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Largest small business health insurance companies

by Tony Novak, CPA, MBA, MT,  updated November 16, 2010


Small businesses nationwide are dropping health plans at an increasing pace as the price gap between individual insurance and small group insurance widens. These businesses and their employees increasing realize that the majority of employees can find insurance that provides a higher level of employee satisfaction at a lower price in the individual insurance market. Part of the problem is attributable to the lack of competition in the group health insurance market and the growing number of mandates that raise the cost of group insurance.  But another part of the problem may be that the market is dominated by Blue Cross insurance carriers that are simply not designed to be low cost insurance leaders. In fact, none of the leading small group insurers are listed in any of the states' low cost health individual insurance listings. Blue Cross and Blue Shield plans were the largest carrier in 36 of the 44 states reported in the GAO survey. This list is based on a 2009 report by the General Accounting Office based on data collected in 2008. Links are provided to each states exchange page that lists the lowest cost individual health insurance policies and provides some additional data on the state's health insurance environment. Data on small group insurance is not available for 7 states.

Alabama - Blue Cross Blue Shield of Alabama
Alaska - Premera Blue Cross
Arizona - PacifiCare (UnitedHealthcare)
Arkansas - na
California - Kaiser
Colorado - Kaiser
Connecticut - Anthem Blue Cross
Delaware - Blue Cross Blue Shield of Delaware
District of Columbia - Group Hospitalization & Medical Services, Inc.
Florida - Blue Cross Blue Shield of Florida
Georgia - Blue Cross Blue Shield Healthcare of Georgia
Hawaii - HMSA
Idaho - Regence Blue Shield of Idaho
Illinois - Health Care Service Corporation
Indiana - na
Iowa - Wellmark
Kansas - Blue Cross Blue Shield of Kansas
Kentucky - Anthem Blue Cross Plans of Kentucky
Louisiana - Louisiana Health Service & Indemnity Company
Maine - Anthem Blue Cross Blue Shield
Maryland - CareFirst Blue Choice Inc.
Massachusetts - Blue Cross Blue Shield of Massachusetts HMO
Michigan - Blue Cross Blue Shield of Michigan
Minnesota - Blue Cross Blue Shield of Minnesota
Mississippi - na
Missouri - Health Alliance
Montana - Blue Cross Blue Shield of Montana
Nebraska - Blue Cross Blue Shield of Nebraska
Nevada - Health Plan of Nevada
New Hampshire - Anthem Blue Cross of New Hampshire
New Jersey - Horizon Health Care
New Mexico - na
New York - Oxford
North Carolina - Blue Cross Blue Shield of North Carolina
North Dakota - Blue Cross Blue Shield of North Dakota
Ohio - Anthem Blue Cross
Oklahoma - Blue Cross Blue Shield Oklahoma
Oregon - Regence Blue Cross Blue Shield
Pennsylvania - na
Rhode Island - Blue Cross Blue Shield of Rhode Island
South Carolina - Blue Cross Blue Shield of South Carolina
South Dakota - Wellmark Blue Cross Blue Shield of South Dakota
Tennessee - Blue Cross Blue Shield of Tennessee
Texas - Blue Cross Blue Shield of Texas
Utah - na
Vermont - MVP Health Plan
Virginia - na
Washington - Regence Blue Shield
West Virginia - Highmark Blue Cross Blue Shield
Wisconsin - UnitedHealthcare
Wyoming - Blue Cross Blue Shield of Wyoming

The largest insurer typically covers 30% to 50% of all people covered by small group health insurance. In North Dakota and Rhode Island, however, the market share of the plan listed is about 90% so these state are sometimes referred to as "Single carrier" health insurance markets. A listing of the largest health insurance companies in the United States, combining all types of health insurance, is published separately on this Web site.

This listing underscores that small groups health plans are unlikely to be highly cost-competitive compared to individual insurance and that the Blue Cross managed care major medical plans are declining in popularity due to their cost. In contrast, mini-med group insurance plans like Core Health Insurance and the Assurant small business portfolio are gaining popularity.

by Tony Novak, revised 11/6/2009

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