Insurance carriers · Plan year 2024 · Form 5500 Schedule A

Who insures America's employer health plans

Updated Oct 24, 2026

Employer health plans with 100 or more participants reported $37B in insurance premiums for plan year 2024, across 1,452 carriers with three or more employer clients. Medical premium alone was $28B; the twelve largest medical insurers wrote 67% of it.

Largest medical insurers

Medical (health) contracts only, by earned premium.

Unitedhealthcare Insurance Company

$3.3B

Blue Cross Blue Shield of Massachusetts, Inc.

$3.0B

Cigna Health and Life Insurance Company

$2.9B

Bluecross Blueshield of Illinois

$2.2B

Blue Cross Blue Shield of Michigan

$1.5B

Blue Cross Blue Shield of Florida

$1.3B

Blue Cross and Blue Shield of Alabama

$1.3B

Independence Blue Cross

$904M

Blue Care Network of Michigan

$703M

Blue Cross Blue Shield of South Carolina

$629M

Anthem Health Plans of Maine, Inc.

$563M

Bluecross Blueshield of Tennessee, Inc.

$562M

The 100 largest carriers

All coverage lines (medical, dental, vision, life, disability, stop-loss), by total earned premium.

#	Carrier	Premium	Employers	People covered	Broker pay rate
1	Unitedhealthcare Insurance Company	$3,263,621,498	7,563	3,898,836	16.3%
2	Blue Cross Blue Shield of Massachusetts, Inc.	$3,014,692,590	879	418,399	2.8%
3	Cigna Health and Life Insurance Company	$2,897,931,630	7,765	2,669,520	19.3%
4	Bluecross Blueshield of Illinois	$2,349,851,402	1,428	894,877	5.0%
5	Blue Cross Blue Shield of Florida	$1,578,584,236	748	125,533	2.3%
6	Blue Cross Blue Shield of Michigan	$1,483,724,104	926	454,500	3.1%
7	Blue Cross and Blue Shield of Alabama	$1,317,696,352	508	206,195	0.1%
8	Standard Insurance Company	$1,127,073,837	2,919	5,201	11.5%
9	Metropolitan Life Insurance Company	$1,045,855,347	8,049	4,697,798	42.8%
10	Independence Blue Cross	$950,062,048	277	124,490	1.8%
11	Blue Care Network of Michigan	$717,869,356	608	166,217	2.7%
12	Blue Cross Blue Shield of South Carolina	$635,793,249	260	77,863	2.6%
13	Wellmark Blue Cross and Blue Shield of Iowa	$615,699,205	245	66,179	0.5%
14	Bluecross Blueshield of Tennessee, Inc.	$615,143,482	544	168,519	5.5%
15	Vision Service Plan	$601,058,223	9,228	2,894	6.8%
16	Anthem Health Plans of Maine, Inc.	$563,104,417	42	37,926	1.0%
17	Bluecross Blueshield of Texas	$549,697,335	1,539	746,153	23.4%
18	Excellus Blue Cross Blue Shield	$545,664,006	341	75,093	4.1%
19	Blue Cross Blue Shield of Kansas City	$525,265,142	186	104,458	3.3%
20	Health Options	$472,853,022	460	48,592	2.8%
21	Aetna Life Insurance Company	$442,366,036	3,495	2,122,638	42.7%
22	Blue Cross and Blue Shield of Louisiana	$355,274,108	247	72,990	5.2%
23	Medical Mutual	$346,285,023	191	33,391	3.0%
24	Anthem Blue Cross	$331,944,095	317	82,744	6.5%
25	Prudential Insurance Company of America	$328,787,318	1,884	50,316	38.6%
26	Blue Cross Blue Shield	$308,318,552	98	75,126	1.3%
27	Health Care Service Corporation	$274,010,330	279	165,199	7.5%
28	Triple S Salud, Inc.	$265,161,956	321	69,443	4.7%
29	Delta Dental of California	$265,029,276	646	14,375	3.7%
30	Sanford Health Plan	$260,770,937	35	56,447	0.4%
31	Medical Mutual of Ohio	$245,092,757	155	25,004	3.4%
32	Delta Dental of Michigan	$223,560,580	752	—	3.3%
33	Independence Administrators	$219,054,425	12	13,284	0.1%
34	Arkansas Blue Cross and Blue Shield	$207,215,567	157	37,510	2.3%
35	Blue Cross and Blue Shield of Kansas	$205,320,782	148	39,842	1.6%
36	Delta Dental Insurance Company	$200,388,767	746	—	8.4%
37	Delta Dental of Ohio	$196,506,382	404	—	2.3%
38	Blue Cross Blue Shield of Rhode Island	$178,839,264	126	59,524	2.8%
39	Delta Dental of Washington	$175,543,820	389	—	2.6%
40	Wellmark Blue Cross and Blue Shield of South Dakota	$174,568,703	47	15,894	0.3%
41	Blue Cross Blue Shield of Nebraska	$169,373,564	58	24,477	3.4%
42	Carefirst of Maryland, Inc.	$162,611,206	111	52,561	5.3%
43	University Health Alliance	$150,449,876	131	26,724	1.3%
44	The Lincoln National Life Insurance Company	$144,415,945	4,473	37,953	199.0%
45	The Guardian Life Insurance Company of America	$142,977,162	6,408	20,859	164.8%
46	Highmark Blue Cross Blue Shield	$142,503,894	12	30,039	4.2%
47	Ace Insurance Company	$133,858,594	6	15,446	0.0%
48	MCS Life Insurance Company	$132,702,381	139	47,977	5.9%
49	Curative Insurance Company	$129,679,749	78	19,448	5.9%
50	Bluecross Blueshield of Oklahoma	$123,476,908	274	96,177	15.4%
51	Delta Dental of Virginia	$112,733,326	200	—	2.2%
52	Delta Dental of Tennessee	$109,734,830	190	—	4.3%
53	Delta Dental of Kentucky	$109,661,568	274	136	4.3%
54	Cigna Healthcare of California	$105,418,547	56	33,738	1.6%
55	Keystone Health Plan East	$102,245,848	32	10,347	0.8%
56	Delta Dental of North Carolina	$91,122,756	181	—	3.5%
57	Delta Dental of Indiana	$89,241,410	174	—	3.7%
58	United Concordia Insurance Company	$79,250,405	500	—	6.6%
59	Anthem Life Insurance Company	$75,501,988	1,040	4,252	8.6%
60	Blue Cross & Blue Shield of Mississippi	$66,657,511	56	15,996	4.7%
61	Delta Dental of Wisconsin	$66,132,041	354	—	4.7%
62	Hartford Life and Accident	$65,880,533	3,905	44,743	319.4%
63	Kaiser Foundation Health Plan, Inc.	$65,386,776	5,619	3,013,037	293.6%
64	Capital Advantage Assurance Company	$63,999,084	84	10,280	2.4%
65	Hawaii Medical Service Association	$61,661,206	943	127,919	1.5%
66	Regence Bluecross Blueshield of Oregon	$60,829,199	131	1,060,454	10.3%
67	Delta Dental of New Jersey, Inc.	$60,488,796	268	—	4.8%
68	Blue Cross of Idaho	$60,071,996	64	23,007	12.2%
69	Wellmark Health Plan of Iowa	$59,452,486	104	13,395	1.0%
70	Blue Cross Blue Shield of Il	$53,886,335	5	4,215	1.2%
71	Select Health	$51,621,024	24	17,058	8.8%
72	Bluechoice Healthplan	$49,800,110	16	4,449	3.4%
73	Bluecross Blueshield of New Mexico	$49,670,295	53	19,193	6.5%
74	Bluecross Blueshield of Montana	$48,654,727	77	25,261	9.7%
75	Highmark Western and Northeastern New York Inc.	$45,964,233	110	42,814	12.4%
76	Delta Dental of Colorado	$45,729,204	151	—	3.2%
77	Anthem Blue Cross Life and Health Insurance Company	$43,964,385	657	114,600	60.8%
78	Fidelity Security Life Insurance Company	$43,804,564	1,433	10,823	21.4%
79	Security Health Plan of Wisconsin, Inc.	$43,258,709	24	5,585	1.9%
80	Amerihealth Insurance Company	$41,215,906	33	4,958	3.2%
81	Anthem Blue Cross and Blue Shield	$40,706,068	209	194,001	36.3%
82	Selecthealth	$39,642,833	161	84,773	32.4%
83	Bluechoice Healthplan South Carolina	$39,060,761	16	4,015	3.6%
84	Independence Blue Cross - Keystone	$38,122,076	21	4,995	2.9%
85	Kaiser Foundation Health Plan of Washington Options, Inc.	$37,877,938	153	44,646	10.7%
86	Florida Blue	$37,129,318	24	10,499	2.3%
87	Independence Blue Cross - Personal Choice	$36,830,761	14	5,223	2.0%
88	Delta Dental of Arizona	$36,738,169	142	—	6.6%
89	Independent Health Benefits Corporation	$36,073,250	72	14,296	4.2%
90	Kaiser Foundation Health Plan of Washington	$33,096,430	504	79,330	12.6%
91	Univera Healthcare	$33,026,007	29	3,447	3.0%
92	Blue Cross Blue Shield of Ri	$33,017,746	3	4,717	0.1%
93	Highmark Inc.	$32,280,597	526	329,046	63.4%
94	Keystone	$31,448,855	36	3,885	4.1%
95	Delta Dental Plan of Arkansas	$31,426,553	139	—	5.1%
96	Premera Blue Cross	$31,355,102	157	134,522	32.6%
97	Dentegra Insurance Company	$30,653,863	36	—	1.8%
98	Horizon Healthcare Services, Inc.	$29,113,093	220	31,421	48.4%
99	Blue Cross Blue Shield of MS, Inc.	$28,469,991	13	5,282	2.4%
100	Wisconsin Physicians Service Insurance Corporation	$28,443,731	10	3,493	2.5%

Source: DOL Form 5500 Schedule A, plan year 2024; built October 24, 2026. "People covered" counts medical contracts at year end.

Which insurer collects the most employer health-plan premium?

Unitedhealthcare Insurance Company reported the most medical premium in plan year 2024 employer filings, $3.3B covering 3,898,836 people, ahead of Blue Cross Blue Shield of Massachusetts, Inc. ($3.0B).

Why do Blue Cross plans appear separately by state?

Each Blue Cross Blue Shield licensee is a separate insurer that files under its own name, so Massachusetts, Michigan, Illinois and the others rank on their own.

What does the carrier ranking leave out?

Self-funded employers pay claims themselves and usually report only stop-loss or administrative contracts on Schedule A, so the premiums here understate the carriers that administer self-funded plans.