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New Source of State-Level Accident and Health Insurance Data for the Broader Insurance Industry

 

August 31, 2023

A new source of state-level Accident and Health (A&H) insurance data was recently published and is now available in Mark Farrah Associates’ (MFA) Health Coverage Portal™. The A&H insurance market is expansive, with a variety of health and medical products available to consumers, employers, and government agencies. Insurers across the country submitted the revised Accident and Health Policy Experience Exhibit (AHPEE) on April 1, 2023, as part of the 2022 National Association of Insurance Commissioners’ (NAIC) annual financial statements. The new AHPEE contains premiums, claims, lives, member months, and number of policies for multiple health insurance segments. Historically, this information was only available based on the domicile of the insurer. In 2021, the AHPEE was modified to provide state insurance regulators with additional data and improve consistency across the annual financial statements.[1] In 2022, all types of insurers [2] were required to report data at the state level, based on the location of the contract. MFA has categorized this newly available AHPEE data and presents key findings from its analysis.

 

 

  • Traditionally, when health insurance is discussed, Government programs such as Medicare Advantage, Medicare Part D (PDP), Medicare Supplement, Medicaid, and State Children’s Health Insurance Programs (S-CHIP) are at the forefront of the conversation – and for good reason, as this category accounts for the largest share of premium dollars, at nearly $709.8 billion (B) in 2022, and covers 114.8 million (M) lives.[3]
  • Government programs and comprehensive Major Medical coverage, comprised of the Federal Employer Health Benefits Program (FEHBP), Group (small, large, and multiple and other association & trust segments), and Individual (either purchased directly or through an exchange), are highly regulated – it is no surprise that the medical loss ratios for both categories are 85% and 86%, respectively.
  • Non-comprehensive (Non-Comp) medical, a broad category with nearly 471 million enrolled, is among the most profitable A&H categories with a loss ratio of 68%. This combination consists of Group and Individual Long- and Short-Term Disability, Long Term Care (LTC), Accident, Named Disease, Limited Benefit, and Student plans. These policies are also among the lowest cost products at $17 per member per month.
  • Ancillary plans, including dental and vision coverage purchased either individually or as part of a group, have a higher loss ratio than Non-Comp medical, 76%, but premiums also average $17 per member per month.
  • Administrative Services Only (ASO) is the second largest category based on covered lives and includes both Administrative Services Only and Administrative Services Contract type arrangements [4], as well as other Credit and Stop Loss products.

About the Data

The data used in this analysis brief was obtained from Mark Farrah Associates' Health Coverage Portal™ database and sourced from health insurance companies reporting through the NAIC (National Association of Insurance Commissioners) via the Accident and Health Policy Experience Exhibit (AHPEE). This analysis excludes a small number of plans that have not yet filed 2022 Annual data. Mark Farrah Associates' Health Coverage Portal™, A&H Policy Experience Exhibit by State table presents summary level data including premiums, claims, lives, member months, and number of policies for multiple health insurance segments, as mentioned above. This table does not include data for plans regulated by the California Department of Managed Health Care and not all health insurers are required to file with the state insurance departments. This table presents data for NAIC plans licensed as Fraternal, Life, Property, & Health. MFA’s A&H tables exclude non-health related segments, such as life, property, or flood policies. In 2021, the Accident and Health Policy Experience Exhibit (AHPEE) was modified to provide state insurance regulators with additional data and improve consistency across the annual financial statements. The AHPEEs prior to 2022 are available but not compatible with the current year.

About Mark Farrah Associates (MFA)

Mark Farrah Associates (MFA) is a leading data aggregator and publisher providing health plan market data and analysis tools for the healthcare industry. Our product portfolio includes Health Coverage Portal™, County Health Coverage™, 5500 Employer Health plus, Medicare Business Online™, Medicare Benefits Analyzer™, and Health Plans USA™. For more information about these products, refer to the informational videos and brochures available under the Our Products section of the website or call 724-338-4100.

Healthcare Business Strategy is a FREE brief that presents analysis of important issues and developments affecting healthcare business today. If you would like to be added to our email distribution list, please submit your email to the "Subscribe to MFA Briefs" section at the bottom of this page.


[1] From NAIC’s 2022 Accident and Health Policy Experience Report.
https://content.naic.org/sites/default/files/publication-ahp-lr-accident-health-report.pdf

[2] Types of insurers include Health; Life, Accident & Health; Fraternal; and Property & Casualty type entities.

[3] Lives covered is also referred to as enrollment or members; an individual can, and often does, have more than one type of policy.

[4] For Administrative Services Only and Administrative Services Contract segments only lives, member months, and number of policies are available in the A&H data. In graphic, the PMPM calculations are for other Credit and Stop Loss segments only.

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