Establishing an Analytical Framework for Measuring the Role of Reinsurance in the Health Insurance Market. Attachment C

03/20/1997

HMO Annual Statement Data

Table C -1 Selected Reinsurance Data from Pennsylvania HMO Filings, Sorted by Total Premiums

No. Company Reinsurance Expense Net Recoveries Total Premiums Earned Name of Reinsurer Limits of Coverage Exp Date Comments
1 U.S. Health Care Systems of PA 0 1,312,067,811 None (self-insured)      
2 The Keystone Health Plan East 0 1,045,082,645 Self Insured      
3 The Keystone Health Plan West (588,398) 455,833,612 Trans-General Life Insurance Co $250,000 deductible 07/01/96  
4 Health America Pennsylvania 2,176,846 414,800,909 American Service Life 80% of inpatient services in excess of $250,000 12/31/95  
5 The Geisinger Health Plan 83,951 216,185,913 Allianz $2 million maximum lifetime 06/30/96  
6 Qualmed Plans for Health of PA (3,228) 215,065,648 Allianz Life Ins Co. of North Am 90% in excess of $100,000 up to $2 million lifetime 06/30/96  
7 The Healthcare Management Alternatives Inc. 1,830,000 212,229,990 Continental Assurance Co $23 million in aggregate 01/31/97  
8 Health Partners of Philadelphia, Inc. 498,366 207,422,231 John Alden Life Ins Co. Reinsurance for 90% of defined costs in excess of $150K and $125K, respectively in '95 and '94, per MA member per policy year. Hospitalization costs subject to recovery were $1,500.8K and $2,231.2K in '95 and '94, respectively. (Not Specified)  
9 The Keystone Health Plan Central 523,051 173,171,138 Trans-General Life Insurance Co Recoveries limited to 70% of amounts in excess of $250,000 stop loss 12/31/96  
10 The HMO of Northeastern PA 326,009 142,615,982 Allianz Life Insurance Co $2 million Continuous until cancelled  
11 Aetna Health Plans of Central and Eastern PA, Inc. (196,698) 114,363,354 Aetna Life Ins Co. Unlimited Indefinite  
12 The Oxford Health Plans (PA) (219,169) 99,847,599 Allianz Life Ins Co. of North Am $150,000 stoploss limit, per member per year, lifetime limit of $2 million 07/31/95  
13 The Prudential Health Care Plan (dba Prucare) 0 56,155,292 The Prudential Insurance Co of America $1 million per person deductible None Unclear why no reinsurance expense
14 Amerihealth HMO, Inc. 280,104 53,656,601 Allianz Life Ins Co. of North Am $75,000 deductible, $2 million per member lifetime 07/01/96  
15 HealthGaurd of Lancaster, Inc. (156,414) 46,249,965 Allianz Life Ins Co $100,000 deductible, $2 million lifetime 12/31/96  
16 Aetna Health Plans of Western PA, Inc. 54,149 27,659,054 Aetna Life Ins Co. Unlimited 03/31/96  
17 Central Medical Health Plan, Inc. 155,967 21,936,814 AON Managed Care/Combined Insurance $125,000 deductible and [$99,000 retension estimate] 09/30/96  
18 Alliance Health Network (65,279) 21,720,860 Allianz Life Ins Co. $50,000 deductible per occurrence on hosp I/P claims, & 85% of excess 04/30/96  
19 Cigna Health Care of PA 23,854 4,891,421 Connecticut General Life $150,000 deductible; amounts thereafter reimbursed at 80% Continuous  
20 Greater Atlantic Health Plans, Inc. 0 0 QualMed Health and Life $1 million per contract year, $2 million per lifetime 06/30/96 "No membership"
21 HIP of PA, Inc (d/b/a HIP Health Plan) 0 0 Allianz Life Insurance Co of North America 2 policies starting with a $50K deductible to $180K and $185K deductible to a maximum individual coverage of $2M. There are varying percentages of coinsurance. 07/01/96  
22 The Medigroup HMO, Inc. 0 0 BCS Insurance Co $2 million per member 06/01/96 (Apparently no membership)
23 The Riverside Health Plan, Inc. 0 0 American Service Life 50%-90% dependent on contracted services 12/31/95 Apparently no membership)
24 The Vista Health Plan 0 0 None     "No subscribers"

Source: The Lewin Group tabulations of HMO Annual Statement data Pennsylvania.

Table C-2 Selected Reinsurance Data from Wisconsin HMO Filings, Sorted by Premiums

No. Company Reinsurance Expense Net Recoveries Total Premiums Earned Name of Reinsurer Limits of Coverage Exp Date Comments
1 U.S. Health Care Systems of PA 0 1,312,067,811 None (self-insured)      
2 The Keystone Health Plan East 0 1,045,082,645 Self Insured      
3 The Keystone Health Plan West (588,398) 455,833,612 Trans-General Life Insurance Co $250,000 deductible 07/01/96  
4 Health America Pennsylvania 2,176,846 414,800,909 American Service Life 80% of inpatient services in excess of $250,000 12/31/95  
5 The Geisinger Health Plan 83,951 216,185,913 Allianz $2 million maximum lifetime 06/30/96  
6 Qualmed Plans for Health of PA (3,228) 215,065,648 Allianz Life Ins Co. of North Am 90% in excess of $100,000 up to $2 million lifetime 06/30/96  
7 The Healthcare Management Alternatives Inc. 1,830,000 212,229,990 Continental Assurance Co $23 million in aggregate 01/31/97  
8 Health Partners of Philadelphia, Inc. 498,366 207,422,231 John Alden Life Ins Co. Reinsurance for 90% of defined costs in excess of $150K and $125K, respectively in '95 and '94, per MA member per policy year. Hospitalization costs subject to recovery were $1,500.8K and $2,231.2K in '95 and '94, respectively. (Not Specified)  
9 The Keystone Health Plan Central 523,051 173,171,138 Trans-General Life Insurance Co Recoveries limited to 70% of amounts in excess of $250,000 stop loss 12/31/96  
10 The HMO of Northeastern PA 326,009 142,615,982 Allianz Life Insurance Co $2 million Continuous until cancelled  
11 Aetna Health Plans of Central and Eastern PA, Inc. (196,698) 114,363,354 Aetna Life Ins Co. Unlimited Indefinite  
12 The Oxford Health Plans (PA) (219,169) 99,847,599 Allianz Life Ins Co. of North Am $150,000 stoploss limit, per member per year, lifetime limit of $2 million 07/31/95  
13 The Prudential Health Care Plan (dba Prucare) 0 56,155,292 The Prudential Insurance Co of America $1 million per person deductible None Unclear why no reinsurance expense
14 Amerihealth HMO, Inc. 280,104 53,656,601 Allianz Life Ins Co. of North Am $75,000 deductible, $2 million per member lifetime 07/01/96  
15 HealthGaurd of Lancaster, Inc. (156,414) 46,249,965 Allianz Life Ins Co $100,000 deductible, $2 million lifetime 12/31/96  
16 Aetna Health Plans of Western PA, Inc. 54,149 27,659,054 Aetna Life Ins Co. Unlimited 03/31/96  
17 Central Medical Health Plan, Inc. 155,967 21,936,814 AON Managed Care/Combined Insurance $125,000 deductible and [$99,000 retension estimate] 09/30/96  
18 Alliance Health Network (65,279) 21,720,860 Allianz Life Ins Co. $50,000 deductible per occurrence on hosp I/P claims, & 85% of excess 04/30/96  
19 Cigna Health Care of PA 23,854 4,891,421 Connecticut General Life $150,000 deductible; amounts thereafter reimbursed at 80% Continuous  
20 Greater Atlantic Health Plans, Inc. 0 0 QualMed Health and Life $1 million per contract year, $2 million per lifetime 06/30/96 "No membership"
21 HIP of PA, Inc (d/b/a HIP Health Plan) 0 0 Allianz Life Insurance Co of North America 2 policies starting with a $50K deductible to $180K and $185K deductible to a maximum individual coverage of $2M. There are varying percentages of coinsurance. 07/01/96  
22 The Medigroup HMO, Inc. 0 0 BCS Insurance Co $2 million per member 06/01/96 (Apparently no membership)
23 The Riverside Health Plan, Inc. 0 0 American Service Life 50%-90% dependent on contracted services 12/31/95 Apparently no membership)
24 The Vista Health Plan 0 0 None     "No subscribers"

Source: The Lewin Group tabulations of HMO Annual Statement data Pennsylvania.