Aetna US Healthcare	BCBSNC	CIGNA/ Healthsource	Doctors Health Plan	Generations	Optimum Choice of the Carolinas	PARTNERS Health Plans
Financial Data Data from 1998 Annual Financial Statement: Five Year Historical Data
Total revenues (1998)	$40,320,315	$309,026,161	$371,430,073	$57,464,612	$4,303,072	$14,555,627	$365,061,690
Total premium per member per month (1998)	$111.25	$127.08	$130.92	$122.83	$128.79	$107.16	$153.98
Five-year premiums per member per month	1998: $111.25 1997: $98.70 1996: $99.17 1995: N/A 1994: N/A	1998: $127.08 1997: $116.63 1996: $111.94 1995: $135.18 1994: NA	1998: $130.92 1997: $126.12 1996: $125.18 1995: $131.45 1994: $130.68	1998: $122.83 1997: $117.40 1996: $119.84 1995: $116.30 1994: NA	1998: $128.79 1997: NA 1996: NA 1995: NA 1994: NA	1998: $107.16 1997: $96.43 1996: $98.59 1995: NA 1994: NA	1998: $153.98 1997: $144.89 1996: $138.82 1995: $130.34 1994: $134.03
Medical/hospital expenses per member per month (1998)	$110.56	$118.82	$115.48	$138.02	$118.62	$103.50	$134.59
Medical loss ratio (percentage of premiums spent on medical/hospital expenses)(1998)	99.4%	93.5%	88.2%	112.4%	92.1%	96.6%	87.4%
Five-year medical loss ratio trends	1998: 99.4% 1997: 98.8% 1996: 126.8% 1995: N/A 1994: N/A	1998: 93.5% 1997: 98.1% 1996: 100.5% 1995: 88.1% 1994: NA	1998: 88.2% 1997: 90.3% 1996: 82.0% 1995: 76.7% 1994: 75.7%	1998: 112.4% 1997: 114.1% 1996: 91.1% 1995: 85.4% 1994: NA	1998: 92.1% 1997: NA 1996: NA 1995: NA 1994: NA	1998: 96.6% 1997: 90.2% 1996: 65.8% 1995: NA 1994: NA	1998: 87.4% 1997: 87.0% 1996: 84.8% 1995: 81.0% 1994: 80.5%
Operating profit margin (1998)	(13.5%)	(.5%)	(.4%)	(22.8%)	(73.6%)	(32.5%)	3.8%
Operating profit margin trends	1998: (13.5%) 1997: (15.9%) 1996: (134.0%) 1995: N/A 1994: N/A	1998: (.5%) 1997: (4.9%) 1996: (10.3%) 1995: 5.0% 1994: NA	1998: .4% 1997: (2.0%) 1996: 2.7% 1995: 8.2% 1994: 14.4%	1998: (22.8%) 1997: (48.0%) 1996: (48.1%) 1995: (167.4%) 1994: NA	1998: (73.6%) 1997: NA 1996: NA 1995: NA 1994: NA	1998: (32.5%) 1997: (35.5%) 1996: (26.5%) 1995: NA 1994: NA	1998: 3.8% 1997: 4.6% 1996: 6.7% 1995: 9.6% 1994: 10.6%

	Coventry/Principal Health Care of the Carolinas	QualChoice	The Wellness Plan of North Carolina, Inc.	United Healthcare of NC	WellPath Select
Financial Data Data from 1998 Annual Financial Statement: Five Year Historical Data
Total revenues (1998)	$29,526,109	$116,145,292	$43,212,605	$304,860,249	$81,903,144
Total premium per member per month (1998)	$115.73	$188.31	$121.33	$134.72	$127.43
Five-year premiums per member per month	1998: $115.73 1997: $99.65 1996: $97.60 1995: $111.39 1994: NA	1998: $188.31 1994: $158.97 1996: $114.39 1995: $126.97 1994: NA	1998: $121.33 1997: $107.81 1996: $98.21 1995: NA 1994: NA	1998: $134.72 1997: $131.14 1996: $130.51 1995: $128.78 1994: $123.47	1998: $127.43 1997: $117.66 1996: $113.96 1995: NA 1994: NA
Medical/hospital expenses per member per month (1998)	$115.54	$198.98	$118.12	$109.46	$128.51
Medical loss ratio (percentage of premiums spent on medical/hospital expenses)(1998)	99.8%	105.7%	97.4%	81.3%	100.8%
Five-year medical loss ratio trends	1998: 99.8% 1997: 95.1% 1996: 99.9% 1995: 90.0% 1994: NA	1998: 105.7% 1997: 108.9% 1996: 89.5% 1995: 127.0% 1994: NA	1998: 97.4% 1997: 86.5% 1996: 84.8% 1995: NA 1994: NA	1998: 81.3% 1997: 80.6% 1996: 80.0% 1995: 80.0% 1994: 82.7%	1998: 100.8% 1997: 88.8% 1996: 84.9% 1995: NA 1994: NA
Operation profit margin (1998)	(21.2%)	(14.5%)	(4.6%)	4.3%	(10.4%)
Operating profit margin trends	1998: (21.2%) 1997: (29.2%) 1996: (51.0%) 1995: (280.5%) 1994: NA	1998: (14.5%) 1997: (51.8%) 1996: (26.7%) 1995: (107.2%) 1994: NA	1998: (4.6%) 1997: (16.7%) 1996: (128.5%) 1995: NA 1994: NA	1998: 4.3% 1997: 7.0% 1996: 7.9% 1995: 6.6% 1994: 6.6%	1998: (10.4%) 1997: 1.0% 1996: 6.6% 1995: NA 1994: NA

¹ Prudential Health Care Plan reported national financial data. The enrollment and financial data include, but are not limited, to North Carolina data. Therefore, it may be difficult to compare Prudential Health Care Plan enrollment and financial numbers to other North Carolina HMOs.

How To Read Financial Data:

• Total Revenues. This shows the HMO’s total annual revenues in 1998. HMOs earn money from the premiums paid per member and from other sources such as investment income. Financial data includes Medicare enrollees when applicable. Partners, QualChoice, United Healthcare and WellPath have Medicare enrollees.

• Average Premiums per member per month. The premiums per member per month is an approximation of an average premium for each HMO. We calculated the average premiums by taking the total amount of premiums earned in 1998, and dividing it by the number of member months. While the actual premium charged to any individual will vary, the average premium per member per month gives an idea of whether a particular HMO generally has higher or lower premiums than other HMOs. Financial data includes Medicare enrollees when applicable. Partners, QualChoice, United Healthcare and WellPath have Medicare enrollees. Premiums for plans that include Medicare enrollees may seem higher than other plans because of the higher premium costs for Medicare enrollees.
  
  
• Five-Year Premium Trends. This shows how much the average premiums per member per month has increased over the last five years. Looking at the premiums over five years is a better way to compare premiums across health plans than examining the premiums in any particular year. For example, a health plan may decide to keep their premiums low in order to attract members over the course of several years. If the premiums are too low, and do not cover actual expenses, then the health plan will have to raise rates in the future. A five-year historical perspective may yield better information about how one-plan compares to the others. Financial data includes Medicare enrollees when applicable. Partners, QualChoice, United Healthcare and WellPath have Medicare enrollees. Premiums for plans that include Medicare enrollees may seem higher than other plans because of the higher premium costs for Medicare enrollees.
  
  
• Medical/Hospital Expenses per member per month. This shows about how much money the HMO spent on health-related expenses each month for its members in 1998. This is an average of all the health care spending among the members. In reality, an HMO may spend a lot more than the average on some members, and a lot less than the average on others. Financial data includes Medicare enrollees when applicable. Partners, QualChoice, United Healthcare and WellPath have Medicare enrollees. Medical/hospital expenses for plans that include Medicare enrollees may seem higher than other plans because of the higher premium costs for Medicare enrollees.
  
  
• Medical-Loss Ratio. This is the percentage of premiums that was spent on health care expenses versus administrative costs or profits in 1998. An HMO that has a high medical-loss ratio - 90 percent or above - spends a greater percentage of its premium dollars on health care than does an HMO with a lower medical-loss ratio. Medical-loss ratios that are either too high or too low may indicate potential problems in the plan. An HMO that spends too much money on medical expenses (high medical loss ratio) may not have enough resources to administer the plan. As a result, providers may not get paid on time and members could have more difficulty reaching HMO staff to answer questions or solve problems. HMOs that consistently spend less of its money on health care (low medical-loss ratios) may not be providing appropriate medical care to their enrollees.
  
  The medical-loss ratio by itself is not enough to determine the quality of care provided under the plan. For example, a low medical-loss ratio does not necessarily indicate that members have problems obtaining needed care. An HMO could spend a lower percentage of its revenues on health care services because it enrolled healthier members, negotiated lower reimbursement rates from the providers, or charged higher premiums. Typically, new HMOs have lower medical-loss ratios because they have higher administrative start-up costs in comparison to other more established plans. Thus, medical-loss ratios should not be considered alone. They should be read in conjunction with other information about quality, use and the costs of health care services. Financial data includes Medicare enrollees when applicable. Partners, QualChoice, United Healthcare and WellPath have Medicare enrollees.
  
  
• Five-Year Medical-Loss Ratio Trends. This shows the HMO’s medical loss ratios over the last five years. An HMO may have an artificially high or low medical loss ratio in any particular year. For example, a health plan that installs a new computer system may have higher administrative expenses that year, leading to a low medical loss ratio. A health plan that set very low premiums in a specific year could have a very high medical loss ratio. Thus, looking at the medical loss ratio over five years gives more accurate information about the amount of premiums spent on health care expenses versus administration and profit. Financial data includes Medicare enrollees when applicable. Partners, QualChoice, United Healthcare and WellPath have Medicare enrollees.
  
  
• Operating Profit Margin. The operating profit margin shows whether an HMO made or lost money in 1998. The operating profit margin is the HMO’s operating income (total revenues minus health care and administrative expenses), divided by its total revenues. The operating profit margin reflects how well the company performed financially in the past year. Note: The numbers listed in parenthesis are negative numbers, which means that the HMO lost money that year. Financial data includes Medicare enrollees when applicable. Partners, QualChoice, United Healthcare and WellPath have Medicare enrollees.
  
  
• Five-year operating profit margin trends. Five-year data may be a more useful source of data in examining a health plan’s financial outlook. The numbers listed in parenthesis are negative numbers, which means that the HMO lost money that year.
  
  Several NC HMOs lost money over the last several years. A health plan may be able to sustain losses over a few years, but may not be able to handle continual losses over longer periods of time. New HMOs generally lose money initially as they incur large start-up costs (relative to revenues) in order to develop the company. The five-year operating profit margin data will show trends over time. For example, it will show which plans have consistently lost money, and which plans are experiencing a short-term loss. The trend data also shows whether HMOs that have lost money in the past have taken steps to improve their bottom line. Financial data includes Medicare enrollees when applicable. Partners, QualChoice, United Healthcare and WellPath have Medicare enrollees.

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