AIS’s Database and Report on 2010 Medical Loss Ratios

Contents

When you order AIS’s Database and Report on 2010 Medical Loss Ratios, you'll receive a CD with a user-friendly Excel spreadsheet and six reports (files on the CD are in .xlsx and .pdf formats), plus a printed report that includes an overview written by Kenneth B. Schnoll of SNR Denton, as well as all the reports from the CD.

Overview

Regulatory and Compliance Issues Associated With the Medical Loss Ratio Regulations, by Kenneth B. Schnoll, a partner at SNR Denton in San Francisco and a member of SNR Denton’s Insurance and Health Care practice.

• The Process HHS Will Use to Collect Data from Health Insurance Issuers
• Special Situations: Associations or Trusts, “Mini-meds” and Newly Issued Policies
• Combining Individual and Small-Group Markets
• “Earned” Versus “Unearned” Premium
• Clinical and Quality-Improvement Costs
• Administrative Costs
• Allocation of Expenses
• Calculating an Issuer’s MLR
• Applying a Credibility Adjustment
• Providing the Rebate
• Regulatory and Compliance Hurdles in Complying with the Interim Final MLR Regulations
• Lack of State-Specific Data
• Administrative Burden
• No Incentive to Incur Certain Costs
• Potential Variations by State

Data on 65 Leading Health Plans and Their Subsidiaries

The 226 health plans/subsidiaries examined in this MLR report represent 65 leading health plans – including Aetna, numerous Blue Cross Blue Shield plans, CIGNA, Humana, Kaiser and more. Click here to see the full list of health plans represented (PDF file).

Data Fields

All of the data are included in an Excel spreadsheet, which consists of 1,579 records, featuring Individual, Small Group and Large Group records for 226 different NAIC codes. Fields included are:

• Company
• NAIC Code
• State
• Subsidiary
• Coverage Type
• Health Premiums Earned
• Premiums Earned Including High-Risk Programs
• Federal Taxes and Assessments
• State Local Premium Taxes
• Regulatory Authority Licenses and Fees
• Adjusted Premiums Earned
• Net Adjusted Premiums Earned After Reinsurance Loss
• Incurred Claims Excluding Rx
• Prescription Drugs
• Pharmaceutical Rebates
• State Stop Loss, Market Stabilization and Claim/Census-Based Assessments
• Incurred Medical Incentive Pools and Bonuses
• Deductible Fraud and Abuse Expenses
• Total Incurred Claims
• Rebates Paid
• Fee-for-Service and Copay Revenue
• Total Quality Improvement Expense
• Preliminary MLR
• Total Claims Adjustment Expenses
• Claims Adjustment Expense Ratio
• Direct Sales Salaries and Benefits
• Agents and Brokers Fees and Commissions
• Total General and Administrative Expenses
• Underwriting Gain Loss
• Federal Income Taxes
• Net Gain or Loss

Six Comprehensive Reports

Our editors have selected the data fields relevant to the MLR calculation and/or to a health plan’s vulnerability to being subject to rebates in future years, and compiled six extensive reports – so you can view the data in a comparative format. The six reports are:

1. MLR Report by Company, by State
2. MLR Report by Company, by Group Size
3. MLR Report by State, by Company
4. Revenue Detail
5. Claims Expense Detail
6. General and Administrative Expenses

Click here to see a detailed list of fields included in each report (PDF file).

Methodology

This report and database features a large sample of health plans that are owned by the leading health insurers in the U.S. and that filed an annual statement for 2010 with Supplemental Health Care Exhibit with the National Association of Insurance Commissioners (NAIC).

Specific health plans, representing 65 of the largest health insurance companies in the U.S., were selected by AIS based on their national medical enrollment and market share in the managed care sector. Additional calculations were applied by AIS. Included in this product are original data as filed by the health insurance companies with NAIC.

AIS examined Annual Statements for 312 company codes, with each company code representing a specific health plan or subsidiary. Of those entities, 226 filed the Supplemental Health Care Exhibit with their 2010 filing. AIS initially sought data for 585 NAIC company codes.

This report and database is based on 2010 annual statements, and MLR calculations provided by insurers for 2010 are preliminary. Starting in 2011 health plans will be required by law to meet certain targets for their medical loss ratios for each plan by state and sector (individual/large group/small group). Starting in 2011, plans that do not meet the targets required by law may have to pay rebates to their customers. Rebates will be applicable to plans that spend too high a percentage on nonmedical costs.

AIS has no role in the collection of this data. All data are as reported by health plans or their representatives to the National Association of Insurance Commissioners. AIS cannot guarantee the accuracy or veracity of any of the data displayed in this product, nor of any results obtained from their analysis.

Written By

AIS’s Database and Report on 2010 Medical Loss Ratios was designed and assembled by Susan Namovicz-Peat, who has been managing AIS’s Directory of Health Plans for more than 10 years and is one of the nation’s foremost health business database researchers. It is produced by Atlantic Information Services, Inc., which has been serving health care business leaders for more than 25 years with timely business and regulatory news, specialized data and strategic information.

Written For

• Health plan business and financial executives seeking competitive data on other commercial health plans in their markets.
• State insurance commissioners and managers seeking perspective and averages among similar health plans.
• Consultants and vendors who work with health plans on specific areas that impact the MLR calculation — such as quality, fraud and abuse, claims expenses, pharmacy expenses, taxes, and benefit design.
• Financial analysts who monitor and assess the health plan sector.

AIS Guarantee

Order AIS’s Database and Report on 2010 Medical Loss Ratios for a 30-day risk-free inspection and test for yourself the value of this highly practical resource. If within 30 days you're not interested in keeping it, just return it to AIS and we will send you a prompt, full refund or credit. Refunds will not be made once the seal on the CD package has been broken. Please review your copy of the printed report prior to breaking the seal.

Shipping Information

This item is shipped via UPS. Please give us your street address when you order (UPS does not deliver to PO boxes.) You should receive your order within two weeks. Shipping and handling cost is $12 per item.

View Sample (PDF)

• MLR Report by Company, by State
• MLR Report by Company, by Group Size
• Revenue Detail
• Claims Expense Detail
• General and Administrative Expenses
• Detailed list of included health plans and reports' data fields