Health 2020 Annual Industry Commentary
U.S. Health Insurance Industry 2020 Annual ResultsU.S. Health Insurance Industry Analysis ReportHEALTH INDUSTRY OVERVIEWTable 1 below provides a 10-year snapshot of the U.S. Health insuranceindustry’s aggregate financial results for health entities who file with theNAIC on the health annual statement blank. The number of Health insurersfiling the health statement type with the NAIC increased to 1,096 from 1,031in 2019. The health insurance industry continued its tremendous growthtrend as it experienced a significant increase in net earnings to 31 billionand an increase in the profit margin to 3.8% in 2020 compared to netearnings of 22 billion and a profit margin of 3% in 2019. The combined ratiodecreased modestly to 97% from 97.6%.Notable items as compared to 2019 include the following: Net earned premium increased 11% ( 81.2 billion). Hospital & medical expenses increased 6.6% ( 42 billion). Aggregated loss ratio decreased to 82.6%. Administrative expenses increased 25.3% ( 22.2 billion). Capital and surplus increased 12.6% ( 19.7 billion) A&H earned premium increased 7% ( 67.2 billion).Inside the ReportPage No.Industry Overview . 1Underwriting Results . 2Analysis of Operations by LOB . 3Enrollment and Premium Revenues . 9Cash Flow and Liquidity . 11Capital and Surplus. 12Accident and Health . 23Health Entities Filing to the '16'17'18'191,096(For insurers filing the A&H Policy Experience Exhibit on the life/A&H, health, and property/casualty financial statements) Impact of COVID-19 on Health Insurance Industry(In Millions, Except PMPM)OperationsDi re ct Wri tten Premi umNet Ea rne d Pre mi umNet Inves tment Income Ea rnedUnde rwri ti ng Ga i n/(Los s )Net Income /Los sTota l Hos pi ta l & Medi ca l ExpLos s Ra ti oAdmi ni s tra ti ve Expens e sAdmi n Expens e Ra ti oCombi ned Ra ti oProfi t Ma rgi nNet Premi um PMPMCl a i ms PMPMCa s h Fl ow from Opera ti onsEnrol l mentTable 1Health Entities as of December 31, 1.6%6.6%(3.2) Pts .25.3%1.5 Pts .(1.6) Pts .0.8 Pts .6.0%2.2%124.3%3.9%2015201420132012'202011 824,728 761,738 716,190 668,521 638,259 593,403 533,083 459,274 443,537 418,482 816,208 734,993 708,473 664,107 631,656 587,374 526,852 450,737 433,211 409,291 4,997 6,083 5,146 4,798 3,331 3,250 3,229 3,152 3,154 3,245 32,970 17,656 21,423 188,358 9,918 6,438 6,618 9,637 11,675 14,763 31,385 22,168 23,142 16,060 7,194 3,672 5,661 9,978 11,744 13,909 674,426 632,412 598,130 568,576 541,886 505,506 450,823 389,206 371,947 7%84.5% 109,750 87,596 92,628 78,499 82,633 78,712 71,538 54,705 51,221 %96.4%3.8%3.0%3.2%2.4%1.1%0.6%1.1%2.2%2.7%3.4% 284 268 261 248 241 232 221 212 205 204 236 231 220 213 207 199 189 183 177 173 55,347 24,674 17,046 25,435 12,266 6,600 6,273 8,120 13,203 15,399240231225221218213204178177168Capital and SurplusCa pi ta l & Surpl usRe turn on Equi ty (ROE)12.6% 175,596 155,944 151,793 137,686 122,392 115,561 112,193 111,140 103,0413.6 Pts .18.5%14.9%15.8%11.9%6.1%3.7%5.7%10.0%12.4% 94,64215.5%AssetsNet Inves te d As s e tsNet Admi tte d As s e tsNet Inv Inc & Rea l i ze d Ga i n/(Los s )Inve s tme nt Yi el dNumber of Compa ni es Fi l ed22.1% 278,475 228,100 217,909 210,825 189,241 177,180 169,991 163,439 155,331 145,70616.7% 375,598 321,761 305,218 289,601 268,386 253,277 238,913 214,328 201,801 188,664(14.7)% 6,585 7,718 5,175 5,438 4,320 4,165 4,832 4,479 4,417 4,249(0.7) Pts 11,010981967958943926880857Note: Aggregate results include only health entities who file annual health statements with the NAIC. 2021 National Association of Insurance Commissioners1 Page
U.S. Health Insurance Industry 2020 Annual ResultsUNDERWRITING RESULTSFigure 1 illustrates the profitability trend for the healthFigure 1insurance industry and the increase in both net earningsNet Income & Profit Marginand profit margin. The significant increase in the industry’sunderwriting results can be attributed to an 11% ( 81.2billion) increase in net earned premium to 816.2 billion.However, the industry partially offset this increase with a6.6% ( 42 billion) increase in total hospital and medicalexpenses to 674.4 billion, a 25.3% ( 22.2 billion) increasein claims adjustment expenses and general administrativeexpenses to 110 billion. Administrative expenses aloneincreased 32.6% ( 20.6 billion) to 84 billion due primarilyto the return of the health insurer fee (HIF) which wasexpensed in full in the first quarter of 2020 at approximately 15.5 billion. Health insurers then pass on the HIF topolicyholders via premiums. The industry also reported an18% ( 1.1 billion) decrease in net investment incomeearned. The decrease can be attributed to a 752 million decrease in interest income from short-term investments. TheFederal Reserve cut interest rates to 0.25% as the COVID-19 Pandemic disrupted economic activities during 2020.Figure 2 illustrates the increase in total hospital and medical benefits compared to earned premium. For 2020, the industryreported a decrease in the combined ratio to 96% due to a 3 basis point decrease in the aggregated loss ratio to 83%partially offset by the aforementioned increase in administrative expenses.Table 2, starting on the next page, provides an analysis of operations by line of business for 2020. In terms of dollar impact,the comprehensive hospital and medical ( 12 billion), Medicare ( 11 billion) and Medicaid ( 7 billion) lines of businesswere the most profitable. Subsequently, Figures 3 through 10 on pages 6 through 9, illustrate underwriting results, earnedpremium, and total hospital and medical expenses in relation to loss ratios by line of business. 2021 National Association of Insurance Commissioners2 Page
U.S. Health Insurance Industry 2020 Annual ResultsDespite the CDC repor ng nearly 33 million COVID-19 cases na onwide, as noted above, the health industry reported onlya 7% increase in benefit claims incurred. This is consistent with prior year-over-year changes. However, it is important tonote, that offse ng factors appear to have reduced the overall financial impact to insurers such as reduced costs relatedto cancelled or delayed medical treatments, procedures, and u lizing other non-emergency health benefits. Theseoffse ng factors are also evident in the decreases in the loss ra os by line of business as included in Table 2 below.However, going forward, there is the poten al that delayed treatments could lead to worsening health condi ons,resul ng in escalated claims expenses. There is also the poten al that Medicare/Medicare Advantage, and Medicaidwriters as well as comprehensive writers serving older and higher risk popula ons could be adversely affected.Table 2Analysis of Operations by Lines of BusinessComprehensiveHospital & Medical2020201920182017201620152014201320122011(In Millions, Except PMPM)Net Earned PremiumTotal Hospital & Medical ExpClaims Adj. ExpensesGeneral Admin. ExpensesTotal Underwriting DeductionsNet Underwriting Gain/(Loss)Loss RatioAdmin Expense RatioCombined RatioNet Premium PMPMClaims PMPMEnrollmentMedicare Supplement 242,290 235,482 240,595 230,831 222,273 215,385 207,534 192,420 191,446 191,945 194,772 195,154 192,884 191,717 191,139 184,916 175,179 163,736 163,346 160,206 7,954 7,740 7,797 7,679 7,381 7,413 7,475 7,167 6,990 6,764 28,445 23,394 27,217 23,236 26,382 26,833 25,852 18,842 18,131 18,365 231,717 226,283 227,850 222,256 223,898 219,054 209,078 189,712 188,553 185,187 12,154 8,857 12,972 9,200( 966) ( 2,017)( 70) 4,023 4,159 .8%96.4% 487 460 460 424 388 363 347 319 309 303 392 384 337 352 319 310 294 271 264 253414243444649495052532020201920182017 11,455 8,385 502 1,666 10,616 80973.9%19.0%92.9% 199 1475 10,940 8,789 547 1,500 10,952( 14)81.4%18.7%100.1% 199 1625 10,234 8,061 486 1,267 9,886 34279.5%17.1%96.7% 197 1574 10,072 7,799 483 1,299 9,637 44477.9%17.7%95.6% 195 1524201620152014201320122011(In Millions, Except PMPM)Net Earned PremiumTotal Hospital & Medical ExpClaims Adj. ExpensesGeneral Admin. ExpensesTotal Underwriting DeductionsNet Underwriting Gain/(Loss)Loss RatioAdmin Expense RatioCombined RatioNet Premium PMPMClaims PMPMEnrollment 2021 National Association of Insurance Commissioners 9,568 7,640 439 1,193 9,320 27180.2%17.0%97.2% 185 1484 9,156 7,368 419 1,189 9,021 11981.1%17.6%98.7% 181 1474 8,690 6,910 379 1,077 8,157 56476.9%16.7%93.5% 181 1394 8,162 6,457 399 948 7,847 30479.8%16.5%96.3% 183 1464 8,088 6,460 385 937 7,815 25880.4%16.4%96.8% 180 1454 7,811 6,336 397 937 7,608 19580.4%17.1%97.5% 177 14243 Page
U.S. Health Insurance Industry 2020 Annual ResultsTable 2Analysis of Operations by Lines of BusinessDental20202019201820172016201520142013 13,511 9,739 737 2,136 12,606 1,38469.6%20.5%90.1% 26 1942 13,754 11,035 691 1,821 13,553 73177.3%17.6%94.9% 27 2242 13,567 10,647 658 1,928 13,235 71176.4%18.5%94.9% 27 2142 12,941 10,158 554 1,765 12,477 82176.4%17.4%93.8% 25 1944 12,685 9,955 513 1,829 12,295 79076.1%17.9%94.0% 25 2042 12,480 9,761 489 1,821 12,071 74976.1%18.0%94.2% 25 2041 11,752 9,132 428 1,685 11,241 75876.1%17.6%93.7% 25 2040 10,449 8,059 384 1,282 9,722 85676.2%15.7%91.9% 26 20342020201920182017201620152014201320122011(In Millions, Except PMPM)Net Earned PremiumTotal Hospital & Medical ExpClaims Adj. ExpensesGeneral Admin. ExpensesTotal Underwriting DeductionsNet Underwriting Gain/(Loss)Loss RatioAdmin Expense RatioCombined RatioNet Premium PMPMClaims PMPMEnrollmentVision 9,995 7,789 407 1,206 9,403 70377.1%16.0%93.0% 25 19332012 9,327 7,389 412 1,091 8,895 53278.4%15.9%94.4% 24 19322011(In Millions, Except PMPM)Net Earned PremiumTotal Hospital & Medical ExpClaims Adj. ExpensesGeneral Admin. ExpensesTotal Underwriting DeductionsNet Underwriting Gain/(Loss)Loss RatioAdmin Expense RatioCombined RatioNet Premium PMPMClaims PMPMEnrollmentFEHBP 3,848 2,734 77 527 3,338 73367.2%14.8%82.0% 9 636 3,831 3,000 71 497 3,568 43874.9%14.2%89.1% 9 736 3,624 2,893 67 511 3,471 33276.1%15.2%91.3% 9 735 2,651 2,050 58 415 2,520 31172.3%16.7%89.0% 7 533 2,469 1,927 51 405 2,378 25173.1%17.4%90.5% 7 531 2,300 1,832 46 388 2,272 18274.9%17.7%92.6% 6 530 2,148 1,703 37 369 2,109 17874.5%17.7%92.2% 6 529 1,694 1,364 32 234 1,629 18175.3%14.7%90.0% 6 525 1,606 1,312 30 220 1,559 18275.2%14.4%89.5% 6 425 1,500 1,223 25 211 1,463 14976.1%14.7%90.8% 5 4232020201920182017201620152014201320122011 40,456 36,123 999 2,168 39,291 56390.6%7.9%98.6% 369 3359 38,744 36,669 911 1,485 39,064 10893.6%6.1%99.7% 371 3489 37,529 35,246 972 1,955 38,172 29391.6%7.6%99.2% 415 3818 37,796 34,643 870 1,355 36,866 15893.6%6.0%99.6% 399 3748 37,868 34,005 854 2,013 36,854 54190.9%7.7%98.6% 409 3738 36,313 33,031 809 2,025 35,859 41391.0%7.8%98.9% 406 3707 34,138 31,622 782 1,835 34,251 37691.4%7.6%98.9% 403 3697 32,058 30,234 782 1,112 32,132 24793.4%5.9%99.2% 369 3467 31,601 29,578 704 1,078 31,358 25293.6%5.6%99.2% 357 3347 31,266 28,398 695 1,042 30,138 25293.5%5.7%99.2% 356 3337(In Millions, Except PMPM)Net Earned PremiumTotal Hospital & Medical ExpClaims Adj. ExpensesGeneral Admin. ExpensesTotal Underwriting DeductionsNet Underwriting Gain/(Loss)Loss RatioAdmin Expense RatioCombined RatioNet Premium PMPMClaims PMPMEnrollment 2021 National Association of Insurance Commissioners4 Page
U.S. Health Insurance Industry 2020 Annual ResultsTable 2Analysis of Operations by Lines of 122011 97,810 84,119 2,705 7,696 94,594 4,42485.0%10.5%95.5% 919 7919 90,958 77,532 2,282 7,096 86,952 4,08385.2%10.3%95.5% 941 8028201320122011 88,067 77,470 2,957 7,168 87,606 1,10687.3%11.4%98.8% 292 25726 77,730 68,810 2,283 6,622 77,836 48088.0%11.4%99.4% 266 23625 65,653 56,259 1,900 6,040 64,225 1,65085.4%12.1%97.5% 253 21723(In Millions, Except PMPM)Net Earned PremiumTotal Hospital & Medical ExpClaims Adj. ExpensesGeneral Admin. ExpensesTotal Underwriting DeductionsNet Underwriting Gain/(Loss)Loss RatioAdmin Expense RatioCombined RatioNet Premium PMPMClaims PMPMEnrollmentMedicaid 249,351 209,661 192,548 171,532 159,507 146,804 131,029 105,568 205,418 179,337 164,541 146,837 135,243 127,385 113,800 91,644 8,337 7,432 6,424 5,831 5,118 4,766 4,071 3,184 23,341 16,042 17,597 13,493 14,456 13,144 11,684 8,399 237,276 203,124 188,474 166,258 154,519 145,377 129,762 103,325 11,377 6,818 4,435 5,225 4,929 1,219 1,448 97.0%96.9%99.2%98.9%97.8% 1,083 990 970 939 923 891 901 909 897 848 828 805 781 775 783 78925181715151412102020201920182017201620152014(In Millions, Except PMPM)Net Earned PremiumTotal Hospital & Medical ExpClaims Adj. ExpensesGeneral Admin. ExpensesTotal Underwriting DeductionsNet Underwriting Gain/(Loss)Loss RatioAdmin Expense RatioCombined RatioNet Premium PMPMClaims PMPMEnrollmentOther Health 234,853 204,595 190,505 180,994 170,461 148,609 115,661 199,032 182,883 167,308 160,899 148,585 127,938 98,905 6,373 6,103 5,751 5,388 5,134 4,872 3,637 22,086 16,497 17,218 14,112 15,520 13,073 10,322 227,342 205,305 190,142 180,540 169,393 145,857 113,074 6,770 138 1,066 1,033 1,405 3,635 97.6%98.1% 461 389 368 387 360 339 317 394 348 323 344 315 291 0122011 20,434 18,222 822 3,374 22,763( 748)84.3%19.1%103.4% 46 4237 17,977 15,545 782 1,868 18,218 64082.6%14.1%96.6% 42 3636 18,328 15,171 391 2,060 17,581 1,31980.1%13.0%93.0% 45 3734 17,271 14,473 645 1,245 16,378 1,57680.7%10.5%91.2% 44 3733 16,773 13,392 438 844 14,717 2,66677.3%7.4%84.7% 44 3532 16,269 13,275 772 618 14,600 2,12879.0%8.3%87.3% 47 3829 15,792 13,569 1,045 758 15,400 94483.2%11.0%94.2% 49 4228 12,145 10,232 790 886 11,912 63281.6%13.4%95.0% 44 3823 13,181 10,549 778 972 12,301 1,15578.4%13.0%91.4% 49 4022 10,701 8,711 793 546 10,060 95679.2%12.2%91.3% 48 3919(In Millions, Except PMPM)Net Earned PremiumTotal Hospital & Medical ExpClaims Adj. ExpensesGeneral Admin. ExpensesTotal Underwriting DeductionsNet Underwriting Gain/(Loss)Loss RatioAdmin Expense RatioCombined RatioNet Premium PMPMClaims PMPMEnrollment 2021 National Association of Insurance Commissioners5 Page
U.S. Health Insurance Industry 2020 Annual Results 2021 National Association of Insurance Commissioners6 Page
U.S. Health Insurance Industry 2020 Annual Results 2021 National Association of Insurance Commissioners7 Page
U.S. Health Insurance Industry 2020 Annual Results 2021 National Association of Insurance Commissioners8 Page
U.S. Health Insurance Industry 2020 Annual ResultsENROLLMENT AND PREMIUM REVENUESEnrollment increased 4% (9 million) to 240 million. The enrollment increase is reflected in a 37% (6.6 million) increase inMedicare, a 4.8% (2.1 million) increase in the Medicaid line of business, and a 3.1% (1.1 million) increase in Medicare PartD Prescription Drug coverage. However, the industry also reported a 4.3% (1.3 million) decrease in the groupcomprehensive line of business. Figure 11 illustrates the enrollment trend for the four largest revenue generating lines ofbusiness for the past 10 years. Despite the COVID-19 pandemic, the industry still experienced growth in Medicaid andMedicare. Increased unemployment rates caused by the pandemic have also disrupted health coverage for millions ofpeople as most working-age adults receive health insurance coverage for themselves and their families through their9 Page 2021 National Association of Insurance Commissioners
U.S. Health Insurance Industry 2020 Annual Resultsemployer. However, many of those who lost job-based health insurance coverage would possibly qualify for Medicaid orhad the opportunity to purchase individual health coverage through the exchange or other managed care health providers.The shi in business concentration can also be attributed to an increase in the number of insureds becoming eligible foreither Medicare or Medicaid as evidenced by increases in enrollment in these lines. A certain amount of the Medicaidenrollment increase is likely due to the continued expansion of Medicaid programs in certain states.Direct written premium increased 8.3% ( 63 billion) to 824.7 billion. Figure 12 illustrates the mix of direct writtenpremium for 2020. During the last several years, there has been a gradual shift in the allocation of premium between thelines of business. In comparison to 2019, direct comprehensive medical decreased to 29.8% of total premium from 31.7%,while Medicare increased to 30.4% from 28.6% and Medicaid increased modestly to 28.6% from 27.7%.Health entities reported premium per member per month (PMPM) of 284 and claims PMPM of 236 for 2020. Figure 13illustrates a 10-year trend on an aggregate basis of the increase in premium PMPM vs claims PMPM and the resultingspread. In referring back to Table 2, it is apparent the Medicare line of business is the most expensive at over 1 thousandper member month but also reported one of the highest net underwriting gains with a spread of premium PMPM overclaims PMPM of 186 and an aggregate underwriting gain of 11 billion.Table 3 on page 11, provides direct written premium by line of business for the last 10 years. The largest increases inwritten premium from 2019 are most evident in a 13% ( 29 billion) increase in Medicare, a 12% ( 26 billion) increase inMedicaid, an 8% ( 6 billion) increase in the individual comprehensive line of business, and a 3% ( 1 billion) increase inFederal Employee Health Benefit Plan. The overall premium growth can be attributed to increases in enrollment, andpremium rates. In a 10-year comparison to 2011, the most significant increases in written premium are in the Medicaid( 168 billion), Medicare ( 157 billion), individual comprehensive ( 56 billion), Federal Employee Health Benefit Plan,Dental ( 4 billion), Medicare Supplement ( 4 billion), and Medicare Part D ( 10 billion) lines of business. The groupcomprehensive Line of business decreased ( 10 billion). Table 4 on pages 13-21 provides a further breakout of writtenpremium, claims, loss ratio, and enrollment by state and by line of business. The states high-lighted in yellow are the fivelargest writers in that particular line of business. 2021 National Association of Insurance Commissioners10 P a g e
U.S. Health Insurance Industry 2020 Annual ResultsTable 3Direct Written Premium by Lines of Business(In Millions)Individual ComprehensiveGroup ComprehensiveMedicare SupplementVisionDentalFEHBPMedicareMedicaidOther 4.8%2020 78,232 165,839 12,041 2,619 13,579 42,639 248,793 234,421 21,1442019 72,722 166,717 11,546 2,654 14,048 41,218 219,554 208,695 20,1702018 76,017 165,339 10,807 2,561 13,855 38,942 192,253 192,181 18,883 2021 National Association of Insurance Commissioners2017 68,660 162,605 10,596 2,410 14,090 37,860 170,413 180,535 18,1422016 63,310 160,574 10,061 2,255 13,074 37,923 158,908 170,234 18,5692015 55,292 162,297 9,609 2,099 12,561 36,356 147,273 149,148 17,3492014 43,388 166,375 9,105 1,952 12,017 34,140 128,890 115,977 16,9002013 24,713 172,220 8,531 1,635 10,046 32,061 105,917 89,069 14,1112012 23,389 174,959 8,439 1,550 10,113 31,669 99,981 78,535 14,1942011 22,624 175,843 8,138 1,448 9,587 31,209 91,519 65,994 11,37311 P a g e
U.S. Health Insurance Industry 2020 Annual ResultsCASH FLOW AND LIQUIDITYThe health insurance industry showed a significant increase in operating cash flow to 55.3 billion in 2020 as compared tooperating cash flow of 24.7 billion in 2019. The considerable increase in positive cash flow is due primarily to a 9.6% ( 72billion) increase in premiums collected. However, this was partially offset by a 4% ( 22.4 billion) increase in benefits andloss-related payments and a 16.7% ( 15 billion) decrease in commissions and expenses paid.As illustrated in Figure 14, liquid assets and receivables increased 18% ( 52 billion) to 332 billion in 2020 from 280 billionin the prior year end. This was partially offset by a 20% ( 31 billion) increase in current liabilities to 185 billion from 155billion. This resulted in an unfavorable decrease in the ratio of liquid assets and receivables to current liabilities to 179%from 181%.CAPITAL AND SURPLUSHealth entities reported a 12.6% ( 20 billion) increase in capital and surplus to 176 billion from 156 billion at Dec. 31,2019 as illustrated in Figure 15. The increase is due primarily to net income of 31 billion, a 3 billion increase in unrealizedcapital gains, and paid-in surplus of 3.4 billion. These items were partially offset by dividends of 14 billion paid tostockholders, and a 1.7 billion increase in non-admitted assets.Figure 15Capital & Surplus, Net Income & Dividends Paid 2021 National Association of Insurance Commissioners12 P a g e
U.S. Health Insurance Industry 2020 Annual ResultsTable 4 - Individual Comprehensive Hospital & MedicalAs reported in theExhibit of Premiums, Enrollment and Utilization( in Millions except rniaColoradoConnecticutDelawareDistrict of kaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth est VirginiaWisconsinWyomingAmerican SamoaGuamNorthern Mariana IslandsPuerto RicoU.S. Virgin IslandsAggregate Other AlienGrand TotalsDirect Written Premium20202019% Chg. 1,527 160 1,205 1,650 280 1,321 958 251 200 12,303 3,194 313 777 2,435 609 695 448 666 1,032 438 1,382 2,531 1,813 1,085 936 961 335 848 564 268 2,078 202 1,667 4,273 229 1,471 1,099 1,297 3,848 237 1,670 407 1,135 6,511 1,371 258 1,803 1,576 289 1,767 305 1 2 342 1 3,225 1,368 156 1,111 1,433 398 1,351 867 228 169 11,554 2,906 232 665 2,638 544 711 360 687 878 529 1,358 2,466 1,863 766 810 828 385 918 595 264 1,892 286 1,911 4,196 262 1,525 1,181 1,155 3,470 247 1,704 348 1,109 6,232 1,171 230 1,741 1,618 241 1,815 302 1 2 306 1 6.7% 78,232 72,7227.6%Claims2020 1,194 182 839 1,185 204 938 740 168 185 9,453 2,483 198 444 2,181 468 507 265 502 724 341 1,366 2,354 1,349 686 707 673 291 642 445 179 1,856 148 1,400 3,375 201 1,194 1,027 1,016 2,461 184 1,257 307 845 5,731 905 210 1,172 1,192 181 1,399 223 303 1 482019Loss Ratio*% Chg.20202019 1,103 162 785 1,152 337 1,057 702 140 168 8,333 2,256 199 551 2,040 448 513 259 526 759 385 1,233 2,283 1,381 700 638 642 296 661 439 190 1,780 238 1,676 3,264 228 1,195 859 1,046 2,612 193 1,165 297 848 5,205 967 215 1,193 1,198 182 1,426 219 260 1 %0.0%232.7%91.0%8.8% 58,519 56,6693.3%75.0%79.6%Enrollment%Pt 202,95125,938112205,86122917,1402019% 340,32727818,461(4.6) 11,942,107 )%(7.2)%2.4%*Based on earned premium. This loss ratio should not to be confused with the Preliminary MLR on the Supplemental Health Care Exhbit. 2021 National Association of Insurance Commissioners13 P a g e
U.S. Health Insurance Industry 2020 Annual ResultsTable 4 - Group Comprehensive Hospital & MedicalAs reported in theExhibit of Premiums, Enrollment and Utilization( in Millions except rniaColoradoConnecti cutDelawareDistrict of kaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth est VirginiaWisconsinWyomingAmerican SamoaGuamNorthern Mariana IslandsPuerto RicoU.S. Virgin IslandsAggregate Other AlienGrand TotalsDirect Written Premium20202019 3,015 300 1,393 1,053 524 3,104 1,776 305 1,470 9,323 4,248 3,078 1,208 11,002 1,721 2,116 534 1,873 2,514 1,155 3,037 8,679 9,108 4,217 899 2,039 485 1,023 1,767 1,050 5,671 523 17,714 2,753 1,079 5,054 1,832 4,283 8,502 771 1,785 698 2,423 9,984 1,779 342 3,929 5,914 607 4,916 164 1 34 4 842 11 172 2,868 292 1,355 1,122 652 3,160 1,888 373 1,420 9,945 4,317 3,155 1,192 10,979 1,771 2,117 547 1,891 2,463 1,145 3,057 8,758 9,126 4,368 862 2,342 453 1,006 1,761 1,066 5,926 556 17,569 2,828 1,058 4,876 1,824 4,229 8,703 806 1,736 678 2,519 9,532 1,691 386 3,905 5,891 651 4,702 170 4 53 4 835 11 65 165,839 166,717% Chg.Claims20202019 2,789 246 1,119 847 411 2,607 1,459 235 1,146 7,831 3,804 2,666 1,026 9,753 1,381 1,717 413 1,548 2,042 919 2,410 7,014 7,610 3,499 749 1,619 394 873 1,461 820 4,577 432 14,661 2,316 932 4,139 1,538 3,489 7,017 638 1,382 567 1,992 8,669 1,484 284 3,123 4,822 518 4,322 136 1 43 4 643 7 2 2,618 219 1,065 925 554 2,759 1,609 284 1,140 8,561 3,890 2,818 1,020 9,327 1,479 1,723 421 1,579 2,109 986 2,457 7,545 7,738 3,790 771 1,965 376 853 1,402 850 4,924 466 14,847 2,363 959 4,110 1,466 3,710 7,509 670 1,417 566 2,008 8,271 1,467 354 3,213 4,954 543 4,346 149 2 54 5 688 7 2(0.5)% 138,099 .3%Loss Ratio*% 66.1%3.4%(2.7)%84.0%85.4%Enrollment%Pt ,03882,808161,6063
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Bible Commentary Acts of the Apostles, The Barclay, William 1 B Bible Commentary AMOS - Window To God Kirkpatrick, Dow 1 K Bible Commentary Amos - Window to God Kirkpatrick, Dow 1 K Bible Commentary Basic Bible Commentary, Acts Sargent James E. 1 S Bible Commentary Basic Bible Commentary, Exodus & Leviticus Schoville, Keith N. 1 S
4200 Human Supervised Automatic Method 4300 Holistic Auditory Perceptual 4500 Spectrographic 4400 Expert-Driven Auditory Phonetic & Acoustic Phonetic Analysis 5100 Evaluation/ Generating Conclusion 5200 Verification 5300 Case Close-Out Terminate Case Commentary Commentary Commentary Commentary Commentary 4
EU Tracker Questions (GB) Total Well Total Badly DK NET Start of Fieldwork End of Fieldwork 2020 15/12/2020 16/12/2020 40 51 9-11 08/12/2020 09/12/2020 41 47 12-6 02/12/2020 03/12/2020 27 57 15-30 26/11/2020 27/11/2020 28 59 13-31 17/11/2020 18/11/2020 28 60 12-32 11/11/2020 12/11/2020 28 59 12-31 4/11/2020 05/11/2020 30 56 13-26 28/10/2020 29/10/2020 29 60 11-31
The Townsend Press Sunday School Commentary, based on the International Lessons Series, Townsend Press Sunday School Commentary, based on the International Lessons Series, Townsend Press Sunday School Commentary lessons consists of the follow-
Boundaries and Dominion: An Economic Commentary on Leviticus (Full version of previous book, 1994) *Sanctions and Dominion: An Economic Commentary on Numbers (1997) Inheritance and Dominion: An Economic Commentary on Deuter-onomy (4 vols., 1999, 2003) This edition: July 4, 2009 Priorities and Dominion: An Eco
Anchor Bible Commentary Anchor Bible Dictionary. Edited by D. N. Freedman. 6 vols. New Yorlc Doubleday, 1992. Biblical Commentary on the Old Testament A Continental Commentary A Critical and Exegetical Commentary Currents in Theology and Mission Dictionary of Biblical I
John 14:1-7 Commentary King James Version . Questions for Discussion and Thinking Further follow the verse -by-verse . International Bible Study Commentary. Study Hints for Discussion and Thinking Further. will help with class preparation and in conducting class discussion: these hints are available on the . International Bible Study Commentary .
4. Nelson’s New Illustrated Bible Commentary, Thomas Nelson Publishers 5. Wycliffe Bible Commentary, Moody Press 6. The MacArthur Bible Commentary, Thomas Nelson Publishers Commentaries: Two Volumes 1. Bible Knowledge Commentary, Cook Communications 2. The Expositors Bible
