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 #InsurViewDaily Medicaid disenrollments surpass 18M, exceeding HHS projections   March 25, 2024 - The Families First Coronavirus Response Act required Medicaid to provide continuous coverage for beneficiaries throughout the COVID-19 pandemic. With disenrollments paused, Medicaid and the Children’s Health Insurance Program (CHIP) enrollment grew by over 23 million beneficiaries.   The continuous coverage policy ended with the public health emergency, and states could begin coverage redeterminations on April 1, 2023. HHS had projected that 15 million beneficiaries would lose Medicaid coverage. However, as of March 20, 2024, more than 18 million people have been disenrolled. What’s more, 35 million beneficiaries’ eligibility redeterminations have either still not been completed or have not been reported.   Disenrollment numbers and processes have varied across states. Starting from April 2023, states have up to twelve months to initiate redeterminations. Some states began disenrollments in April, while others waited until May, June, or July. Oregon did not resume coverage determinations until October.   “Medicaid unwinding has been a massive undertaking for states,” Louise Norris, a health policy analyst for healthinsurance.org, said. “Not only do states have to redetermine eligibility for the record-high number of people enrolled in Medicaid, but they also have to continue to process new applications.”   Texas has disenrolled the most Medicaid beneficiaries so far at 2 million, while Wyoming has disenrolled the fewest number at 5,300 beneficiaries, according to KFF data. Utah has disenrolled the highest percentage of its completed Medicaid redeterminations (57 percent), and Maine has disenrolled the lowest percentage (12 percent).   Since the Medicaid unwinding started, coverage has been renewed for 40 million beneficiaries. Most renewals did not require beneficiaries to provide any information to confirm their eligibility, but 40 percent of cases required individuals to complete a renewal packet for confirmation.   The majority of disenrollments were due to procedural reasons, meaning beneficiaries did not complete the required renewal process to maintain coverage. These beneficiaries may have misunderstood the process, not had the resources to complete it, or may not even know they had to complete anything.   Many people who lost Medicaid eligibility are now eligible for an employer-sponsored health plan. Individuals have also transitioned to marketplace coverage. Through November 2023, nearly 2.3 million people moved from Medicaid to a marketplace plan, while 229,000 had transitioned to Basic Health Program coverage.   Disenrolled beneficiaries moving to a marketplace plan can enroll before July 31, 2024, as part of an extended unwinding special enrollment period. These individuals may qualify for premium subsidies to offset costs. (Source: Health Payer Intelligence)

#InsurViewDaily Marsh unveils cyber group captive for clients seeking more insurance stability   Marsh, an insurance broker, risk advisor and business of Marsh McLennan, has unveiled Edgware Re Ltd., a group captive insurance company that has been created for organisations “seeking more control and stability in their cyber insurance programs.”   Based in Bermuda, Edgware Re is a cyber-only group captive that will only transact business with its participating members, Marsh stated.   According to the insurance broker, participating members can purchase up to $10 million in insurance or reinsurance from Edgware Re based on their needs.   At the same time, Marsh also confirmed that it will provide captive management, incident response, vendor engagement, and claims advocacy support to Edgware Re.   Marsh explained that the creation of the new group captive insurance company comes after a volatile period of cyber insurance pricing and coverage modification.   In order to help stabilize these effects, Edgware Re will use Marsh’s cyber policy forms, pool participants cyber risks and premiums, absorb their losses, and foster the exchange of cybersecurity best practices, Marsh confirmed.   An important factor to note is that participant members will be eligible for dividends in the event of requisite profitability.   Tom Reagan, Global Cyber Practice Leader, Marsh Specialty, commented: “As the scale, frequency, and economic impact of cyber events continue to grow, organizations must regularly reconsider and optimize their cyber risk strategies. Edgware Re is a great example of Marsh working with its clients to use their own capacity to create a sustainable insurance program that better meets their needs in today’s market.”   Ellen Charnley, President of Marsh Captive Solutions, said: “The captive insurance market is a proven risk financing alternative for organizations that want to take greater control of their risk and gain increased financial flexibility and protection. Edgware Re offers its participants the potential for more stable pricing and control, access to shared best practices, and potential profit sharing; and is the latest Marsh captive innovation following the recent launch of ReadyCell.”   If you recall, Marsh launched ReadyCell in January. The insurance broker described ReadyCell as a risk financing solution that “enables organisations of all sizes to quickly open their own insurance company and take greater control of their risk management.” (Source: Reinsurance News)

Goalsetter raises $9.6 million   Goalsetter, a fintech platform dedicated to providing families and K-12 youth with access to banking, savings, investing, and financial education tools, announced the closing of a $9.6 million Series A extension round led by an affiliate of Edward Jones and MassMutual through its MM Catalyst Fund. Fiserv, Webster Bank, Seae Ventures, Astia Fund, Partnership Fund for New York City, Reseda Group and InTouchCU also participated in the round.   Founded in 2016, the New York-based startup offers banking and investment products with a focus on financial literacy. Some of Goalsetter’s features include “Learn to Earn,” which lets kids earn money for every financial quiz question they get right, and “Learn Before You Burn,” which lets parents freeze their kids debit card if they haven’t taken their financial literacy quizzes for the week.   Banking services are provided by Webster Bank, N.A., Member FDIC and Cashola Prepaid Debit Mastercard® is issued by Pathward, N.A. fka MetaBank, N.A., Member FDIC.   #InsurViewDaily Goalsetter has secured partnerships with several financial services companies, including Fiserv, Trustage, and CUNA Strategic Services, along with financial institutions, including MSU Federal Credit Union, InTouch CU, Solutions Bank and Liberty Bank.   “Our new Series A extension marks a significant milestone for Goalsetter as we continue to redefine financial education and inclusion across America. This funding will empower us to enhance our B2B offerings and forge stronger partnerships with credit unions, banks, and wealth management institutions, expanding our reach and impact to ensure that the next generation can grow into savvy savers and investors. This is an investment in Goalsetter and in the future financial well-being of millions of young Americans. Together, we are building a foundation for a more equitable and financially literate future for all.” – Goalsetter Founder and CEO Tanya Van Court. (Source: Coverager)

#InsurViewDaily Elevance Health to acquire Kroger Specialty Pharmacy   Elevance Health has inked a deal to acquire Kroger Specialty Pharmacy.   The grocery chain announced Monday that an agreement is in place, saying it's expected to close in the back half of 2024 pending regulatory approvals. Elevance intends to add Kroger Specialty Pharmacy to its CarelonRx business, which houses its pharmacy benefit management services.   Financial terms of the sale were not disclosed.   Kroger Specialty Pharmacy works with patients facing a wide array of chronic and complex conditions such as rheumatoid arthritis, growth hormone deficiencies, multiple sclerosis and bleeding disorders. Patients are connected with a clinical team and therapy programs that offer education, side effect management, financial assistance, counseling, personalized care and more.   "Kroger Specialty Pharmacy has been part of our company since 2012, and we want to thank our management team and associates for their enduring commitment to their patients," said Colleen Lindholz, president of Kroger Health, in the press release.   "As part of our regular review of assets, it became clear that our strong specialty pharmacy business unit will better meet its full potential outside of our business," Lindholz said. "One of the most important considerations was continued operations to ensure minimal disruption to our associates and patients. We are confident this transaction will help the business to grow and deliver better results for patients. We look forward to working toward a smooth transition for associates and patients."   The retailer noted that the specialty pharmacy arm is separate from Kroger's in-store retail pharmacies and Little Clinic locations, which are not included in the deal.   Kroger and Elevance Health have an existing partnership, joining forces to launch co-branded Medicare Advantage plans in 2021.   Elevance also announced earlier this month that it has closed a deal to acquire infusions services provider Paragon Healthcare. (Source: Fierce Healthcare)

#InsurViewDaily The CareVoice Raises US$10 Million in Series B Round   The CareVoice, a leading global embedded health enabler for insurers, has announced the successful completion of its Series B funding, raising a total of nearly US$10 million, in a round led by Apis Insurtech Fund I.   According to reports, the funding will be used to accelerate the Company’s growth, expand collaborations with insurers across regions, and invest in the next generation of the CareVoiceOS platform.   The Fund, managed by Apis Partners LLP (“Apis”), a UK-based asset manager renowned for its emphasis on financial returns and social impact, has been instrumental in driving growth and development within its portfolio companies. Apis leverages its sector expertise to implement value creation initiatives, positively affecting the lives of numerous individuals.   Since its initial investment in CareVoice in 2019, Apis has actively supported the company’s expansion and development efforts. These include facilitating business development activities to attract enterprise customers, utilizing its network in the insurance industry, and engaging stakeholders to foster partnerships. Apis’ investment strategy is aligned with CareVoice’s mission to transform insurer-customer engagement for improved health outcomes.   Over the past two years, CareVoice has expanded its operations and formed partnerships with leading insurers, including reinsurers and digital distribution enablers. It has also experienced a significant doubling of revenues in 2023 compared to the previous year.   In a joint statement about the Series B round, Matteo Stefanel and Udayan Goyal, Co-Founders and Managing Partners at Apis Partners, said: “The success of CareVoice is clear, demonstrated by the revenue growth of 2x year-on-year by the end of 2023, and the geographical expansion to 15 countries worldwide. With this Series B commitment from Apis Insurtech Fund I, we look forward to continuing to support CareVoice as it matures further and leads the embedded health category as a global leading software for insurance companies.”   Sebastien Gaudin, CEO and Co-founder of CareVoice, also commented, saying: “We are collaborating with two types of insurers, those early movers in the health and wellness space who are already aware of the gaps in their capabilities, and new entrants who want to accelerate, avoiding the pitfalls and challenges other insurers have faced.”   He added: “Both types are looking to generate additional profitable insurance business directly and through attracting and retaining healthier customer profiles. We see an exciting future development of this partnership approach which delivers mutual growth.” (Source: Insurtech Insights)

#InsurViewDaily Google to launch personal health AI model for Fitbit, Pixel devices   Fitbit and Google Research are working together to build a health LLM to give Fitbit and Pixel device users a personalized health coach based on their own data.   This model is being fine-tuned to deliver personalized coaching capabilities, like actionable messages and guidance, that can be individualized based on personal health and fitness goals. Last fall, the company launched Fitbit Labs which uses AI to provide deeper health insights.   "We're partnering with Google Research, health and wellness expert doctors and personalized and certified coaches to create personal health large language models that can reason about your health and fitness data and provide tailored recommendations, similar to how a personal coach would," Florence Thng, director of product management at Fitbit, during the event. "This personal health LLM will be a fine-tuned version of our Gemini model. This model fine-tuned using high-quality research case studies based on the de-identified diverse health signals from Fitbit will help users receive more tailored insights based on patterns in sleep schedule, exercise intensity, changes in heart rate variability, resting heart rate and many more metrics."   As one example, the model may be able to analyze variations in users' sleep patterns and sleep quality, and then suggest recommendations on the user might change the intensity of workouts based on those insights.   The AI-based coaching capabilities can mimic real-world coaching scenarios, Thng said.   "Imagine a future where you have access to an on-demand personal coach that can provide you with daily guidance. For example, it can analyze variation in your sleep patterns and sleep quality and make recommendations on how you might change the intensity or the time of your workout based on these insights," she said. "We're also keeping responsible AI practices at the center of this new model by thoughtfully designing it and training it on a diverse and curated sets of health and wellness data that's covering a wide range of domains."   The new personal health LLM will power future AI features across the Fitbit portfolio to bring personalized health experiences to users. (Source: Fierce Healthcare)

#InsurViewDaily Insurtech Coterie raises $27mn in “oversubscribed” funding round with Hiscox backing   Small business-focused insurtech Coterie has raised $27mn in a post-Series B funding round, securing fresh backing from Hiscox along with participation from existing investors Intact Ventures, Weatherford Capital and RPM Ventures, The Insurer can reveal. (Source: The Insider)

#InsurViewDaily Highmark Health hits $27B in revenue and net income exceeds half-billion following layoffs   Highmark Health recorded $27.1 billion in revenue and a net income of $533 million for 2023, the company announced during its fourth-quarter results Monday.   The company reported an operating margin of $338 million, though there was an operating loss of of $117 million during 2023 for the Allegheny Health Network as the system recovers from the pandemic. That was offset by gains seen in health insurance and other investments.   According to a press release, Highmark holds $11 billion in cash and investments, and Highmark Health Plans reported an operating gain of approximately $400 million in 2023. It remains the largest insurer in Pennsylvania, Delaware, Virginia and western New York, said CEO David Holmberg. It was also selected to provide Medicaid to eligible members in West Virginia.   He said Highmark's annual revenue has grown 72% and Highmark Health Plan's membership has grown 32% since 2013.   "We have transformed from a successful regional insurer into an innovative, diversified health organization, comprehensive solutions and national influence," he said.   Last week, the company laid off 182 employees across the country, most of which were working for Blue Cross Blue Shield insurance plans in western Pennsylvania, reported the Pittsburgh Post-Gazette.   "We've been redesigning work and eliminating some roles in other cases," said Karen Hanlon, executive vice president and chief operations officer. "We've hired 6,100 people in 2023. If you look at the workforce changes we've made overall throughout 2023, we actually grew the workforce by about 2%."   She noted that some of that hiring growth has moved outside of the U.S., but 44,000 people are employed by Highmark overall, and total employment within the U.S. has increased.   Allegheny Health Network saw inpatient discharges and observations increase 7%, outpatient registrations increase 5%, physician visits increase 3% and emergency room visits increase 6%.   The network does not expect a loss of revenue following the Change Healthcare cyberattack, though there may be delays in submitting claims to insurers, said Kate Musler, senior vice president of health plan risk management and provider network, on the call.   United Concordia Dental also delivered an operating gain of $105 million and HM Insurance Group posted an operating gain of $55 million. Highmark boasted it has provided more than $225 million in community support and $825 million toward investments into its Living Health model. (Source: Fierce Healthcare)

#InsurViewDaily Singapore general insurance sector sees growth in domestic and offshore segments – GIA   The General Insurance Association of Singapore (GIA) has found that the domestic and offshore general insurance segments saw a combined year-over-year growth of 10.1% in gross written premiums, reaching about S$10.2 billion, with the sector also recording an underwriting profit of S$608.1 million.   “The sector’s sustained growth this year reflects its resilience and underscores our enduring commitment to safeguarding the interests of consumers and businesses,” said Ronak Shah, president of GIA.   There was a 7.3% growth in gross written premiums within the domestic segment, which amounted to S$5.2 billion, while the profit for underwriting fell by 11.2% to S$262.9 million. The net incurred claims also increased by 44%, while the motor segment increased in claims by 73.3% to S$573.4 million.   The sector has also launched the Vehicle Accident Report History (VARH) service, which allows car owners to buy a report which shows the dates of accident reports made by owners or drivers of their vehicles within the past six years. This allows a buying and selling experience that is more transparent for those looking to buy vehicles.   Travel insurance had a 37.6% increase in gross written premiums, which was the highest among various business segments. The health segment saw a 12.1% increase in gross written premiums, but it saw an underwriting loss of S$10.6 million.   Gross written premiums for employer’s liability saw an increase of 10.2% along with an underwriting profit of S$45.7 million.   “Despite the positive results, we remain keenly aware of economic headwinds and the continued threat posed by fraudulent activities. Protecting and supporting our motoring public will remain a key focus for the sector in the coming year,” said Shah. (Source: Insurance Business)

#InsurViewDaily General insurance premium up 13% till February in FY24, shows data   The non-life insurance industry, including general, standalone health and specialised PSU insurance companies, have witnessed a 13.1 per cent growth in premiums to Rs 2.63 trillion in the first 11 months of FY24, up from Rs 2.32 trillion in the year-ago period. The growth was backed by the rise in health and motor insurance premiums.   According to the data released by the general insurance council, health insurance premiums have grown by 20.39 per cent year-on-year (Y-o-Y) during the April 2023-February 2024 period, while motor insurance premiums have gone up by 13.60 per cent.   The two segments of the industry together account for more than 60 per cent of the overall non-life insurance business. Since the pandemic, the demand for health insurance policies has been on the rise due to increased awareness among people of being underinsured and rising medical inflation. Meanwhile, rising vehicle sales support the growth in motor insurance. According to the data, retail health and group health premiums have increased by 19.22 per cent and 20.56 per cent, respectively so far in FY24.   "The industry gross domestic premium income (GDPI) growth in 11MFY2024 has been supported by the strong growth in the health segment driven by a surge in demand for health policies following the Covid-19 pandemic. GDPI growth for the motor segment remains strong with relatively higher growth in the motor – OD segment as compared to the motor - TP segment likely due to no hikes in the motor -TP rates,” said Neha Parikh, Vice President, Sector Head-Financial Sector Ratings, ICRA. OD is own-damage and TP is third party.   However, due to higher base, the growth in health insurance policies have moderated in the period under review to 20 per cent from nearly 24 per cent in the corresponding year ago period. Similarly, the motor segment has also seen a moderation in growth rate from 16 per cent in April – February period of FY23 to nearly 14 per cent so far in this financial year.   Among other segments, the premium growth in fire, marine, and crop insurance has seen a tepid performance. According to the data, fire insurance premiums have increased by 8.16 per cent so far in the current FY, whereas marine insurance premiums are down by 1 per cent during this period. Similarly, crop insurance premium has also declined by 5 per cent.   Parikh added that ICRA expects incremental GDPI of Rs 42,500 crore - Rs 44,000 crore for the industry in FY25 to reach an overall GDPI of Rs 3.22-3.24 trillion, translating into an estimated growth of 15-16 per cent Y-o-Y from Rs 2.79 - 2.80 trillion estimated for FY24. The figure for FY23 was Rs 2.41 trillion. Private insurers are expected to continue to gain market share with a 69 per cent share in GDPI in FY25, up from 66 per cent in FY23 and 50 per cent in FY17, she said. (Source: Business Standard)