The Health Insurer Database was compiled by Alpha Center with grant funding from the Robert Wood Johnson Foundation. The Health Insurer Database contains information about every health insurer in the U.S. that wrote at least $500,000 of major medical insurance coverage in any state in 1995, 1996 or 1997. Much of the database was compiled from publicly available data reported to state departments of insurance, departments of health, or (in California) the Department of Corporations. However, because much of the database’s information about commercial insurers was obtained from confidential responses to a survey conducted by Alpha Center, the final database is proprietary.

The Health Insurer Database was compiled in three segments, reflecting differences in the states’ reporting requirements and regimes for each of the major types of insurers -- commercial insurers, Blue Cross and Blue Shield organizations, and health maintenance organizations.

Commercial insurers

The NAIC data. Our basic source of information about commercial insurers is the annual financial reports that each admitted insurer files in each state, compiled by the National Association of Insurance Commissioners (NAIC). In all states, each commercial insurer files an extensive set of forms with the state, submitting information on premiums (written and earned), medical losses, administrative costs, surplus and reserves. These data are public use.

Alpha Center Survey of Commercial Insurers. In August and September 1998, Alpha Center fielded a mail survey of all commercial insurers that reported writing at least $500,000 in any line of health insurance in any state. Lines of health insurance that insurers report as an aggregate include major medical, hospital or hospital surgical, accident, disability, dread disease, dental, vision, or any other specialty health insurance product. The survey consisted of individualized forms mailed to each insurer (679 companies). Separate surveys were sent for group and individual lines of business; an insurer writing both lines received two survey forms. In all, 885 line-of-business surveys were mailed. Respondents were asked to identify how much of their business in each state and year (1995, 1996, and 1997) was major medical, how many lives were covered, and whether they were actively marketing in the state in that year. We requested and obtained from HIAA a personally signed letter endorsing the survey and asking that the insurer respond.

Survey response. In October, Alpha Center staff began follow-up phone calls to each insurer that had not responded to the survey, and repeated phone calls to the largest insurers in the survey. The largest insurers were called not fewer than five times, and other avenues (e.g., having HIAA also place a call to the insurer) also were pursued to obtain a response. At the conclusion of this effort, 334 companies had responded, providing information on 446 lines of business. The overall company response rate was 49.2 percent; the line-of-business response rate was 50.4 percent. Survey response rates by line of business are reported in Table A1.

Supplemental sources of information. To gain information about insurers that did not respond to the survey, we went to other public sources of information. None of these sources provides complete information about a reporting commercial insurers group and individual business, but each was valuable in providing some key information about at least part of the insurers business.

• The NAIC Accident and Health Policy Exhibit. The Accident and Health Policy Exhibit provides valuable detail about companies individual health insurance business. However, not all companies file this Exhibit, and the NAIC sells it only in photocopy form. Of the insurers that did not respond to our survey, 60 companies did file this exhibit. We obtained this exhibit these companies, as well as a number of reporting companies in order to ascertain the comparability and integrity of this source.
• Schedule H Accident and Health Exhibit. In 1997, the NAIC added a new section to this Exhibit, requiring companies to report their claims by type of claim (i.e., medical, dental and other). We assumed that companies which reported no medical claims for the year wrote no medical coverage that year. Using this information, we ascertained that 55 non-respondents in the individual market and 54 non-respondents in the group market wrote no major medical coverage.

Using these three sources of information – the Alpha Center survey, the NAIC Accident and Health Policy Exhibit, and the NAIC Schedule H Accident and Health Exhibit – we obtained observations for 314 of 359 commercial insurers in the individual market (87.5 percent) and 301 of 526 companies in the group market (57.2 percent). To improve our information about the group market, we systematically explored additional avenues of information about nonreporting companies (specifically, their SEC filings, the states’ Department of Insurance web pages, and conversations with various Department of Insurance officials). Our estimates of the proportion of the group and individual markets “known” in each state include information obtained by these other means for 13 group insurers and 2 individual insurers.

Blue Cross and Blue Shield Plans

Alpha Center obtained copies of the annual statement of all companies filing as a Hospital, Medical, Dental or Indemnity (HMDI) carrier in 1995, 1996 or 1997. For some states, these were obtainable from NAIC; we contacted other states directly to obtain statements. These statements provide information about every Blue Cross and Blue Shield (BCBS) organization admitted in any state.

Health Maintenance Organizations

Alpha Center obtained photocopies of every HMO filing in 1995, and coded and entered selected fields from these filings into an electronic database. To obtain 1996 and 1997 information, we purchased from InterStudy its standard HMO financial database for 1996 and 1997, enhanced with selected additional premium and medical loss figures by line of business. Due to the enhancement of the standard database, these data are proprietary to Alpha Center. From these data, we identified 638 HMOs operating in 1996 and 671 HMOs operating in 1997.

Market Knowledge by State

The proportion of the group and individual markets in each state that is “known” after compiling data from each of the sources of information described above is listed in Table A2. The proportion of the market that is known is measured as the major medical premiums earned in the state by all of the health insurers about which we have information, divided by the total premium volume of all health insurers in the state with at least $500,000 in earned premiums. Because Hawaii does not require HMOs to file financial reports, we have omitted Hawaii from the database; the database does include, however, the District of Columbia, bringing our total count of state-level markets to 50. Because the denominator for this measure includes all health premiums earned by insurers for which we do not have information (and, therefore, may include health lines other than major medical), these estimates are conservative.

Using earned premiums as a measure, we know at least 89 percent of the group market in all states and at least 95 percent of the group markets in 25 states. In the individual market, we know at least 90 percent of the market in all states but Texas (at 87 percent); in 29 states, we know at least 95 percent of the market.