) -- As the U.S. unemployment rate dropped to 10% in November, health insurers stand to benefit.

The biggest insurers, such as





(HUM) - Get Report


UnitedHealth Group

(UNH) - Get Report




, now see a starting point for growth, even before health-care reform kicks in.

As employment grows and people return to work, coverage from companies will generate increased premium income. Insurance-premium income rose 2.6% to $216.8 billion in the first half of the year, slower than the 7.6% pace a year earlier.

Health insurers have suffered, along with increasingly unemployed Americans, as people lost insurance, resulting in a lopsided administrative burden designed for high volume. In addition, insurers' profit margins have been squeezed, in part, because people have sought treatment before coverage stops.

That means efficiency is paramount. Cost-cutting has meant layoffs even in health care, previously seen as the only guaranteed growth industry. Layoffs have occurred across the board, from psychiatrists working for Kaiser in California to administration staff at Blue Cross Blue Shield of Michigan, faced with $1 billion in losses.

In the first six months of the year, WellPoint and UnitedHealth subsidiaries were among the most efficient. WellPoint had impressive results at some of its insurers, recording an average margin on health care of 7.9%, suggesting it might be best positioned to take advantage of growth as the recession ends.

Reported by Gavin Magor in Jupiter, Fla.

Gavin Magor is the senior analyst responsible for assigning financial-strength ratings to insurance companies. He conducts industry analysis and supports consumer products. Magor has more than 22 years of international experience in operations and credit-risk management, commercial lending and analysis. His experience includes international assignments in Sweden, Mexico, Brazil and the U.S. He holds a master's degree in business administration from The Open University in the U.K.