AIS’s Directory of Health Plans is the most comprehensive resource available on the U.S. health plan market with enrollment data and contact information for health plans and primary care preferred provider networks operating in the U.S. as of year-end 2011. The database is also available on CD to permit the creation of the specific analysis that suits the needs of each user. View Episode 1 for more information about what is included in AIS’s Directory of Health Plans.

1. Episode I
What’s Included in
AIS’s Directory of Health Plans?

2. The Directory comes in 2 versions…
• A printed book version
• A CD database version, which comes with a free copy of the printed book
ALL the information in the book is on the CD.
The CD has the data in Excel, Access, CSV and
ASCII file formats.
The CD also has some additional data
not found in the book (more on that later).

3. Two Data Sets
The Directory includes databases on two types of
organizations —
•Health Plans
All insurance carriers, or managed care organizations, in the U.S.
that offer fully insured health plans based on a regional network.
Includes primary medical insurance only. The latest edition of the
Directory has 500 Health Plan records.
• Preferred Provider Networks
Organizations that offer primary medical networks to
self-insured plans or insurance carriers via a fee or lease
agreement. These companies do not offer insurance
products. The latest edition of the Directory has
135 Network records.
This slide presentation focuses on the Health Plan data sets only.

4. Overview of Health Plan Data Fields
Company Data:
• Company Name
• Company Address — street, city, state, zip
• Telephone Numbers — corporate business phone, automated number for
members and claims info, corporate fax number
• Company Owner — with Owner ID to link plan to other subsidiaries of the same
parent company
• Company URL
• Profit Status of Company
• Private/Public Status of Company
• Stock Symbol
• State Service Area (states in which company operates)
• Contracted Pharmacy Benefit Manager(s)
• Aliases — a list of subsidiaries, product names, former names and other names by
which this organization may be known in various markets
• Publication Notes — additional information about the company (e.g., recent
mergers, name changes) or about the enrollment data in the record

5. Overview of Health Plan Data Fields
Key Executives
Up to 17 names per company — First Name, Last Name — Listed by Job Function
• CEO
• President
• Operations Executive
• Finance Executive
• Medical Executive
• Legal Executive
• Provider Relations Executive
• Marketing Executive
• Member Relations Executive
• Pharmacy Executive
• Specialty Pharmacy Executive
• Public Relations Executive
• Information Systems Executive
• Purchasing Executive
• Claims Management Executive
• Reimbursement Executive
• Disease Management/Wellness Executive

6. Overview of Health Plan Data Fields
Key Executives
Up to 17 names per company — First Name, Last Name — Listed by Job Function
• The CD offers complete mailing lists, with phone numbers, in convenient Excel,
Access, CSV and ASCII formats.
• Data can be imported into your sales force software.
• Your purchase of the CD entitles you to unlimited use of these mailing lists.
• Names are collected/verified by AIS editorial staff with knowledge
of each health plan’s structure and organization,
job functions, etc.
• Mailing lists include the MCO ID
field —a unique identifier
that links each executive
with the full company
record. So you can sort
and filter the names by
geography, type of plan
model, membership,
job function, etc.

7. Overview of Health Plan Data Fields
Enrollment Data (aka Membership or Covered Lives)
We count members enrolled in primary medical products only — not specialty
benefits like pharmacy, vision, dental, etc.
Starting with:
Total Medical Enrollment — the total
number of members in medical plans (risk and
non-risk) nationally, for the whole company
Total Medical Enrollment is then broken
down into 2 main categories:
•Fully Funded (Risk-Based)
•Self-Funded (ASO)
Which are further broken down…

8. Overview of Health Plan Data Fields
Enrollment Data (aka Membership or Covered Lives)
Members enrolled in primary medical products only — not specialty benefits like
pharmacy, vision, dental, etc.
This is how enrollment is broken down into subsets:
• Total Fully Funded (Risk) Enrollment • Total Self-Insured (Non-Risk/ASO)
• Total Commercial Risk Enrollment Enrollment
• HMO • Total Commercial Non-Risk Enrollment
• POS
• PPO
• Total Public Sector Non-Risk Enrollment
• FFS/indemnity
• Medicare Supplement (Medigap)
• Total Public Sector Risk Enrollment Also provided:
• Medicare Enrollment (Part C) Number of lives in Individual
• Medicare (coordinated care) (non-Group) plans and,
• Medicare PFFS
• PACE Program Enrollment specific to each
• Medicaid HMO State, plus DC and Puerto Rico
• Medicaid FFS (state agencies)
• SCHIP/other local enrollment

9. Overview of Health Plan Data Fields
Enrollment Data (aka Membership or Covered Lives)
Members enrolled in primary medical products only — not specialty benefits like
pharmacy, vision, dental, etc.
This is what it looks like in the book:

10. Overview of Health Plan Data Fields
Health Plan Enrollment fields and definitions of health plan
models can be confusing

11. Overview of Health Plan Data Fields
Health Plan Enrollment fields and definitions of health plan
models can be confusing
• AIS offers full support to make sure you understand the data accurately and use
it appropriately for your specific projects.
• AIS’s Directory of Health Plans provides thorough explanations of each type of
enrollment in the Introduction section of the book (also in PDF on the CD).
• Our knowledgeable editorial staff is available to answer any
questions this material doesn’t cover.

12. Highlights and Analysis of the
Health Plan Industry
Highlights — Chapter 1 offers many tables, charts and calculations that
have been performed for you by AIS editorial staff, to answer such questions as:
Which health insurer is the largest by membership?
Where does my insurer rank by enrollment?
Who has the largest Medicare membership?
Which are the top 10 companies by HMO enrollment?
What % of U.S. covered lives are enrolled in for-profit plans?
Individual (non-group) plans? Risk-based plans? POS plans?
Non-risk (ASO) plans? Public-sector plans? Medicaid HMOs?
Commercial PPOs? Publicly traded corporations…
AIS’s Directory of Health Plans is the foremost authority on health plan enrollment statistics

13. Special Features of the CD Version
The CD version of AIS’s Directory of Health Plans
offers many special features and capabilities:
• Electronic files allow you to sort, filter and export the data for
your specific purposes
• A PDF version of the book allows for fast keyword searching
• You get a free copy of the paper book, so you’re not giving up
anything
Free
Copy!

14. Special Features of the CD Version
Files are in regular Windows formats — no special
software to learn

15. Special Features of the CD Version
Spreadsheets Developed for the CD Only
Subsidiary Addendum Excel workbook with:
•Worksheets featuring enrollment details for 20 large national companies with multi-
state service areas
•Lines for distinct subsidiaries/units by state, with enrollment breakdowns by type of
product

16. Special Features of the CD Version
Spreadsheets Developed for the CD Only
Subsidiary Addendum Excel workbook with:
•Worksheets featuring enrollment details for 20 large national companies with multi-
state service areas
•Lines for distinct subsidiaries/units by state, with enrollment breakdowns by type of
product
Parent Organizations
spreadsheet with:
•Total enrollment, by
product type, for all
subsidiaries
•Corporate address, phone
and CEO for 39 large
national organizations

17. Special Features of the CD Version
Spreadsheets Developed for the CD Only (continued)
• Convenient mailing lists
• Total enrollment by company by state
• Enrollment breakdowns, rolled up by parent organization
Spreadsheets for specific market sectors:
•Breakdowns by company, by state, of commercial enrollment only
•Breakdowns by company, by state, of Medicare Advantage enrollment only
•Breakdowns by company, by state, of Medicaid HMO enrollment only
•Breakdowns by company, by state, of FFS Medicaid enrollment only
•All of the above enrollment types, broken down by company, by state
Additional Data Fields Included on the CD Only
• Checkbox indicating whether a company is a Blue Cross and Blue Shield affiliate
• Total number of physicians (PCPs) and hospitals (acute-care) in health plan
networks

18. Methodology
All known health insurers and PPO networks operating
as of Jan. 1 believed to fit the criteria of the database are
Q: How Can AIS Get
included. Inclusion is not optional. Companies are surveyed
Such Comprehensive
by AIS staff between Oct. 1 and Dec. 31 of the year preceding
Participation from
the date of the Directory. AIS researchers are specially trained
Health Plans?
to understand enrollment terminology and how membership
is counted by plans.
Each organization is contacted and offered options to fill out A: As the publishers of Health
an online or paper form, or to provide data via email, fax, mail Plan Week, and many other
or via telephone interview. Information provided directly by long-running, highly respected
companies is deemed the most accurate and up-to-date industry publications, AIS has
information. For companies that do not return a survey, or established relationships with
where blanks are left on responses, researchers endeavor to all the major health insurers.
complete the record through other means. Survey data is
audited against public records as available. Additionally, AIS’s Directory of
Health Plans is an official
Fully insured commercial HMO enrollment is audited against directory resource of America’s
state insurance department filings. Medicare enrollment is Health Insurance Plans (AHIP),
audited against Centers for Medicare and Medicaid Services the trade association
(CMS) records. Medicaid enrollment is verified with state representing health insurance
Medicaid agencies. Records are supplemented by data from companies.
company websites, SEC filings, press releases and news
reports.
AIS’s Directory of Health Plans is the foremost authority on health plan enrollment statistics

19. What Other Health Plan Data Does AIS Have?
Employer Health Plan Data
AIS’s Employer Health Plan Database and Directories
provides valuable competitive intelligence on
employers; their health insurance carriers, brokers and
TPAs; plan designs; markets; fees and charges; claims;
and membership. Based on ERISA 5500 filings, records
link to AIS’s Directory of Health Plans records via MCO
ID.
Expand your knowledge of health plans’ commercial
client base.
http://aishealth.com/marketplace/aiss-employer-health-plan-database-and-directories

20. Ready to Order
AIS’s Directory of Health Plans?
Order Via Our Website at http://
aishealth.com/marketplace/aiss-directory-health-plans
Or call Customer Service at (800) 521-4323
Still Have Questions?
Our Customer Service Representatives will gladly put you in touch with our
technical editors to make sure you have a full understanding of the database and
how to apply it to your specific projects. Call us!
•View Episode 2 for more information about how to use the Directory to research
details about insurance companies.
•View Episode 3 if you don’t know whether to purchase the book OR the CD.
•View Episode 4 for more information about using the contact data and mailing
lists.