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World’s Largest Insurers

Health underwriters see gains in ranking.
  • David Pilla
  • February 2020
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Health insurers made the biggest moves on AM Best's annual world's largest insurers ranking based on 2018 net premiums written, while life insurers, measured by nonbanking assets, also saw changes in their ranking.

Among the biggest gainers by NPW is Centene Corp. The health insurer rose to No. 12 from No. 18 a year earlier.

In October 2018, Centene said it would increase its participation in the Affordable Care Act individual markets, entering four new states and expanding its footprint in six states it now serves. “We have successfully navigated a difficult enrollment environment, gaining market share and exceeding our growth targets,” Michael F. Neidorff, chairman, president and chief executive officer, said at the time.

Big deals promise to further change the health insurance landscape.

Centene is progressing with its acquisition of WellCare Health Plans Inc. after the health insurer's recent agreement to offload its Medicaid operations in two states to Anthem Inc. The approval process for the acquisition “continues to go well and is ahead of schedule” as Centene expects to close in first half of 2020, Neidorff said in a conference call. The cash-and-stock transaction is valued at $17.3 billion, a combination that will bring together two health insurers with a strong presence in state and federal government insurance program.

UnitedHealth Group Inc., which held onto its No. 1 position from the previous year, saw strong growth prospects in its research and development, venture and mergers and acquisitions capacities, said Chief Executive Officer David S. Wichmann in a November 2018 investor conference call .

He said the group is seeing these capacities in each of its five “growth pillars”: care delivery, consumer-centric health benefits, pharmacy care services, digital health and global health care, where UnitedHealth is developing key private healthcare markets in South America.

UnitedHealth is targeting diversification across its health care businesses, with nearly 50% of its projected 2019 earnings coming from health care services, Wichmann said at the November 2018 investor conference. He said the group's businesses are drawing on the collective strengths of its two main segments—UnitedHealthcare and Optum—as it works out a continued transformation as a health care and health technology company over the next decade.

UnitedHealth's 2018 NPW rose 12.39% to $178.09 billion.

Following UnitedHealth in the ranking, Axa S.A. stayed at No. 2 while two Chinese companies— Ping An Insurance (Group) Company of China Ltd. and China Life Insurance (Group) Co.—traded places, with Ping An rising to third and China Life falling to fourth.

Rounding out the top five is Kaiser Foundation Group of Health Plans, which traded places with Allianz SE, which dropped to No. 7.

Anthem Inc. remains in its No. 6 position.

The rest of the top 10 are Assicurazioni Generali S.p.A., State Farm Group, and People's Insurance (Group) of China Ltd., which remain in their eighth, ninth and 10th places respectively.

Axa's NPW rose 3.22% to $103.0 billion in 2018. The group closed on its acquisition of XL Group in September 2018, which added commercial lines and specialty underwriting to its ranks.

China Pacific Insurance (Group) Co. Ltd. rose to 19th from 24th place and Japan's National Mutual Insurance Federation of Agricultural Cooperatives rose to 16th from 20th place. Four insurers made the top 25 list that weren't on it a year earlier: CVS Health Corp. Group, which closed on its acquisition of health insurer Aetna Inc. in 2018; MetLife Inc. at No. 21; Liberty Mutual Holding Co. at No. 24 and Health Care Service Corporation Group at No. 25. Losing ground by 2018 premiums was Prudential plc, which fell to 22nd from 13th place.

Amid preparations for the demerger of its U.K. investment management arm, Prudential plc reported a 6% increase in group operating profit in 2018 to £4.82 billion (US$6.37 billion). The results were led by a strong performance in Asia, Prudential said early last year. The demerger of M&GPrudential, the group's investment management business, was announced in March 2018. It will create an entity that will serve an international market.

Munich Reinsurance Co. fell to No. 15 from No. 12 and Allianz SE fell to seventh from fifth place. 

Ranking by Nonbanking Assets

Looking at the top 25 by nonbanking assets, Axa and Allianz SE traded places. With Axa rising to No. 1 and Allianz slipping to No. 2. Prudential Financial Inc. remained in third place.

Nippon Life Insurance Co. rose from seventh to fourth place and Berkshire Hathaway Inc. rose to fifth from sixth. Nonbanking assets for Axa rose 6.71% to $1.01 trillion in 2018, making it the only insurer to reach the trillion-dollar level.

Among the top five, only Nippon Life saw assets rise significantly, up 5.95%. from 2017. No. 10 Ping An's nonbanking assets rose 13.87%. Four of the top 10 saw their assets decline in 2018.

In May 2018, Nippon Life completed its ¥104.2 billion ($955 million) cash acquisition of an 85.1% stake in MassMutual Japan as the companies plan to work together to expand group and high-net- worth businesses. MetLife fell to No. 6 from No. 5 in the assets ranking while Japan Post Insurance Co. fell to No. 7 from No. 4.

In December 2018, Japan Post Holdings said it would acquire a 7% stake in U.S. insurer Aflac Inc. for about $2.4 billion as part of the Japanese group's efforts to find new profit drivers. Japan Post was to acquire the stake through open market or private block purchases in the United States via a trust to be established by the Japanese postal and financial conglomerate, Aflac said in a statement at the time.

Both parties said the deal would further strengthen and renew their mutual commitment to the cancer insurance marketplace in Japan. Japan Post will continue to offer Aflac's cancer products through its more than 20,000 postal outlets across Japan, as well as through Japan Post Insurance's 76 sales offices.

In November 2018, Japan Post Insurance said it was seeking regulatory approvals for new operations, which involve the underwriting of new types of insurance.

Prudential plc moved up one notch to No. 8 while Legal &General Group plc moved down one notch to No. 9.

The biggest gainers by non-banking assets are Japan's Nippon Life; Ping An Insurance (Group) Company of China Ltd., moving to No. 10 from No. 13; and China Life Insurance (Group) Co., to 12th from 15th place.

Ping An reported a 20.6% surge in net profit attributable to shareholders in 2018.

China Life reported a 64.7% drop in 2018 net profit on a decline in income from open market equity investments due to overall volatility and a downward trend of the stock market. China's economy “slowed down slightly in 2018, with interest rates trending down in the bond market and a decline in stock market second only to that in 2008,” China Life said.

In addition to Japan Post, companies sliding on the assets side include Aviva plc, which fell to No. 14 from No. 11; and CNP Assurances, which fell to No. 18 from No. 16.


Click here to view the World's Largest Insurers rankings.



David Pilla is news editor, BestWeek. He can be reached at:

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