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WellPoint Rate Hike Brings Calif. Probe

Wellpoint, one of the most profitable health insurers, has increased its rates and the California state insurance commissioner has launched an investigation.



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, one of the most profitable health insurers, has increased its rates and the California state insurance commissioner has launched an investigation.

Citing state law requiring at least 70 cents of every dollar in premiums to be spent on medical care, California Insurance Commissioner Steve Poizner said he was "alarmed by the Anthem Blue Cross health insurance rate hikes." He added, "I have instructed my department to hire an outside actuary to examine their rates line by line," saying he would bring the rates down if they are found to be excessive.

Profit margins for health insurers aren't typically large. The average insurer spent 88% of its premiums, in the nine months to September, on medical expenses. This is before administration expenses tied to this care that averaged 10.5%. The average insurer, therefore, had a 1.56% profit margin through September, before investment income was factored in.

Wellpoint, though, isn't typical. Through September, for all of its insurance companies, it managed to keep medical expenses down to 83.3% of premiums and administration down to 9.3%. This gave it a 6.3% profit margin. Anthem Health Plans of Virginia reported a 15.1% margin on health care but even this wouldn't exceed the 30% California maximum.

Other groups, such as



, have thinner margins. Aetna reported an overall health profit margin of 1.3%. This was below average but mainly because its administrative expenses were higher than most.

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reported a health loss of 0.7%. Again, like Aetna, medical expenses were controlled, but expenses, of more than 15% of premiums, weren't.


UnitedHealth Group

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only had a group health profit margin of 3.3%. Losses at some subsidiaries masked the largest margins of any insurer at others. UnitedHealthcare of Colorado reported a health margin of over 29%.

These margins suggest that it is unlikely any investigation by California will result in a finding that the margins are excessive. Insensitive as it might appear to be raising rates by large margins, up to 40% according to a report in the

Los Angeles Times

, it could be that it can be justified.

California, unlike every other state, doesn't release sufficient details of its registered insurance companies to examine the profitability levels. It is, therefore, impossible to establish the precise margins that the insurer operates with or the appropriateness. In the meantime, Poizner did want to remind Californians that they do have over 70 insurers from which to choose.

-- 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.