Skip All Navigation

Maine.gov > PFR Home > Insurance Regulation > Hearing Decision Index > Document 26 : INS 99-14 : Hearing Decision

November 2, 1999

 

BY HAND DELIVERY

 

Alessandro A. Iuppa, Superintendent of Insurance

c/o Lyndy Morgan

Docket No. INS-99-14

Maine Department of Professional and Financial Regulation

Bureau of Insurance

124 Northern Avenue

Gardiner, Maine 04345

Re: In Re: Conversion of Associated Hospital Service of Maine (d/b/a Blue Cross and Blue Shield of Maine) to a Stock Insurer and Acquisition of its Assets by Anthem Health Plans of Maine, Inc. (d/b/a Anthem Blue Cross Blue Shield of Maine), a wholly owned subsidiary of Anthem Insurance Companies, Inc.: Anthem’s Response to the First Discovery Request of the Superintendent of Insurance

Dear Superintendent Iuppa:

Please find for filing in the above-referenced action, Anthem Insurance Company, Inc.’s Response to the First Discovery Request of the Superintendent of Insurance ("Anthem’s Response"). Consistent with the procedures we understand will soon be set forth in a procedural order, we have enclosed two paper copies of the entire response, including all responsive documents. We have also enclosed two discs, one not read only, of the portions of Anthem’s Response that were created for the response, as opposed to existing responsive documents. As reflected in the Certificate of Service attached to the Response, one paper copy of this letter and the enclosed response have been sent to Judith Chamberlain, Esq., William Laubenstein, Esq., and to those whom we understand represent the putative intervenors, by mail.

If we should be following some other procedure, e.g., submitting more copies and/or in a different form, please tell us. Thank you for your attention to this matter.

 

Very truly yours,

 

Christopher T. Roach

 

 

cc:                 Robert S. Frank, Esq.

Judith Chamberlain, Esq.

Martin Robles, Esq.

William Laubenstein, Esq.

Gregory A. Brodek , Esq. (Maine Health Alliance)

Andrew B. MacLean, Esq. (Thomas D. Hayward, M.D., Maroulla S. Gleaton, M.D., and

the Maine Medical Association)

Joseph P. Ditre, Esq. (Consumers for Affordable Health Care Foundation/Coalition)

Michele M. Gavin, Esq. (Central Maine Healthcare Corporation)

Robert I. Goldman (Maine Council of Senior Citizens)

Bonnie Post (Sacopee Valley Health Center, Regional Medical Center at Lubec, Eastport

Health Care, Inc. and the Maine Ambulatory Care Coalition)

John Dieffenbacher-Krall (Maine People’s Alliance)

 

Enclosures

CERTIFICATE OF SERVICE

The under signed person hereby certifies that on November 2, 1999, he caused a copy of the following documents to be served by United States mail, first class postage prepaid, on each of the persons listed below.

Anthem Health Plans of Maine, Inc.’s Response to

First Discovery Request of the Superintendent of Insurance

Robert S. Frank, Esq.

Judith Chamberlain, Esq.

Martin Robles, Esq.

William Laubenstein, Esq.

Gregory A. Brodek , Esq. (Maine Health Alliance)

Andrew B. MacLean, Esq. (Thomas D. Hayward, M.D., Maroulla S. Gleaton, M.D., and

the Maine Medical Association)

Joseph P. Ditre, Esq. (Consumers for Affordable Health Care Foundation/Coalition)

Michele M. Gavin, Esq. (Central Maine Healthcare Corporation)

Robert I. Goldman (Maine Council of Senior Citizens)

Bonnie Post (Sacopee Valley Health Center, Regional Medical Center at Lubec, Eastport

Health Care, Inc. and the Maine Ambulatory Care Coalition)

John Dieffenbacher-Krall (Maine People’s Alliance)

 

DATED: November 2, 1999

 

                                                                                _____________________________

                                                                                Christopher T. Roach

 

STATE OF MAINE

DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION

BUREAU OF INSURANCE

In Re: Application Of Associated )
Hospital Service Of Maine, )
D/B/A Blue Cross And Blue )
Shield Of Maine, To Convert )
To A Stock Insurer And )
Voluntarily Liquidate And )
Dissolve )

 

In Re: Application Of Anthem  ) Anthem Health Plans of Maine, Inc.’s
Health Plans Of Maine, Inc.,  ) Response to First Discovery Request of
To Acquire To Acquire The Assets  ) the Superintendent of Insurance
Of Associated Hospital Service  )
Of Maine, D/B/A Blue Cross And  )
Blue Shield Of Maine, )
And Related Transactions )
Docket No. INS 99-14 (CONSOLIDATED)

Anthem Insurance Companies, Inc., on behalf of its subsidiary to be formed, Anthem Health Plans of Maine, Inc., d/b/a Anthem Blue Cross and Blue Shield of Maine, responds to the Superintendent of Insurance First Discovery Request, dated October 19, 1999, as follows:

Valuation
1. Please provide the curriculum vitae for each of the review appraisers and contributing appraisers identified in the certification of appraisal appended to the valuation of Blue Cross and Blue Shield of Maine completed by Houlihan, Lokey, Howard and Zukin Financial Advisors, Inc. which appears as Tab D to the application on file with the Superintendent.
Response:
Please see Associated Hospital Services of Maine d/b/a Blue Cross Blue Shield of Maine’s Response to Superintendent of Insurance’s First Discovery Request ("BCBSME Response"), valuation response #1.
2. In addition to a curriculum vitae, please provide any other relevant background information with respect to the contributing and reviewing appraisers including similar engagements in which each individual has been involved over the course of the past ten years.
Response:
Please see BCBSME Response, valuation response #2.
3. Please describe in detail the process utilized by the Board of Directors of Associated Hospital Service in selecting Houlihan, Lokey, Howard and Zukin as the appraisal firm for the completion of the valuation of Blue Cross and Blue Shield of Maine.
Response:
Please see BCBSME Response, valuation response #3.
 Financial
1. Please provide the audited financial statements for Anthem Insurance Companies on a GAAP basis for the years ended December 31, 1997 and 1998 including the report of Independent Auditors. Note: Although some statements are referenced in the filing as appearing in Book 2 at Tab I, they appear to be missing.
Response:
These documents were provided under cover letter of October 19, 1999 from Robert S. Frank to Judith Chamberlain, and bear document control numbers AN 000001-00049.
2. The auditor’s report for the year ended December 31, 1998 of Blue Cross and Blue Shield of Maine appears in Book 2, Tab Q of the filing. Please provide pages 7, 8 and 10, as those pages appear to be missing.
Response:
These documents were provided under cover letter of October 19, 1999 from Robert S. Frank to Judith Chamberlain, and bear document control numbers B 00063-00065.
3. Financial projections for Blue Cross and Blue Shield of Maine on a consolidated basis are provided in the confidential portion of the filing. Please identify the companies whose financial figures are included within the projections.
Response:
Please see BCBSME Response, financial response #3.
4. Financial statements for Anthem Insurance Companies are provided at Book 2, Tabs K, L, M, R and S. For each of these statements, please indicate which are done on a consolidated basis. For those statements which are consolidated, please identify the companies included within each statement.
Response:
The financial statements of Anthem Insurance Companies, Inc. ("Anthem" or "AICI") provided at Tab K, L and M of Book 2 are statutory basis financial statements, which are not on a consolidated basis. These statements contain revenues, expenses, asset and liabilities for the AICI mutual insurance company only. All subsidiary companies are carried as investments in subsidiaries on the balance sheet at their statutory equity level, if they are regulated companies, or at their Generally Accepted Accounting Principle (GAAP) basis equity balance for non-regulated companies. Results of operations for these subsidiary companies do not run through the Statement of Income of the AICI mutual insurance company but are reported as a "Change in equity of subsidiaries" as a direct adjustment to Policyholder’s Surplus.

The financial statements included at Tab R and S of Book 2 are GAAP basis consolidated financial statements. These statements include the revenues, expenses, assets and liabilities of the AICI mutual insurance company and all its subsidiary companies where AICI has ownership of 50% or more. Subsidiary companies included in these consolidated financial statements can be seen on the legal organization chart for year-end 1998 and 1997, attached hereto as document numbers AN-00050 through AN-00061.

5. The membership information contained in the BCBSME financial projections in the confidential binder at page 50 provided with respect to Maine Partners Health Plan as of the year ended December 31, 1998 differs from the same information provided on the 1998 annual statement filed with the Bureau of Insurance. Please compare the two documents and explain the deviation. Additionally, please prepare and file the same financial projections on a SAP basis.
Response:
Please see BCBSME Response, financial response #5.
6. The information contained in the BCBSME financial projections in the confidential binder at page 51 provided with respect to Central Maine Partners Health Plan as of the year ended December 31, 1998 differs from the same information provided on the 1998 annual statement filed with the Bureau of Insurance. Please compare the two documents and explain the deviation. Additionally, please prepare and file the same financial projections on a SAP basis.
Response:
Please see BCBSME Response, financial response #6.
7. Please provide the NAIC annual statement for the year ended December 31, 1998 for Anthem Insurance Companies.
Response:
Please see the attached document numbers AN-00062 through AN-00226.
8. A comparison of the 1997 financial statement on a GAAP basis (at Book 2, Tab R) to the 1997 financial statement on a SAP basis (at Book 2, Tab J) for Anthem Insurance Companies revealed discrepancies in some of the values including revenue and assets. Please compare the two documents and explain in detail any discrepancies.
Response:

The differences between the revenues and assets in GAAP basis financial statements at Tab R and the SAP basis financial statements at Tab J are due to the following principal items:

The SAP basis revenues include only the revenues from the AICI mutual insurance company stand-alone, as none of the revenues of it subsidiary companies are included (no consolidation). The GAAP basis revenues include the revenues of all subsidiary companies where AICI ownership is 50% or more. Hence, the GAAP basis revenues are significantly more than the SAP basis revenues.

The SAP basis assets include only the assets of the AICI mutual insurance company, whereby the net assets of all subsidiary companies are carried as "Investment in subsidiaries". For SAP purposes the basis of the investment in subsidiary is equal to the statutory equity of the subsidiary, if it is a regulated company or at their GAAP basis equity (net assets) balance for a non-regulated company. The GAAP basis assets include the assets of the AICI mutual insurance company and all subsidiary companies added together and are significantly higher than SAP basis assets.

9. The June 30, 1999 quarterly statement for Anthem Insurance Companies (at Book 2, Tab M) reflects a refund from the Internal Revenue Service. Please explain the basis for this refund and whether such a refund is expected to be a one-time event. What amount of tax refund is projected as of year end 1999 and what percentage of income is it expected to comprise?
Response:
The refund reflected in Anthem’s June 30, 1999 quarterly statement consists of three items: (1) tax payments receivable from the subsidiaries in the consolidated return based on the group’s tax sharing agreement; (2) a pending refund due to NOL carrybacks; and (3) overpayment of federal income taxes as of June 30 that will be used later in 1999. Although the particular circumstances which resulted in the referenced refund are not likely to repeat in precisely the same way in the future, these occurrences are not unusual. Anthem is unable to project the amount of the tax refund account at December 31, 1999, although it is expected to decrease from the June 30 levels.
10. Please describe in detail the methodology used by Anthem Insurance Companies in determining the appropriate deduction from the purchase price should Blue Cross and Blue Shield of Maine fall short in its financial projections. Identify all considerations taken into account in reaching the conclusion that a $5.00 reduction in the purchase price is appropriate.
Response:
Anthem did not create a particular methodology to use in determining the $5.00 deduction from the purchase price contained in Section 2.07 of the Asset Purchase Agreement should Blue Cross and Blue Shield of Maine fall short of its income projections. Rather, Anthem selected the $5.00 adjustment mechanism as a matter of business judgment, based on Anthem’s overall assessment of the value of Blue Cross and Blue Shield of Maine, Anthem’s assessment of the content and trends reflected in the Benchmark Projections developed by Blue Cross and Blue Shield of Maine, the purchase price being offered by Anthem, and the fact that similar $5.00 purchase price adjustments tied to projections were utilized by Anthem in its proposals to acquire the Blue Cross and Blue Shield plans in Colorado and New Hampshire.
11. Please explain with specificity the measures Anthem Insurance Companies, through Anthem Health Plan of Maine, will undertake in order to improve the administrative expense ratio of Blue Cross and Blue Shield of Maine should the proposed acquisition be approved.
Response:

As described in the Form A previously filed with the Bureau, Anthem believes that an important part of its core strategy is to establish regional centers of focus having a significant share of the region's health insurance and managed care market. Creation of regional centers offers the ability to consolidate operational functions where appropriate to eliminate redundancies, improve the efficiency of backroom processing and take advantage of best practices – all resulting in more efficiently run and cost effective individual operations.

More specifically, to achieve these efficiencies Anthem operates with a management system that consists of Corporate, Shared Service, Regional and State level functions. The "Corporate" functions are generally performed in Indiana, and include activities such as payroll, treasury and compensation/benefits design. "Shared Service" functions refers to those activities which are delivered on a standardized basis under the direction of a single corporate executive (e.g. information systems and legal), but the employees are distributed throughout the Anthem services areas. "Regional" services are managed regionally and include claims and billing and enrollment.

The intent is to deliver internal services more efficiently (and therefore less expensively) by having one group of specialists, rather than several smaller departments delivering the same functionality. Anthem intends to pursue this same approach if the proposed purchase of BCBSME is approved.

Finally, as part of a larger organization, Blue Cross and Blue Shield of Maine will be able to take advantage of Anthem’s superior purchasing power. Computer equipment, telephone service, office supplies and printing services are just a few examples of necessary expenditures for which bulk purchasing can often reduce per unit costs.

Consistent with Anthem’s approach of creating efficient operations, Anthem’s practice is to keep local those functions that are most efficiently performed locally. For example, local employees will be responsible for coordinating and overseeing enrollment activity, supervising educational activities, providing service to accounts, tracking customer satisfaction, and provider contracting and medical management and will serve as local contact centers for members, providers, employees and regulatory authorities. In addition, the marketing of health care coverage to Maine residents will be performed by local employees.

In sum, Anthem’s intention is to build a strong New England region (similar to Anthem’s position in the Midwest) to take advantage of the efficiencies outlined above. Anthem’s merger with Blue Cross and Blue Shield of Connecticut, its completed purchase of the business of BCBSNH, and its proposed purchase of BCBSME, are significant steps toward realizing that goal.

12. Please describe the procedures currently utilized by Anthem Insurance Companies and its subsidiaries to assure compliance with 18 U.S.C. §§1033 and 1034. Does Anthem anticipate the use of these same procedures by Anthem Health Plan of Maine should the proposed acquisition be approved? If not, please describe in detail the procedures to be used by Anthem Health Plan of Maine.
Response:

Anthem inquires as to felony and misdemeanor convictions in its standard employment application and in its standard Personal Data Sheet. In addition, a background check is completed for every new hire. The Personal Data Sheet is completed by every new agent as well as by every existing agent during the recredentialing process.

No decision made with respect to whether Anthem’s existing practices will be used by Anthem Blue Cross and Blue Shield in Maine. After closing, there will be an evaluation of the efficacy of Anthem's practices versus those used by Blue Cross and Blue Shield of Maine. Those deemed superior will be adopted as a best practice.

13. The bulk reinsurance agreement as well as other documents within the application on file refers to the intent of Anthem Health Plan of Maine to assume "substantially all" of the liabilities of BCBSME. Please provide a detailed itemization of those liabilities which will not be assumed including a complete description of the liability and the estimated or known amount of the liability.
Response:
Section 2.02 of the Asset Purchase Agreement addresses the BCBSME liabilities that Anthem Health Plans of Maine will not assume when the transaction closes. Given the hypothetical nature of the bulk of the excluded liabilities, there are no working estimates of the amount of potential excluded liabilities. BCBSME’s tax liability is the one liability that is capable of estimation. BCBSME has informed Anthem that BCBSME currently is analyzing the tax liability issue and will provide the results of that analysis to the Superintendent as soon as that analysis is concluded.

As set forth in Section 2.02, the excluded liabilities are:

(1) All liabilities relating to or arising out of the Seller's rights under the Agreement and the Ancillary Agreements, and the Tax Refunds (to the extent provided in Section 7.07). As stated above, BCBSME is analyzing the tax issues and will provide that analysis when it is available. Amounts other than the tax liability are hypothetical and unquantifiable at this time.

(2) All liabilities relating to Blue Alliance. According to BCBSME, there currently exist no liabilities relating to Blue Alliance.

(3) Any liabilities in the aggregate in excess of an amount equal to three percent (3%) of the Total Consideration (i.e., $120,000,000 less the consideration paid by Purchaser to Blue Alliance in connection with Purchaser's acquisition of Blue Alliance's equity interest in Machigonne, Inc.), after all adjustments, with regard to services/actions of BCBSME under Medicare. According to BCBSME, there currently exist no liabilities relating to Medicare.

(4) Other sums for which Seller is liable pursuant to this Agreement and the Ancillary Agreements, including without limitation, liability pursuant to Articles VII (Tax Matters) and IX (Indemnification) of this Agreement. As stated above, BCBSME is analyzing the tax issues and will provide that analysis when it is available. Amounts other than the tax liability are hypothetical and unquantifiable at this time.

(5) Seller's Aggregate Tax Liability. As stated above, BCBSME is analyzing the tax issues and will provide that analysis when it is available.

Dated at Portland, Maine this 2nd day of November, 1999.

________________________

                                                            James B. Zimpritch, Esq.

                                                            Pierce Atwood

                                                            One Monument Square

                                                            Portland, Maine 04101

                                                            Counsel for Anthem Insurance Companies, Inc.

 

Last Updated: March 27, 2012