Medical Membership (covered lives) by Payer, Point in Time (PIT) Effective 6/8/2017
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1 Medical Membership (covered lives) by Payer, Point in Time (PIT) Aetna 123, ,751 72,517 66,381 62,362 65, ,329 67,230 American Enterprise (2) 206 1,826 2,127 Anthem 225, , , , , , , ,514 Assurant (5) 32,442 39,172 36,335 28,661 24,867 23,835 14,050 1,121 CIGNA 44,384 52,721 59,834 61,532 53,624 90, , ,519 CNICHS (3) 16,979 19,958 Colorado Access (6) Colorado Choice 4,123 4,180 3,498 3,395 4,043 3,910 4,350 26,198 Health Markets (1) 10,693 6,917 4,885 3,772 3,063 2, Humana 70,193 67,191 79,086 69,333 73,500 79,905 66,651 53,322 Insurance Administration (2) Kaiser Permanente 411, , , , , , , ,517 Physicians Mutual 2,698 2,688 2,736 2,855 4,432 3,259 3,205 3,216 Rocky Mountain Health Plan 69,029 63,397 69,167 68,094 65,003 69,518 60,623 42,972 State Farm 4,106 4,021 3,987 3,837 1,343 1,067 3,303 3,191 United Healthcare (7) 187, , , , , , , ,542 US Health Group (1) 5,982 6,975 7,084 4,901 3,689 2,764 2,770 1,353 USAA Enterprise (2) 3,863 4,243 4,802 Total Commercial 1,202,551 1,237,930 1,149,487 1,131,180 1,245,725 1,313,127 1,829,756 1,558,003 Medicare Health First Colorado (Colorado's Program) Centers for Medicare & Services (4) 622, , , , , , ,042 TOTAL Medical Membership by PIT 2,373,558 2,500,067 2,486,455 2,583,744 2,780,451 3,185,743 3,904,405 *This report is based on membership versus persons, thus the total commercial counts may have some double counting of persons for those that have primary and secondary coverage. ** Total Membership includes undefined Line of Business (payer), therefore some volume may be represented in total and not included in Fully insured or Selffunded summaries. (1) Left the Colorado Market in 2015 No longer meets the statutory requirements to submit to the CO APCD (2) New submitter. Submitted all historical data that was available. (3) New submitter under Self funded Rule Update. Historical submissions starting (4) 2016 CMS Medicare Fee for service data not yet available. (5) Left the Colorado Market in 2016 (6) Primarily a submitter with intermittent Commercial submissions. (7) Addition of Self Insured in Due to Supreme Court ruling, ERISA plans not required in 2016.
2 Fully Insured Medical Membership (covered lives) by Paye,r Point in Time (PI Aetna 123, ,751 72,517 66,381 62,362 65,315 74,995 67,230 American Enterprise (2) 206 1,826 2,127 Anthem 225, , , , , , , ,003 Assurant (5) 32,442 39,172 36,335 28,661 24,867 23,835 14,050 1,031 CIGNA 44,384 52,721 59,834 61,532 53,624 87,096 73,613 64,010 CNICHS (2) 3,295 Colorado Access (6) Colorado Choice 4,123 4,180 3,498 3,395 4,043 3,910 4,350 18,518 Health Markets (1) 10,693 6,917 4,885 3,772 3,063 2, Humana 70,193 67,191 79,086 69,333 73,500 79,905 66,651 53,322 Insurance Administration (2) Kaiser Permanente 411, , , , , , , ,517 Physicians Mutual 2,698 2,688 2,736 2,855 4,432 3,259 3,205 3,216 Rocky Mountain Health Plan 69,029 63,397 69,167 68,094 65,003 69,518 60,623 42,972 State Farm 4,106 4,021 3,987 3,837 1,343 1,067 3,303 3,191 United Healthcare 187, , , , , , , ,189 US Health Group (1) 5,982 6,975 7,084 4,901 3,689 USAA Enterprise (2) 3,863 4,243 4,802 Total Commercial 1,202,551 1,237,930 1,149,487 1,131,180 1,245,725 1,306,979 1,304,093 1,320,844 Medicare Health First Colorado (Colorado's Program) Centers for Medicare & Services (4) 622, , , , , , ,042 TOTAL Medical Membership by PIT 2,373,558 2,500,067 2,486,455 2,583,744 2,780,451 3,179,595 3,378,742 *Since this is based on membership versus persons, the total commercial counts have some double counting of persons for those that have primary and secondary coverage. (1) Left the Colorado Market in 2015 No longer meets the statutory requirements to submit to the CO APCD (2) New submitter. Submitted all historical data that was available. (4) 2016 CMS Medicare Fee for service data not yet available. (5) Left the Colorado Market in 2016 (6) Primarily a submitter with intermittent Commercial submissions.
3 Self Funded Membership (covered lives) by Payer, Point in Time (PIT) Self Funded By PIT Commercial Aetna 98,334 Anthem 50,511 CIGNA 3,384 91,008 89,509 CNICHS 11,813 Colorado Choice 7,680 United Healthcare 316,572 71,353 US Health Group 2,764 2,770 1,353 Total Commercial 6, , ,219 TOTAL Self Funded Membership PIT 6, , ,219 NOTES: *Since this is based on membership versus persons, the total commercial counts have some double counting of persons for those that **This analysis only includes data. Self funded data not required in the COAPCD until Due to Supreme Court ruling, ERISA plans not required in Non ERISA mandated and ERISA is voluntary. Some plans voluntarily submitted 2014 claim history.
4 Pharmacy Membership (covered lives) by Payer, Point in Time (PIT) Aetna 110,320 91,666 64,910 56,969 54,379 62, ,620 56,124 Assurant 30,151 37,256 34,947 27,726 24,108 22,744 13,116 1,031 Anthem 217, , , , , , , ,587 Cigna 29,249 36,994 44,478 48,614 43,240 90, , ,915 Colorado Access (1) Colorado Choice 3,744 3,829 3,142 3,075 3,756 3,691 4,194 26,152 HealthMarkets (2) 8,766 5,459 3,757 2,862 2,277 1, Humana 69,602 66,731 78,853 69,185 74,398 79,166 68,109 53,316 Kaiser Permanente 411, , , , , , , ,533 Physicians Mutual ^ ^ ^ ^ ^ ^ Rocky Mountain Health Plan 69,024 63,396 69,164 68,094 65,003 69,518 60,623 42,972 State Farm 997 1,091 1,180 1,156 1, United Healthcare (3) 86, , , , , , , ,639 US Health Group 4,514 5,944 5,791 3,579 2,711 2,053 3,445 2,628 Total Commercial 1,051,620 1,057,826 1,025, ,048 1,125,539 1,200,588 1,425,715 1,324,716 Health First Colorado (Colorado's Program) TOTAL Rx Membership 1,599,865 1,674,534 1,695,437 1,716,725 1,924,407 2,304,770 2,715,322 2,714,471 NOTES: *Since this is based on membership versus persons, the total commercial counts have some double counting of persons for those that have primary and secondary coverage. '** Medicare Pharmacy eligibility is available and in the data warehouse. Full representation of applicable beneficiaries available at a later date. ^ When less than 11, data suppressed (1) Primarily a submitter with intermittent Commercial submissions. (2) Left the Colorado Market in 2015 No longer meets the statutory requirements to submit to the CO APCD (3) Addition of Self Insured in Due to Supreme Court ruling, ERISA plans not required in 2016
5 Dental Membership (covered lives) by Payer, Point in Time (PIT) Commercial* Aetna ,206 40,669 Anthem 468 6,270 18,350 Assurant ^ CIGNA 246, , ,214 Colorado Access (1) ^ 47 Colorado Choice Delta Dental 479, , , ,192 Dentegra 9,539 Health Markets (2) ^ ^ United Healthcare 82,376 82,284 82, ,272 US Health Group 770 1,272 3,090 5,677 Total Commercial 563, ,700 1,353, ,269 Health First Colorado (Colorado's Program) 795,807 1,101,411 1,286,647 1,386,891 TOTAL Dental Membership FTE 1,359,540 1,944,111 2,640,189 2,177,160 *Since this is based on membership versus persons, the total commercial counts have some double counting of persons for those that have primary and secondary coverage. ^ When less than 11, data suppressed (1) Primarily a submitter with intermittent Commercial submissions. (2) Left the Colorado Market in 2015 No longer meets the statutory requirements to submit to the CO APCD
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