主要医疗保健止损保险公司市场驱动因素和趋势

IN THIS ISSUE112017–2022 Statutoryfinancial results12Stop lossmarket trends13High dollarclaims trends14Healthcare andlarge claimsapplications ofadvanced analytics © Oliver Wyman2017–2022 STATUTORY FINANCIAL RESULTS1All Section 1 information summarized from NAIC Annual Statements, Accident & Health Policy Experience Exhibits.By Marc Lambright, FSA, MAAA and John Rienstra, FSA, MAAAMARKET-WIDE STOP LOSS PREMIUM AND ENROLLMENT TRENDSWe summarize enrollment, premiums, claims, and loss ratio trends of carriers with 2022 reported statutory financialinformation for the various segments of the stop loss market. Overall, the market has seen considerable growth intotal premium which has increased at an average rate of 13% annually driven primarily through higher premiumsper member per month (PMPM) which have increased at an average rate of about 10% per year while covered livesincreased at about a 4% annual rate over the period.2017201820192020202120225-year averagegrowth rateCovered lives (million)58.059.362.564.162.671.8Premium (million)$16,785$20,114$23,470$25,512$27,577$31,424Premium PMPM$26.06$29.45$34.59$36.69$40.85$42.41 4.4%13.4%10.2% © Oliver WymanComprehensive Medical•Aultman Health Foundation•HealthPartners, Inc.•Humana Inc.•Lifetime Healthcare, Inc.•Medica Holding Company•Medical Mutual of Ohio•Preferred Insurance GroupSpecialty & Life Ins Cos•AXA SA•Berkshire Hathaway Inc.•Cameron Associates, Inc.•Educators Mutual Insurance Association•QBE Insurance Group Limited•Swiss Re AG•The Westaim Corporation•Trustmark Mutual Holding Company•Ullico Inc.•W. R. Berkley Corporation•Zurich Insurance Group AGMGU Paper•Brookfield Asset Management Reinsurance Partners Ltd.•Fairfax Financial Holdings Limited•Fidelity Security Life Insurance Company•Nationwide Mutual Group•Pan-American Life Mutual Holding Company•Western & Southern Mutual Holding CompanyLarge National Medical•Centene Corporation•Cigna Corporation•CVS Health Corporation•UnitedHealth Group IncorporatedCARRIER TYPESWe assigned a carrier type to each company that hadpremiums and lives reported in the AHPEE based oneach company’s characteristics, including distributionapproach. Blues•Elevance / Anthem, Inc.•Aware Integrated, Inc.•BCS Financial Corporation•Blue Cross & Blue Shield of Mississippi, a Mutual InsuranceCompany•Blue Cross & Blue Shield of Rhode Island Inc.•Blue Cross and Blue Shield of Alabama•Blue Cross and Blue Shield of Kansas City•Blue Cross and Blue Shield of Kansas, Inc.•Blue Cross and Blue Shield of Massachusetts, Inc.•Blue Cross and Blue Shield of North Carolina•Blue Cross and Blue Shield of South Carolina•Blue Cross and Blue Shield of Vermont•Blue Cross Blue Shield of Arizona, Inc.•Blue Cross Blue Shield of Michigan Mutual InsuranceCompany•Blue Cross Blue Shield of Wyoming•Blue Cross Complete of Michigan LLC•Blue Cross of Idaho Health Service, Inc.•BlueCross BlueShield of Tennessee, Inc.•California Physicians' Service, Inc.•Capital Blue Cross, Inc.•CareFirst, Inc.•Elevance Health, Inc.•GoodLife Partners, Inc.•GuideWell Mutual Holding Corporation•Hawaii Medical Service Association•Health Care Service Corporation, a Mutual Legal ReserveCompany•HealthyDakota Mutual Holdings•Highmark Health•Horizon Healthcare Services, Inc.•Independence Health Group, Inc.•Louisiana Health Service and Indemnity Company•PREMERA•Premera Blue Cross•Prosano, Inc.•Trigon Healthcare, Inc.•Wellmark, Inc.Large Direct ESL•Sumitomo Life Insurance Company•Sun Life Financial Inc.•Tokio Marine Holdings, Inc.•Voya Financial, Inc. © Oliver WymanPREMIUM AND CLAIMS TRENDS BY CARRIER TYPEThe table below shows annual direct premiums and calculated trends by carrier type. Large National Medical Carrier,MGU Paper, and Comprehensive Medical carrier types have seen higher premium growth than the total market’s13.4% annual rate for 2017–2022, and expanded their market share, while the Large Direct writers and Blues haveseen their shares decline. Overall, the Large National Medical, the Blues, and Large Direct ESL continue to dominatethe market as they still represent almost 80% of total premium earned.Total direct premiums by carrier type 2017–2022In millionsYearLargeNationalMedicalBluesLargeDirect ESLSpecialtyand LifeIns CosMGU PaperComprehensiveMedical2017$5,115$4,722$3,966$1,113$5372018$6,532$5,168$4,391$1,686$7042019$7,669$5,818$4,990$1,848$1,3312020$8,234$6,372$5,483$1,985$1,4602021$9,141$6,934$5,897$1,855$1,5002022$10,463$7,573$6,650$2,292$1,5735-year avg.growth rate15.4%9.9%10.9%15.5%24.0%Growthvariance tototal market2.0%-3.5%-2.5%2.2%10.6%2017 Marketshare30.5%28.1%23.6%6.6%3.2%2022 Marketshare33.3%24.1%21.2%7.3%5.0%In the following table, we show the premium PMPM and resulting trends by carrier type. The Specialty andLife Insurance Cos and MGU Paper carrier types have seen the lowest average premium increases. MGU Papercontinues to have lower average PMPM premiums than the other carrier types while both Large National Medicaland Comprehensive Medical have higher than average