1. Section 7: Health Plans Health plan market shares1
Section 7: Health Plans
Health plan market shares
Fully-insured market in total
Small group and individual market
HMO financial statistics
Net income & margins
Reserves
Health Plan Medical Loss Ratios
HMO enrollment statistics

2. Health Plan Market Shares

3. 3
Health Plan Market Shares: Total Fully-Insured Private Market, 2013* (Premium Volume: $6.2 billion)
Companies with common ownership were treated as one entity. For example, Blue Cross Blue Shield of Minnesota includes BCBSM and Blue Plus. Fully insured market only, market share based on premium volume. Source: MDH Health Economics Program, analysis of MCHA Premium Database for 2013.
*Contains preliminary unaudited and incomplete data

4. Market Share of Minnesota Non-Profit Health Plans 2005 to 20134
Market Share of Minnesota Non-Profit Health Plans 2005 to 2013
Market share calculated as share of premiums in the fully-insured health insurance market.
Source: MDH analysis of the premium assessment base for the Minnesota Comprehensive Health Association.
Contains preliminary data

5. Health Plan Market Shares: Small Group Market, 2013
Total Premium Volume in 2013: $1.35 Billion
Companies with common ownership were treated as one entity. For example, Blue Cross Blue Shield of MN includes Blue Cross Blue Shield of Minnesota and Blue Plus. Market shares based on premium volume; fully insured market only.
Source: Minnesota Department of Commerce, "Report of 2013 Loss Ratio Experience in the Individual and Small Employer Health Plan Markets for: Insurance Companies Nonprofit Health Service Plan Corporations and Health Maintenance Organizations," June 2014.

6. Health Plan Market Shares: Individual Market, 2013
Total Premium Volume in 2013: $710 Million
*Completed with most recent report, 2012
Note: Companies with common ownership were treated as one entity. Market shares based on premium volume; fully insured market only.
Source: Minnesota Department of Commerce, "Report of 2013 Loss Ratio Experience in the Individual and Small Employer Health Plan Markets for: Insurance Companies, Nonprofit Health Service Plan Corporations, and Health Maintenance Organizations ," June 2014.

7. HMO Financial Statistics

8. Summary of HMO Financial Trends, 2008 to 2013
In Millions of Dollars
2008
2009
2010
2011
2012
2013
Net Income
$26.0
$175.5
$250.6
$233.7
$250.3
$226.0
Total Revenue
$5,786.3
$6,582.9
$6,954.5
$6,971.7
$7,326.8
$7,746.9
Operating Income as % of Revenue
0.5%
1.9%
2.6%
2.3%
2.4%
2.2%
Net Income as % of Revenue
0.4%
2.7%
3.6%
3.4%
2.9%
Minnesota products only.
Source: MDH Health Economics Program analysis of HMO annual reports.

9. Net Income and Profitability by HMO, 20139
Net Income and Profitability by HMO, 2013
Net Income
(millions)
Total Revenue
Net Income as % of Revenue
Blue Plus
$73.2
$1,016.7
7.2%
Group Health
$43.0
$1,040.2
4.1%
HealthPartners
$65.6
$1,279.2
5.1%
Gundersen
$0.0
$2.2
(1.4%)
Medica
($3.8)
$1,778.4
(0.2%)
Metropolitan
$4.0
$154.5
2.6%
PreferredOne
($2.7)
$59.6
(4.5%)
Sanford
($0.4)
$3.0
(13.0%)
UCare
$47.2
$2,413.2
2.0%
All HMOs
$226.0
$7,746.9
2.9%
Minnesota products only. Source: MDH Health Economics Program analysis of HMO annual reports.

10. Minnesota HMO Net Income by Product Line, 2008 to 201310
Minnesota HMO Net Income by Product Line, 2008 to 2013
PMAP is Prepaid Medical Assistance Program; PGAMC is Prepaid General Assistance Medical Care; MSHO is Minnesota Senior Health Options; All Other includes: Medicare Supplemental, Dental and Minnesota Disability Health Options.
Source: MDH Health Economics Program analysis of HMO annual reports.

11. 11
Minnesota HMO Net Income per Member Month by Product Line, 2008 to 2013
PMAP is Prepaid Medical Assistance Program; PGAMC is Prepaid General Assistance Medical Care; MSHO is Minnesota Senior Health Options; and MDHO is Minnesota Disability Health Options.
Source: MDH Health Economics Program analysis of HMO annual reports.

12. Minnesota HMO Net Income by Product Line, 201312
Minnesota HMO Net Income by Product Line, 2013
PMAP is Prepaid Medical Assistance Program; MSHO is Minnesota Senior Health Options; MDHO is Minnesota Disability Health Options; SNBC is Special Needs Basic Care; All Other includes: Medicare Supplemental, and Dental.
Source: MDH Health Economics Program analysis of HMO annual reports.

13. Minnesota HMO Net Income per Member Month by Product Line, 2013
PMAP is Prepaid Medical Assistance Program; MSHO is Minnesota Senior Health Options; MDHO is Minnesota Disability Health Options; SNBC is Special Needs Basic Care; All Other includes: Medicare Supplemental, and Dental.
Source: MDH Health Economics Program analysis of HMO annual reports.

14. Minnesota HMO Profitability by Product Line, 2008 to 201314
Minnesota HMO Profitability by Product Line, to 2013
PMAP is Prepaid Medical Assistance Program; MSHO is Minnesota Senior Health Options; MDHO is Minnesota Disability Health Options; SNBC is Special Needs Basic Care; All Other includes: Medicare Supplemental, and Dental.
Source: MDH Health Economics Program analysis of HMO annual reports.

15. Sources of HMO Net Income, 2008 to 201315
Sources of HMO Net Income, 2008 to 2013
In Millions of Dollars
2008
2009
2010
2011
2012
2013
Sources of Net Income:
Net underwriting gain/loss
$31.3
$123.1
$181.4
$161.6
$174.9
$173.0
Investment Income
($5.5)
$52.4
$69.4
$44.5
$39.9
$39.4
Other
$0.2
$0.0
($0.2)
$27.5
$35.5
$13.7
Net Income
$26.0
$175.5
$250.6
$233.7
$250.3
$226.0
Investment income as % of net income
(21.2%)
29.8%
27.7%
19.1%
16.0%
17.4%
Minnesota products only.
Source: MDH Health Economics Program analysis of HMO annual reports.

16. Investment Income as a Percent of Net Income by HMO, 201316
Investment Income as a Percent of Net Income by HMO, 2013
Investment Income
(millions)
Net Income (millions)
Investment Income as Pct of Net Income
Blue Plus
$14.8
$73.2
20.2%
Group Health
$3.2
$43.0
7.5%
HealthPartners
$3.6
$65.6
5.5%
Gundersen
$0.0
($0.0)
0.0%
Medica
$11.5
($3.8)
(301.0%)
Metropolitan
($0.3)
$4.0
(7.1%)
PreferredOne
$0.2
($2.7)
(6.8%)
Sanford
($0.4)
0.5%
UCare
$6.3
$47.2
13.4%
All HMOs
$39.4
$226.0
17.4%
Source: MDH Health Economics Program analysis of HMO annual reports.

17. Reserves, Medical Expenses, and Regulatory Minimum Level by HMO, 201317
Reserves, Medical Expenses, and Regulatory Minimum Level by HMO, 2013
Reserves
(millions)
Total Expenses
Reserves as % of Total Expenses
Reserves as % of Regulatory Level
Blue Plus
$448.9
$924.7
48.5%
1162%
Group Health*
$158.8
$405.5
39.1%
737%
Gundersen
$1.5
$2.0
74.3%
230%
HealthPartners*
$846.4
$1,100.5
76.9%
632%
Medica
$404.5
$1,212.6
33.4%
609%
Metropolitan
$28.3
$131.3
21.5%
504%
PreferredOne
$7.7
$53.7
14.3%
278%
Sanford
$1.3
$3.1
41.0%
395%
UCare
$443.2
$2,195.6
20.2%
501%
All HMOs
$2,340.5
$6,560.4
35.7%
653%
*Fee-for-service revenue earned was subtracted from expenses to approximate member only expenses.
“Regulatory level” is the authorized control level; total expenses is from line 16 of HMO Minnesota Supplement Report #1.
Minnesota products only. Source: MDH Health Economics Program analysis of HMO annual reports.

18. Total Minnesota HMO Reserves Relative to Regulatory Minimum Levels, 2003 to 2013
Fee-for-service revenue earned was subtracted from expenses to approximate member only expenses.
“Regulatory minimum level” is the authorized control level.
Source: MDH Health Economics Program analysis of HMO annual reports.

19. Health Plan Medical Loss Ratios

20. Medical Loss Ratio in the Individual Market, (Carriers with $2 million or more in Premium Revenue)
Claims Expense
MLR2
Net Premium1
Incurred Claims
Quality Improvement
Fraud
Total
American Family Mutual
5,917,850
5,686,970
102.5%
BCBSM
445,433,947
410,826,000
2,682,963
52,655
413,561,618
92.8%
HealthPartners Inc.
15,979,000
17,283,000
145,000
17,428,000
114.2%
HealthPartners IC
53,738,000
45,452,000
1,335,000
46,787,000
90.8%
John Alden Life IC
2,514,806
1,571,953
15,086
973
1,588,012
70.1%
Medica Health Plans
5,560,982
8,456,183
17,060
8,473,243
52.7%
Medica IC
106,802,111
102,155,810
900,156
103,055,966
90.5%
PreferredOne IC
19,924,470
14,363,661
376,987
14,740,648
78.0%
Time IC
38,664,498
30,125,280
298,233
19,589
30,443,102
80.4%
694,535,664
635,920,857
5,770,485
73,217
641,764,559
Source: MDH Health Economics Program analysis of data from National Association of Insurance
Commissioners (NAIC), Supplementary Health Care Exhibit—Part 1; Note 1: premiums exclude taxes and fees. Note 2: Beginning in 2012, federal law requires insurance companies that don’t include certain small and new companies to issue rebates to consumers for an MLR under 80% in the individual market for the prior year.

21. Medical Loss Ratio in the Small Group Market, (Carriers with $2 million or more in Premium Revenue)
Claims Expense
MLR2
Net Premium1
Incurred Claims
Quality Improvement
Fraud
Total
BCBSM
529,674,020
476,362,000
3,545,565
51,205
479,958,770
91.3%
Federated Mutual IC
31,932,465
26,461,065
86.7%
Healthpartners Inc.
323,110,000
277,786,000
3,880,000
281,666,000
Healthpartners IC
76,514,000
71,263,000
903,000
72,166,000
98.7%
Medica IC
299,272,020
267,717,416
2,715,508
270,432,924
90.9%
PreferredOne Health Plan
36,264,677
32,094,820
363,256
30,196
32,488,272
93.9%
PreferredOne IC
39,155,657
37,352,947
424,368
37,777,315
96.9%
1,335,922,839
1,189,037,248
11,831,697
81,401
2,536,873,185
91.7%
Source: MDH Health Economics Program analysis of data from National Association of Insurance
Commissioners (NAIC), Supplementary Health Care Exhibit—Part 1 ; Note 1: premiums exclude taxes and fees.
Note 2: Beginning in 2012, federal law requires insurance companies that don’t include certain small and new companies to issue rebates to consumers for an MLR under 80% in the small group market for the prior year.

22. Medical Loss Ratio in the Group Market, 2013 (Carriers with $2 million or more in Premium Revenue)
Claims Expense
MLR2
Net Premium1
Incurred Claims
Quality Improvement
Fraud
Total
BCBSM
1,051,092,006
947,944,693
6,809,048
124,978
954,878,719
91.6%
Blue Plus
16,872,124
14,626,747
131,027
1,749
14,759,523
90.6%
Connecticut Gen Life IC
7,073,857
6,709,178
35,229
6,744,407
100.0%
Federated Mut IC
14,543,933
14,277,854
102.7%
Group Health Inc.
45,669,000
44,185,000
952,000
45,137,000
99.0%
Healthpartners Inc.
313,632,000
250,539,000
2,434,000
252,973,000
84.4%
Healthpartners IC
564,402,000
471,256,000
6,406,000
477,662,000
89.1%
Medica Health Plans
3,931,079
4,976,761
28,948
5,005,709
351.2%
Medica IC
691,482,013
587,524,258
5,751,170
593,275,428
90.4%
PreferredOne Health Plan
23,426,313
21,640,519
289,090
20,367
21,949,976
98.3%
PreferredOne IC
91,261,807
79,169,535
896,600
80,066,135
92.3%
Sanford Health Plan
2,477,302
2,500,574
22,738
2,523,312
109.0%
2,825,863,434
2,445,350,119
23,755,850
147,094
2,469,253,063
No data available.
Source: MDH Health Economics Program analysis of data from National Association of Insurance
Commissioners (NAIC), Supplementary Health Care Exhibit—Part 1; Note 1: premiums exclude taxes and fees.
Note 2: Beginning in 2012, federal law requires insurance companies that don’t include certain small and new companies to issue rebates to consumers for an MLR under 85% in the large group market for the prior year.

23. HMO Enrollment Statistics

24. Minnesota HMO Member Months by Product Line, 2008 to 2013
PMAP is Prepaid Medical Assistance Program; MSHO is Minnesota Senior Health Options; MDHO is Minnesota Disability Health Options; SNBC is Special Needs Basic Care; All Other includes: Medicare Supplemental, and Dental.
Source: MDH Health Economics Program analysis of HMO annual reports.

25. Distribution of Minnesota HMO Enrollment by Region, 2012
Northwest
Northeast
West Central
Central
Southwest
Southeast
Twin Cities
State-wide
BluePlus
14,213
16,431
16,294
40,343
25,745
43,383
50,687
207,096
GroupHealth
186
721
368
4,431
291
1,929
43,471
51,397
Gundersen 33
HealthPartners
160
435
349
28,090
2,735
3,182
190,470
225,421
Medica
2,015
20,788
7,729
24,165
107
1,056
82,666
138,526
Metropolitan 1 3
10,096
10,105
PreferredOne 99
362
630
2,863
985
1,535
8,955
15,429
Sanford
735 15
750
Ucare
3,420
14,614
3,628
27,272
9,632
36,221
207,230
302,017
All HMOs
20,094
53,354
28,998
127,167
40,231
87,355
593,575
950,744
Source: MDH Health Economics Program analysis of HMO annual reports

26. Minnesota HMO Enrollment as Percent of Regional Population, 2012
Northwest
Northeast
West Central
Central
Southwest
Southeast
Twin Cities
State-wide
BluePlus
8.4%
5.0%
7.3%
5.5%
9.2%
5.9%
1.7%
3.8%
GroupHealth
0.1%
0.2%
0.6%
0.3%
1.5%
1.0%
Gundersen
0.0%
0.005%
0.001%
HealthPartners
0.4%
6.5%
4.2%
Medica
1.2%
6.4%
3.5%
3.3%
2.8%
2.6%
Metropolitan
PreferredOne
Sanford
Ucare
2.0%
4.5%
1.6%
3.7%
7.1%
5.6%
All HMOs
11.9%
16.4%
13.0%
17.4%
14.4%
12.0%
20.3%
17.7%
Gundersen Luthern Health Plan is new to the Minnesota market as of 2012.
Source: MDH Health Economics Program analysis of HMO annual reports

27. Minnesota HMO Enrollment as Percent of Regional Population, 2012
11.9%
16.4%
13.0%
17.4%
20.3%
14.4%
12.0%
Source: MDH Health Economics Program analysis of HMO annual reports; U.S. Census Bureau.

28. Minnesota HMO Enrollment by Firm, 2013
Source: MDH Health Economics Program analysis of Minnesota Supplement # 1 available April 1st of
the following calendar year.

29. Minnesota HMO Enrollment by Product Line, 2013
Source: MDH Health Economics Program analysis of Minnesota Supplement # 1 available April 1st of the following calendar year.

30. Total Minnesota HMO Enrollment, 2006 to 2012
Source: MDH Health Economics Program analysis of HMO annual reports.

31. Minnesota HMO Market Penetration, 2006 to 2012
Source: MDH Health Economics Program analysis of HMO annual report, U.S. Census Bureau.

32. HMO Enrollment in Minnesota by Product Line, 2006 to 2012
Source: MDH Health Economics Program analysis of HMO annual reports.

33. Rates of Enrollment Growth for Minnesota HMOs by Product Line, 2007 to 2012
Source: MDH Health Economics Program analysis of HMO annual reports.

34. HMO Enrollment in Minnesota by Firm, 2006 to 2012
2007
2008
2009
2010
2011
2012
Blue Plus
151,751
136,204
132,279
136,210
176,357
201,754
207,096
First Plan
10,347
15,573
16,057
11,130
Group Health
26,047
23,986
21,634
51,334
48,626
50,827
51,397
Gundersen - 33
HealthPartners
334,938
320,734
328,621
286,953
265,930
227,872
225,421
Medica
183,884
179,045
157,957
171,445
192,087
176,692
138,526
MHP
16,941
17,861
21,624
18,662
18,112
19,009
10,105
PreferredOne
48,187
50,022
46,301
37,596
37,440
21,633
15,429
Sanford (Sioux Valley)
459
419
521
965
813
899
750
UCare
121,875
126,062
139,125
172,259
194,251
215,915
302,017
All HMOs
894,429
869,906
864,119
886,554
933,616
914,601
950,774
Change from previous year
(8.8%)
(2.7%)
(0.7%)
2.6%
5.3%
(2.0%)
4.0%
Source: MDH Health Economics Program analysis of HMO annual reports

35. Commercial Enrollment in Minnesota HMOs, 2006 to 2012
2007
2008
2009
2010
2011
2012
Blue Plus
42,649
32,268
26,289
16,302
11,114
9,661
4,998
First Plan
1,285
1,810
1,580
618
Group Health
23,172
22,210
16,088
15,030
11,121
10,151
8,884
Gundersen - 33
HealthPartners
250,881
234,995
245,219
226,436
201,758
157,709
141,152
Medica
50,472
50,024
24,615
21,620
16,585
13,160
1,257
MHP
PreferredOne
48,187
50,022
46,301
37,596
37,440
21,633
15,429
Sanford (Sioux Valley)
438
388
472
683
467
591
473
UCare
All HMOs
417,084
391,717
360,564
318,285
278,485
212,905
172,226
Change from previous year
(15.3%)
(6.1%)
(8.0%)
(11.7%)
(12.5%)
(23.5%)
(19.1%)
Source: MDH Health Economics Program analysis of HMO annual reports

36. Medicare Advantage Enrollment in Minnesota HMOs, 2006 to 2012
2007
2008
2009
2010
2011
2012
Blue Plus
First Plan
Group Health
2,875
1,776
1,549
Gundersen -
HealthPartners
839
503 16 31
Medica
MHP 15
1,018
4,567
218 46
PreferredOne
Sanford (Sioux Valley)
308
UCare
33,827
37,189
44,672
61,960
74,022
82,620
86,237
All HMOs
36,717
39,983
50,788
63,017
74,571
82,944
86,268
Change from previous year
(7.9%)
8.9%
27.0%
24.1%
18.3%
11.2%
4.0%
Source: MDH Health Economics Program analysis of HMO annual reports

37. Other Medicare Enrollment in Minnesota HMOs, 2006 to 2012
2007
2008
2009
2010
2011
2012
Blue Plus
12,060
9,520
10,885
10,934
40,406
62,704
82,792
First Plan
838
1,077
1,160
1,263
Group Health
3,997
36,304
37,505
40,676
42,513
Gundersen -
HealthPartners
35,574
37,186
35,049
4,424
4,611
4,604
4,769
Medica
11,629
11,194
13,137
14,341
30,462
12,562
25,686
MHP
931
836
824
1,015
1,161
1,286
3,373
PreferredOne
Sanford (Sioux Valley) 21 31 49
282
346
277
UCare
8,764
9,437
10,079
10,703
9,526
9,310
24,827
All HMOs
69,817
69,281
75,180
79,266
124,017
131,142
184,237
Change from previous year
68.3%
(0.8%)
8.5%
5.4%
56.5%
5.7%
40.5%
*Other Medicare includes Medicare Cost, Minnesota Senior Health Options, Minnesota Disability Health Options
MN Senior Care Plus, and Special Needs Basic Care
Source: MDH Health Economics Program analysis of HMO annual reports

38. Prepaid Medical Assistance Program Enrollment in Minnesota HMOs, 2006 to 2012
2007
2008
2009
2010
2011
2012
Blue Plus
48,242
49,873
52,162
61,445
66,983
82,200
78,279
First Plan
4,338
7,055
7,692
5,334
Group Health
Gundersen -
HealthPartners
30,616
31,653
32,282
36,325
38,933
49,508
60,953
Medica
86,618
85,891
87,680
97,039
103,288
117,697
86,521
MHP
12,209
12,567
12,851
13,537
14,176
16,207
6.732
PreferredOne
Sanford (Sioux Valley)
UCare
56,230
58,040
62,462
73,064
82,198
101,678
157,011
All HMOs
238,253
245,079
255,129
286,744
305,578
367,290
389,496
Change from previous year
(7.8%)
2.9%
4.1%
12.4%
6.6%
20.2%
6.0%
Source: MDH Health Economics Program Analysis of HMO Annual Report

39. Prepaid General Assistance Medical Care Enrollment in Minnesota HMOs, 2006 to 2012
2007
2008
2009
2010
2011
2012
Blue Plus
2,992
1,816
1,962
2,365
First Plan
572
749
755
498
Group Health
Gundersen -
HealthPartners
3,737
2,718
3,020
3,738
Medica
7,081
4,886
5,240
6,342
MHP
2,004
1,484
1,524
1,690
PreferredOne
Sanford (Sioux Valley)
UCare
4,341
3,166
3,711
4,773
All HMOs
20,727
14,819
16,212
19,406
Change from previous year
(7.7%)
(28.5%)
9.4%
19.7%
(100.0%)
0.0%
*The Prepaid General Assistance Medical Care program has been discontinued, and this slide will not be
included in subsequent years.
Source: MDH Health Economics Program analysis of HMO annual reports

40. MinnesotaCare Enrollment in Minnesota HMOs, 2006 to 2012
2007
2008
2009
2010
2011
2012
Blue Plus
45,808
42,727
40,981
45,164
57,854
47,189
41,027
First Plan
3,314
4,882
4,870
3,417
Group Health
Gundersen -
HealthPartners
14,130
14,182
13,051
15,191
20,125
16,035
18,516
Medica
28,083
27,050
27,285
32,103
41,752
33,273
25,062
MHP
1,782
1,956
1,858
2,202
2,729
1,516
PreferredOne
Sanford (Sioux Valley)
UCare
18,713
18,230
18,201
21,759
28,505
22,307
33,942
All HMOs
111,830
109,027
106,246
119,836
150,965
120,320
118,547
Change from previous year
(9.0%)
(2.5%)
(2.6%)
12.8%
26.0%
(20.3%)
(1.5%)
Source: MDH Health Economics Program analysis of HMO annual reports

41. Minnesota HMO Enrollment* by Firm and Age, 2012
<15
15-29
30-44
45-54
55-64
65+
Total
BluePlus
20.0%
17.9%
16.2%
14.8%
14.6%
33.4%
21.6%
Group Health
0.3%
0.9%
0.7%
2.3%
8.8%
17.1%
5.5%
Gundersen
0.0%
HealthPartners
25.1%
31.2%
36.5%
39.4%
2.8%
24.3%
Medica
19.3%
16.9%
16.4%
16.1%
14.5%
5.8%
14.4%
Metropolitan
1.3%
1.9%
2.1%
0.6%
1.0%
PreferredOne
1.2%
2.2%
2.9%
3.4%
0.1%
1.7%
Sanford
0.2%
UCare
34.1%
29.6%
25.4%
21.3%
20.3%
40.1%
31.4%
All HMOs
100.0%
*Includes health plan members that are non-Minnesota residents.
Source: MDH Health Economics Program analysis of HMO annual reports.

42. Distribution of Minnesota HMO Enrollment* by Product Line and Age, 2012
*Includes health plan members that are non-Minnesota residents.
Source: MDH Health Economics Program analysis of HMO annual reports.

43. Additional Information from the Health Economics Program Available Online
Health Economics Program Home Page
Publications
Health Economics Program Publications
Health Care Market Statistics (Presentation Slide Decks)
Health Economics Program Chartbook Homepage
Interactive Health Insurance Statistics