies

    as of Dec 31 as of Dec 31Covered Lives

    Number ofMemberMonths

    A. INDIVIDUAL BUSINESS 1. Comprehensive Major Medical

    $2,450,091 1.1 With contract reserves $3,505,175 )$(21,948 746 1,496 17,215142.17%$8,622,216 1.2 Without contract reserves $10,779,778 )$(360 823 1,129 27,988125.02%

    $11,072,307 1.3 Subtotal $14,284,953 )$(22,308 1,569 2,625 45,203128.81% 2. Short-Term Medical

    $1,765 2.1 With contract reserves $896 $896 21 26 52101.53%$503,271 2.2 Without contract reserves $360,757 $0 10,858 10,900 9,85971.68%$505,036 2.3 Subtotal $361,653 $896 10,879 10,926 9,91171.79%

    3. Other Medical (Non-Comprehensive)$82,301,938 3.1 With contract reserves $45,558,293 $617,675 355,923 415,973 4,979,74956.11%$26,285,320 3.2 Without contract reserves $16,528,282 )$(1,425 3,445 4,153 58,18562.87%

    $108,587,258 3.3 Subtotal $62,086,574 $616,250 359,368 420,126 5,037,93457.74% 4. Specified/Named Disease

    $606,134 4.1 With contract reserves $54,380 $106,600 514 856 8,60626.56%$41,358 4.2 Without contract reserves )$(26,309 $0 470 470 5,749(63.61)%

    $647,492 4.3 Subtotal $28,071 $106,600 984 1,326 14,35520.80% 5. Limited Benefit

    $2,354 5.1 With contract reserves $149 )$(1,026 16 16 210(37.26)%$0 5.2 Without contract reserves $0 $0 0 0 0N/A

    $2,354 5.3 Subtotal $149 )$(1,026 16 16 210(37.26)% 6. Student

    $0 6.1 With contract reserves $0 $0 0 0 0N/A$0 6.2 Without contract reserves $0 $0 0 0 0N/A$0 6.3 Subtotal $0 $0 0 0 0N/A

    7. Accident Only or AD&D$386,523 7.1 With contract reserves )$(33,915 )$(8,037 10,305 11,263 137,404(10.85)%

    $18,898,985 7.2 Without contract reserves $5,941,301 $0 621,954 757,137 6,252,44231.44%$19,285,508 7.3 Subtotal $5,907,386 )$(8,037 632,259 768,400 6,389,84630.59%

    8. Disability Income - Short-Term$5,734,887 8.1 With contract reserves $3,087,858 $1,239,386 7,917 7,917 94,73075.45%

    $87,547,927 8.2 Without contract reserves $35,503,931 )$(26,290 211,035 211,389 2,590,22840.52%$93,282,814 8.3 Subtotal $38,591,789 $1,213,096 218,952 219,306 2,684,95842.67%

    ¹ Loss Ratio = (Incurred Claims Amount + Change in Contract Reserves) / Premiums Earned

    © 2015 National Association of Insurance Commissioners27

  • ACCIDENT AND HEALTH POLICY EXPERIENCE REPORT FOR 2014Aggregated Totals for Property/Casualty

    Premiums

    countrywide

    Earned Claims AmountIncurred

    Contract ReservesChange in

    Loss Ratio ¹or Certificates

    Number of Policies

    as of Dec 31 as of Dec 31Covered Lives

    Number ofMemberMonths

    A. INDIVIDUAL BUSINESS (Continued) 9. Disability Income - Long-Term

    $4,511,477 9.1 With contract reserves $24,517 $703,091 3,201 3,201 37,57316.13%$16,838,554 9.2 Without contract reserves $630,539 $0 10,473 10,473 129,4163.74%$21,350,030 9.3 Subtotal $655,055 $703,091 13,674 13,674 166,9896.36%

    10. Long-Term Care$572,180,190 10.1 With contract reserves $818,017,551 $448,125,477 331,273 331,273 4,048,216221.28%

    $150,280 10.2 Without contract reserves $430,706 $0 140 140 1,536286.60%$572,330,470 10.3 Subtotal $818,448,257 $448,125,477 331,413 331,413 4,049,752221.30%

    11. Medicare Supplement (Medigap)$335,783,495 11.1 With contract reserves $241,156,615 $24,585 145,628 145,705 1,707,48571.83%

    $26,426,600 11.2 Without contract reserves $16,294,424 )$(1,738 7,736 7,736 97,60961.65%$362,210,095 11.3 Subtotal $257,451,040 $22,847 153,364 153,441 1,805,09471.08%

    12. Dental$0 12.1 With contract reserves $0 $0 0 0 0N/A

    $1,827,915 12.2 Without contract reserves $0 $0 2,086 2,086 2,0860.00%$1,827,915 12.3 Subtotal $0 $0 2,086 2,086 2,0860.00%

    13. State Children's Health Insurance Program$0 13.1 With contract reserves $0 $0 0 0 0N/A$0 13.2 Without contract reserves $0 $0 0 0 0N/A$0 13.3 Subtotal $0 $0 0 0 0N/A

    14. Medicare$9,859 14.1 With contract reserves $19,361 $0 28 28 336196.38%

    $0 14.2 Without contract reserves $0 $0 0 0 0N/A$9,859 14.3 Subtotal $19,361 $0 28 28 336196.38%

    15. Medicaid$0 15.1 With contract reserves $0 $0 0 0 0N/A$0 15.2 Without contract reserves $0 $0 0 0 0N/A$0 15.3 Subtotal $0 $0 0 0 0N/A

    16. Medicare Part D - Stand-Alone$0 16.1 With contract reserves $0 $0 0 0 0N/A$0 16.2 Without contract reserves $0 $0 0 0 0N/A$0 16.3 Subtotal $0 $0 0 0 0N/A

    17. Other Individual Business$42,059,563 17.1 With contract reserves )$(70,602,760 )$(95,880 26,717 1,015,172 2,504,629(168.09)%$85,256,458 17.2 Without contract reserves $32,338,894 $0 208,926 413,460 1,127,97337.93%

    $127,316,021 17.3 Subtotal )$(38,263,866 )$(95,880 235,643 1,428,632 3,632,602(30.13)% 18. Total Individual Business

    $1,046,028,275 18.1 With contract reserves $1,040,788,119 $450,690,820 882,289 1,932,926 13,536,205142.58%$272,398,884 18.2 Without contract reserves $118,782,303 )$(29,813 1,077,946 1,419,073 10,303,07143.60%

    $1,318,427,160 19. Grand total individual $1,159,570,424 $450,661,006 1,960,235 3,351,999 23,839,276122.13%

    ¹ Loss Ratio = (Incurred Claims Amount + Change in Contract Reserves) / Premiums Earned

    © 2015 National Association of Insurance Commissioners28

  • ACCIDENT AND HEALTH POLICY EXPERIENCE REPORT FOR 2014Aggregated Totals for Property/Casualty

    Premiums

    countrywide

    Earned Claims AmountIncurred

    Contract ReservesChange in

    Loss Ratio ¹or Certificates

    Number of Policies

    as of Dec 31 as of Dec 31Covered Lives

    Number ofMemberMonths

    B. GROUP BUSINESSComprehensive Major Medical 1. Single Employer 1.1 Small employer 44,140 82,032 918,83781.06%($965,569)$355,014,511$436,768,673 1.2 Other Employer 23,373 65,951 777,08293.16%($30,431)$297,796,103$319,630,977 1.3 Single employer subtotal 67,513 147,983 1,695,91986.17%($996,000)$652,810,614$756,399,650 2. Multiple employer assns and trusts 0 0 28,147101.94%$0$20,662,909$20,270,457 3. Other associations and discretionary trusts 961 1,291 18,51743.62%($1,065,200)$2,839,504$4,067,624 4. Other comprehensive major medical 180 7,901 94,58198.91%$0$34,381,293$34,761,482 5. Comprehensive/major medical subtotal 68,654 157,175 1,837,16486.90%($2,061,200)$710,694,320$815,499,213

    Other Medical (Non-Comprehensive) 6. Specified/named disease 28,502 72,790 868,66061.57%$0$3,309,377$5,375,276 7. Limited benefit 163,587 307,609 2,611,15755.31%$313,464$87,059,636$157,976,521 8. Student 829,787 1,257,981 13,467,26069.87%$0$81,133,859$116,113,189 9. Accident only or AD&D 40,497,239 64,951,295 749,520,58743.34%$362,440$204,280,592$472,135,558 10. Disability income - short-term 44,075 1,051,634 275,48459.45%$2,874,223$51,720,267$91,839,432 11. Disability income - long-term 47,150 47,589 333,772189.71%$0$17,965,557$9,469,940 12. Long-term care 230,372 230,372 2,794,470167.84%$207,776,297$75,072,539$168,518,375 13. Medicare supplement 3 100 1,39865.38%($17,694)$146,369$196,799 14. Federal Employees Health Benefit Plans 0 0 0N/A$0$0$0 15. Tricare 0 0 0N/A$0$0$0 16. Dental 77,203 112,415 802,72047.27%$200$42,653,308$90,232,150 17. Medicare 0 0 0N/A$0$0$0 18. Medicare Part D - Stand-Alone 0 0 0N/A$0$0$0 19. Other group care 2,776,243 23,815,651 38,424,87044.26%($3,457,353)$704,802,354$1,584,778,543 20. Grand total group business 44,762,815 92,004,611 810,937,54262.20%$205,790,377$1,978,838,177$3,512,134,995

    C. OTHER BUSINESS 1. Credit (Individual and Group) 3,659,509 3,659,509 43,926,91810.78%$166,070$18,588,218$173,997,029 2. Stop Loss/Excess Loss 793,745 4,920,153 57,678,32674.85%$2,820,759$560,176,648$752,186,634 3. Administrative Services Only 0 0 0XXXXXXXXXXXX 4. Administrative Services Contracts 0 0 0XXXXXXXXXXXX 5. Grand Total Other Business 4,453,254 8,579,662 101,605,24462.81%$2,986,829$578,764,866$926,183,663

    D. TOTAL BUSINESS 1. Total Non U.S. Policy Forms 2,525,515 6,243,486 66,177,08432.22%$0$22,215,348$68,938,899 2. Grand Total Individual, Group & Other Business 53,701,819 110,179,758 1,002,559,14675.51%$659,438,212$3,739,388,815$5,825,684,717

    ¹ Loss Ratio = (Incurred Claims Amount + Change in Contract Reserves) / Premiums Earned

    © 2015 National Association of Insurance Commissioners29

  • ACCIDENT AND HEALTH POLICY EXPERIENCE REPORT FOR 2014Aggregated Totals for Property/Casualty

    Premiums

    countrywide

    Earned Claims AmountIncurred

    Contract ReservesChange in

    Loss Ratio ¹

    Part 1 - Individual PoliciesSummary

    $1,354,568,19801. U.S. forms direct business $1,186,710,089 $450,555,089 120.87%$88,655,41502. Other forms direct business $32,169,018 $0 36.29%

    $1,443,223,61203. Total direct business $1,218,879,107 $450,555,089 115.67%$1,914,900,04704. Reinsurance assumed $1,260,178,606 $32,662,313 67.51%$1,053,975,50705. Less reinsurance ceded $620,235,855 $22,790,495 61.01%$2,304,148,15206. Total $1,858,817,787 $460,426,907 100.66%

    Part 2 - Group PoliciesSummary

    $4,090,462,63501. U.S. forms direct business $2,448,973,975 $213,411,308 65.09%$247,883,12502. Other forms direct business $121,137,093 $0 48.87%

    $4,338,345,76003. Total direct business $2,570,111,068 $213,411,308 64.16%$2,497,674,28004. Reinsurance assumed $1,525,988,141 )$(13,039,279 60.57%$2,840,279,57705. Less reinsurance ceded $1,567,950,471 )$(8,611,065 54.90%$3,995,697,22906. Total $2,528,216,270 $208,983,094 68.50%

    Part 3 - Credit Policies (Individual and Group)Summary

    $172,279,84401. U.S. forms direct business $17,224,926 $0 10.00%$29,009,89902. Other forms direct business $4,937,018 $0 17.02%

    $201,289,74403. Total direct business $22,161,944 $0 11.01%$1,858,76104. Reinsurance assumed $242,794 $0 13.06%

    $143,229,37505. Less reinsurance ceded $12,210,341 $0 8.53%$59,919,12806. Total $10,194,397 $0 17.01%

    Part 4 - All Individual, Group and Credit PoliciesSummary

    $5,676,658,65301. U.S. forms direct business $3,700,912,042 $663,966,397 76.89%$306,200,46502. Other forms direct business $110,240,077 $0 36.00%

    $5,982,859,11803. Total direct business $3,811,152,119 $663,966,397 74.80%$4,414,433,09004. Reinsurance assumed $2,786,409,542 $19,623,034 63.56%$4,037,484,45905. Less reinsurance ceded $2,200,396,667 $14,179,430 54.85%$6,359,764,51206. Total $4,397,228,457 $669,410,001 79.67%

    ¹ Loss Ratio = (Incurred Claims Amount + Change in Contract Reserves) / Premiums Earned

    © 2015 National Association of Insurance Commissioners30

  • ACCIDENT AND HEALTH POLICY EXPERIENCE REPORT FOR 2014Aggregated Totals for Fraternal

    Premiums

    countrywide

    Earned Claims AmountIncurred

    Contract ReservesChange in

    Loss Ratio ¹or Certificates

    Number of Policies

    as of Dec 31 as of Dec 31Covered Lives

    Number ofMemberMonths

    A. INDIVIDUAL BUSINESS 1. Comprehensive Major Medical 1.1 With contract reserves 980 1,127 13,773$3,920,037 $4,419,239 132.29%$766,529 1.2 Without contract reserves 6 8 144$78,831 $578,237 733.51%$0 1.3 Subtotal 986 1,135 13,917$3,998,868 $4,997,476 144.14%$766,529 2. Short-Term Medical 2.1 With contract reserves 0 0 0$0 $0 N/A$0 2.2 Without contract reserves 0 0 0$0 $0 N/A$0 2.3 Subtotal 0 0 0$0 $0 N/A$0 3. Other Medical (Non-Comprehensive) 3.1 With contract reserves 10,446 13,857 171,900$3,572,652 $2,419,626 58.59%($326,305) 3.2 Without contract reserves 251 259 3,083$11,218 ($409) (85.03)%($9,130) 3.3 Subtotal 10,697 14,116 174,983$3,583,870 $2,419,217 58.14%($335,435) 4. Specified/Named Disease 4.1 With contract reserves 32,223 32,246 397,884$6,676,835 $1,963,300 47.54%$1,210,964 4.2 Without contract reserves 17,800 23,462 210,553$817,282 $178,063 24.20%$19,709 4.3 Subtotal 50,023 55,708 608,437$7,494,117 $2,141,363 45.00%$1,230,673 5. Limited Benefit 5.1 With contract reserves 1,111 1,111 11,256$1,259,437 $338,482 38.37%$144,754 5.2 Without contract reserves 0 0 0$0 $0 N/A$0 5.3 Subtotal 1,111 1,111 11,256$1,259,437 $338,482 38.37%$144,754 6. Student 6.1 With contract reserves 0 0 0$0 $0 N/A$0 6.2 Without contract reserves 0 0 0$0 $0 N/A$0 6.3 Subtotal 0 0 0$0 $0 N/A$0 7. Accident Only or AD&D 7.1 With contract reserves 104,671 106,435 1,140,996$20,335,160 $8,143,695 42.42%$481,868 7.2 Without contract reserves 52,461 55,854 644,006$2,343,865 $866,851 38.86%$43,921 7.3 Subtotal 157,132 162,289 1,785,002$22,679,025 $9,010,546 42.05%$525,789 8. Disability Income - Short-Term 8.1 With contract reserves 11,021 9,984 125,819$2,427,183 $3,047,879 77.08%($1,176,939) 8.2 Without contract reserves 3,266 3,266 38,729$1,373,265 $816,125 52.77%($91,496) 8.3 Subtotal 14,287 13,250 164,548$3,800,448 $3,864,004 68.30%($1,268,435)

    ¹ Loss Ratio = (Incurred Claims Amount + Change in Contract Reserves) / Premiums Earned

    © 2015 National Association of Insurance Commissioners31

  • ACCIDENT AND HEALTH POLICY EXPERIENCE REPORT FOR 2014Aggregated Totals for Fraternal

    Premiums

    countrywide

    Earned Claims AmountIncurred

    Contract ReservesChange in

    Loss Ratio ¹or Certificates

    Number of Policies

    as of Dec 31 as of Dec 31Covered Lives

    Number ofMemberMonths

    A. INDIVIDUAL BUSINESS (Continued) 9. Disability Income - Long-Term

    $48,002,807 9.1 With contract reserves $29,064,354 )$(2,900,927 80,547 80,922 982,61254.50%$659 9.2 Without contract reserves $45,461 $0 2 2 246,898.48%

    $48,003,466 9.3 Subtotal $29,109,815 )$(2,900,927 80,549 80,924 982,63654.60% 10. Long-Term Care

    $254,610,698 10.1 With contract reserves $361,610,936 $296,983,295 154,738 171,194 2,059,602258.67%$2,103 10.2 Without contract reserves )$(2,061 $0 3 3 36(98.00)%

    $254,612,801 10.3 Subtotal $361,608,875 $296,983,295 154,741 171,197 2,059,638258.66% 11. Medicare Supplement (Medigap)

    $252,977,035 11.1 With contract reserves $169,429,335 $17,380,612 91,740 94,348 4,047,83773.84%$13,965,695 11.2 Without contract reserves $9,892,659 $0 4,287 4,287 54,75170.84%

    $266,942,730 11.3 Subtotal $179,321,994 $17,380,612 96,027 98,635 4,102,58873.69% 12. Dental

    $0 12.1 With contract reserves $0 $0 0 0 0N/A$0 12.2 Without contract reserves $0 $0 0 0 0N/A$0 12.3 Subtotal $0 $0 0 0 0N/A

    13. State Children's Health Insurance Program$0 13.1 With contract reserves $0 $0 0 0 0N/A$0 13.2 Without contract reserves $0 $0 0 0 0N/A$0 13.3 Subtotal $0 $0 0 0 0N/A

    14. Medicare$0 14.1 With contract reserves $0 $0 0 0 0N/A$0 14.2 Without contract reserves $0 $0 0 0 0N/A$0 14.3 Subtotal $0 $0 0 0 0N/A

    15. Medicaid$0 15.1 With contract reserves $0 $0 0 0 0N/A$0 15.2 Without contract reserves $0 $0 0 0 0N/A$0 15.3 Subtotal $0 $0 0 0 0N/A

    16. Medicare Part D - Stand-Alone$0 16.1 With contract reserves $0 $0 0 0 0N/A$0 16.2 Without contract reserves $0 $0 0 0 0N/A$0 16.3 Subtotal $0 $0 0 0 0N/A

    17. Other Individual Business$508,331 17.1 With contract reserves $181,335 )$(191,362 15,660 16,870 210,286(1.97)%

    $4,694,369 17.2 Without contract reserves $3,456,038 $0 9,761 10,049 113,08273.62%$5,202,700 17.3 Subtotal $3,637,373 )$(191,362 25,421 26,919 323,36866.24%

    18. Total Individual Business$594,290,175 18.1 With contract reserves $580,618,181 $312,372,489 503,137 528,094 9,161,965150.26%

    $23,287,287 18.2 Without contract reserves $15,830,964 )$(36,996 87,837 97,190 1,064,40867.82%$617,577,462 19. Grand total individual $596,449,145 $312,335,493 590,974 625,284 10,226,373147.15%

    ¹ Loss Ratio = (Incurred Claims Amount + Change in Contract Reserves) / Premiums Earned

    © 2015 National Association of Insurance Commissioners32

  • ACCIDENT AND HEALTH POLICY EXPERIENCE REPORT FOR 2014Aggregated Totals for Fraternal

    Premiums

    countrywide

    Earned Claims AmountIncurred

    Contract ReservesChange in

    Loss Ratio ¹or Certificates

    Number of Policies

    as of Dec 31 as of Dec 31Covered Lives

    Number ofMemberMonths

    B. GROUP BUSINESSComprehensive Major Medical 1. Single Employer 1.1 Small employer 0 0 0$0$0 N/A$0 1.2 Other Employer 0 0 0$0$0 N/A$0 1.3 Single employer subtotal 0 0 0$0$0 N/A$0 2. Multiple employer assns and trusts 0 0 0$0$0 N/A$0 3. Other associations and discretionary trusts 0 0 0$0$0 N/A$0 4. Other comprehensive major medical 0 0 0$0$0 N/A$0 5. Comprehensive/major medical subtotal 0 0 0$0$0 N/A$0

    Other Medical (Non-Comprehensive) 6. Specified/named disease 0 0 0$0$0 N/A$0 7. Limited benefit 0 0 0$0$0 N/A$0 8. Student 0 0 0$0$0 N/A$0 9. Accident only or AD&D 0 0 0$0$0 N/A$0 10. Disability income - short-term 0 0 0$0$106,721 110.46%$96,614 11. Disability income - long-term 0 0 0$0($15,976) N/A$0 12. Long-term care 0 0 0$0$0 N/A$0 13. Medicare supplement 0 0 0$0$0 N/A$0 14. Federal Employees Health Benefit Plans 0 0 0$0$0 N/A$0 15. Tricare 0 0 0$0$0 N/A$0 16. Dental 0 0 0$0$0 N/A$0 17. Medicare 0 0 0$0$0 N/A$0 18. Medicare Part D - Stand-Alone 0 0 0$0$0 N/A$0 19. Other group care 0 0 0$0$0 N/A$0 20. Grand total group business 0 0 0$0$90,745 93.93%$96,614

    C. OTHER BUSINESS 1. Credit (Individual and Group) 0 0 0$0$0 N/A$0 2. Stop Loss/Excess Loss 5 2,636 32,108$0$2,157,092 72.07%$2,993,030 3. Administrative Services Only 0 0 0XXXXXX XXXXXX 4. Administrative Services Contracts 0 0 0XXXXXX XXXXXX 5. Grand Total Other Business 5 2,636 32,108$0$2,157,092 72.07%$2,993,030

    D. TOTAL BUSINESS 1. Total Non U.S. Policy Forms 5,492 5,490 64,987$1,193,599$112,625 33.01%$3,956,549 2. Grand Total Individual, Group & Other Business 596,471 633,410 10,323,468$313,529,092$598,809,606 146.06%$624,623,655

    ¹ Loss Ratio = (Incurred Claims Amount + Change in Contract Reserves) / Premiums Earned

    © 2015 National Association of Insurance Commissioners33

  • ACCIDENT AND HEALTH POLICY EXPERIENCE REPORT FOR 2014Aggregated Totals for Fraternal

    Premiums

    countrywide

    Earned Claims AmountIncurred

    Contract ReservesChange in

    Loss Ratio ¹

    Part 1 - Individual PoliciesSummary

    $618,752,69201. U.S. forms direct business $596,497,746 $311,824,266 146.80%$4,042,54302. Other forms direct business $175,384 $1,190,897 33.80%

    $622,795,23503. Total direct business $596,673,130 $313,015,163 146.07%$004. Reinsurance assumed $0 $0 N/A

    $148,554,37305. Less reinsurance ceded $100,673,489 $5,047,503 71.17%$474,240,86306. Total $495,999,640 $307,967,660 169.53%

    Part 2 - Group PoliciesSummary

    $3,089,64401. U.S. forms direct business $2,247,837 $0 72.75%$002. Other forms direct business $0 $0 N/A

    $3,089,64403. Total direct business $2,247,837 $0 72.75%$004. Reinsurance assumed $0 $0 N/A

    $170,50105. Less reinsurance ceded $88,937 $0 52.16%$2,919,14306. Total $2,158,899 $0 73.96%

    Part 3 - Credit Policies (Individual and Group)Summary

    $2,88301. U.S. forms direct business $810 )$(3,131 (80.51)%$002. Other forms direct business $0 $0 N/A

    $2,88303. Total direct business $810 )$(3,131 (80.51)%$004. Reinsurance assumed $0 $0 N/A$005. Less reinsurance ceded $0 $0 N/A

    $2,88306. Total $810 )$(3,131 (80.51)%

    Part 4 - All Individual, Group and Credit PoliciesSummary

    $621,845,21901. U.S. forms direct business $598,746,392 $311,821,135 146.43%$4,042,54302. Other forms direct business $175,384 $1,190,897 33.80%

    $625,887,76203. Total direct business $598,921,776 $313,012,032 145.70%$004. Reinsurance assumed $0 $0 N/A

    $148,724,87405. Less reinsurance ceded $100,762,427 $5,047,503 71.14%$477,162,88806. Total $498,159,350 $307,964,529 168.94%

    ¹ Loss Ratio = (Incurred Claims Amount + Change in Contract Reserves) / Premiums Earned

    © 2015 National Association of Insurance Commissioners34

  • Accident and Health Policy Experience Report

    Individual Business

    © 2015 National Association of Insurance Commissioners35

  • © 2015 National Association of Insurance Commissioners36

  • Market Share for the Top 125 Insurers

    Individual Business

    © 2015 National Association of Insurance Commissioners37

  • © 2015 National Association of Insurance Commissioners38

  • ACCIDENT AND HEALTH POLICY EXPERIENCE REPORT FOR 2014Individual Market Share for All Statement Types

    Grand Total for Individual Business

    countrywide

    NAICEarned

    Premiums MarketShare %Loss Ratio %

    or CertificatesNumber of Policies

    Code Share %as of Dec 31 as of Dec 31Covered Lives

    Number of CumulativeMarket

    Rank Group/Company Name

    $58,069,837,312 13,885,572UNITEDHEALTH GRP7071 13,714,29481.86% 16.10% 16.10%$34,018,540,366 9,552,181HUMANA GRP1192 7,646,86184.40% 9.43% 25.53%$24,895,182,850 6,768,511ANTHEM INC GRP6713 6,212,79983.24% 6.90% 32.44%$22,170,597,976 5,084,768AETNA GRP14 4,745,18186.09% 6.15% 38.59%$13,571,067,773 3,340,943CENTENE CORP GRP12955 3,332,15188.43% 3.76% 42.35%$11,114,599,291 3,892,406WELLCARE GRP11996 3,892,40686.90% 3.08% 45.43%

    $8,835,052,154 2,442,178CIGNA HLTH GRP9017 1,334,34586.81% 2.45% 47.88%$8,215,109,113 2,091,613MOLINA HEALTHCARE INC GRP15318 2,091,61383.06% 2.28% 50.16%$7,923,246,441 3,072,996HCSC GRP9179 2,319,158101.01% 2.20% 52.36%$7,770,733,372 1,624,958INDEPENDENCE HLTH GRP INC GRP93610 1,526,52289.67% 2.15% 54.51%$7,435,136,580 1,237,959HIGHMARK GRP81211 1,121,24989.61% 2.06% 56.57%$5,629,382,816 1,275,430CARESOURCE GRP368312 1,268,11884.24% 1.56% 58.13%$4,745,872,607 1,086,863BCBS OF NJ GRP120213 1,040,79687.25% 1.32% 59.45%$4,664,793,252 1,743,767AEGON US HOLDING GRP46814 1,344,42915.90% 1.29% 60.74%$4,578,433,850 19,621,152AFLAC GRP37015 10,353,65157.61% 1.27% 62.01%$4,093,813,940 1,071,378GUIDEWELL MUT HOLDING GRP53616 818,29191.81% 1.14% 63.15%$3,995,983,267 1,078,812BCBS OF NC INC5463117 842,67291.06% 1.11% 64.26%$3,206,944,552 825,822BCBS OF TN GRP349818 733,90888.21% 0.89% 65.14%$3,150,896,115 461,280UCARE GRP438019 461,28088.67% 0.87% 66.02%$3,107,566,313 3,020,242CVS CAREMARK GRP466720 3,017,67877.82% 0.86% 66.88%$2,863,717,331 476,734HIP INS GRP112721 450,80991.70% 0.79% 67.67%$2,849,091,544 427,093UPMC HLTH SYSTEM GRP132422 425,77589.22% 0.79% 68.46%$2,709,470,120 751,740BCBS OF MI GRP57223 626,62787.02% 0.75% 69.22%$2,640,626,319 412,061KAISER FOUNDATION GRP60124 341,641102.73% 0.73% 69.95%$2,541,267,372 1,562,091MUTUAL OF OMAHA GRP26125 1,475,72375.35% 0.70% 70.65%$2,504,465,871 3,673,726UNUMPROVIDENT CORP GRP56526 3,673,726110.93% 0.69% 71.35%$2,470,284,680 342,326TUFTS GRP474227 339,02189.65% 0.68% 72.03%$2,400,583,190 1,159,203GENWORTH FIN GRP401128 1,059,442148.13% 0.67% 72.70%$2,372,798,036 372,628MEDICA GRP155229 359,82286.49% 0.66% 73.36%$2,224,113,988 592,443BCBS OF MN GRP46130 532,55188.99% 0.62% 73.97%$2,010,187,289 430,393LIFETIME HLTHCARE GRP118631 422,78993.61% 0.56% 74.53%$1,949,242,192 607,131CAIDAN ENTERPRISES INC GRP464032 607,13186.32% 0.54% 75.07%$1,793,582,661 383,208CAMBIA HEALTH SOLUTIONS INC120733 301,10192.93% 0.50% 75.57%

    © 2015 National Association of Insurance Commissioners39

  • ACCIDENT AND HEALTH POLICY EXPERIENCE REPORT FOR 2014Individual Market Share for All Statement Types

    Grand Total for Individual Business

    countrywide

    NAICEarned

    Premiums MarketShare %Loss Ratio %

    or CertificatesNumber of Policies

    Code Share %as of Dec 31 as of Dec 31Covered Lives

    Number of CumulativeMarket

    Rank Group/Company Name

    $1,778,152,327 124,165HEALTHFIRST INC GRP477834 124,16588.20% 0.49% 76.06%$1,775,857,092 328,897BOSTON MEDICAL CENTER HLTH PLAN INC1320335 328,89795.20% 0.49% 76.55%$1,720,175,188 1,460,868CNO FINANCIAL GRP23336 1,189,42089.45% 0.48% 77.03%$1,659,475,654 282,354HEALTH NET INC GRP62337 222,863102.18% 0.46% 77.49%$1,573,566,309 245,313GEISINGER INS GRP114338 235,10686.58% 0.44% 77.93%$1,560,188,796 959,947NORTHWESTERN MUT GRP86039 959,94768.06% 0.43% 78.36%$1,512,425,502 181,677UNIVERSAL AMER FIN CORP GRP95340 177,41873.38% 0.42% 78.78%$1,499,177,412 195,484MEDICAL CARD SYSTEM INC GRP130141 190,07486.79% 0.42% 79.19%$1,436,129,914 269,388NEIGHBORHOOD HLTH PLAN INC1110942 251,217104.37% 0.40% 79.59%$1,384,788,157 613,307JOHN HANCOCK GRP90443 613,217131.72% 0.38% 79.98%$1,337,463,787 523,095BCBS OF AL GRP57044 414,32994.57% 0.37% 80.35%$1,331,958,162 252,204PRESBYTERIAN HLTHCARE SERV GRP48145 252,20480.66% 0.37% 80.72%$1,293,066,980 236,330UNIVERSITY HLTH CARE INC5262146 236,33085.04% 0.36% 81.07%$1,245,681,310 229,528TRIPLE S GRP480247 200,14982.36% 0.35% 81.42%$1,238,429,866 193,591HEALTH PARTNERS PLANS INC9506648 193,59179.00% 0.34% 81.76%$1,218,063,928 527,939ARKANSAS BCBS GRP87649 464,91386.01% 0.34% 82.10%$1,180,701,843 103,775AMERICAS 1ST CHOICE GRP475550 103,77576.85% 0.33% 82.43%$1,161,240,469 1,905,780ASSURANT INC GRP1951 1,682,915127.45% 0.32% 82.75%$1,130,312,428 351,190COMMUNITY HLTH PLAN OF WA4704952 351,19093.68% 0.31% 83.06%$1,121,374,246 754,882METROPOLITAN GRP24153 304,230158.31% 0.31% 83.37%$1,118,441,000 193,519HEALTHPARTNERS GRP125854 179,35490.26% 0.31% 83.69%$1,111,991,537 219,139SPECTRUM HLTH GRP338355 219,13989.51% 0.31% 83.99%$1,082,098,644 3,471,228TORCHMARK CORP GRP29056 2,401,60667.85% 0.30% 84.29%$1,075,161,195 338,022BCBS OF MA GRP363757 327,50493.79% 0.30% 84.59%$1,054,855,049 138,133INDEPENDENT HLTH ASSN9530858 138,13392.38% 0.29% 84.88%$1,017,369,142 118,994HEALTH NOW NY INC5520459 118,994104.21% 0.28% 85.17%$1,002,608,151 450,434WELLMARK INC GRP77060 388,42086.71% 0.28% 85.44%

    $971,346,730 210,160HAWAII MEDICAL SERV ASSN4994861 206,22693.72% 0.27% 85.71%$946,219,349 422,627CAREFIRST INC GRP38062 289,78694.03% 0.26% 85.98%$895,834,806 147,635NEIGHBORHOOD HLTH PLAN OF RI INC9540263 147,63588.08% 0.25% 86.22%$886,512,070 231,544PREMERA BLUE CROSS GRP96264 164,95790.09% 0.25% 86.47%$878,212,470 236,577VANGUARD HLTH VENTURES GRP121265 236,57785.99% 0.24% 86.71%$875,213,209 288,373BCBS OF SC GRP66166 259,52881.97% 0.24% 86.96%

    © 2015 National Association of Insurance Commissioners40

  • ACCIDENT AND HEALTH POLICY EXPERIENCE REPORT FOR 2014Individual Market Share for All Statement Types

    Grand Total for Individual Business

    countrywide

    NAICEarned

    Premiums MarketShare %Loss Ratio %

    or CertificatesNumber of Policies

    Code Share %as of Dec 31 as of Dec 31Covered Lives

    Number of CumulativeMarket

    Rank Group/Company Name

    $848,759,507 108,589GROUP HLTH COOP GRP118567 93,02491.63% 0.24% 87.19%$833,450,458 116,166SIMPLY HLTHCARE GRP480668 116,16683.70% 0.23% 87.42%$833,326,714 155,688CDPHP INC GRP470869 154,61993.07% 0.23% 87.65%$805,368,285 112,370MVP GRP119870 101,31996.61% 0.22% 87.88%$786,497,647 198,623SENTARA HLTH MGMT GRP118371 190,61189.82% 0.22% 88.10%$775,637,930 25,279ELDERPLAN INC9566272 25,27982.74% 0.22% 88.31%$738,924,737 227,821LOUISIANA HLTH SERV GRP43873 162,95094.30% 0.20% 88.52%$736,535,732 136,869HENRY FORD HLTH SYSTEM GRP131174 128,77685.44% 0.20% 88.72%$724,203,297 236,811IHC INC GRP88075 169,815111.59% 0.20% 88.92%$720,024,268 260,409COMMUNITY HLTH CHOICE INC9561576 260,40988.46% 0.20% 89.12%$696,185,837 0PEOPLES HLTH INC1360777 085.00% 0.19% 89.31%$695,152,852 307,009GUARDIAN LIFE GRP42978 300,57582.44% 0.19% 89.51%$693,877,135 875,936STATE FARM GRP17679 815,02983.66% 0.19% 89.70%$680,014,241 327,960MASS MUT LIFE INS GRP43580 341,57578.44% 0.19% 89.89%$650,236,497 139,115BCBS OF RI5347381


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