Banner Health Insurance Group Inc

What it reported doing in 2024

Banner Health Insurance Group ("BHIG") operates exclusively to promote social welfare purposes within the meaning of Section 501(c)(4) of the Internal Revenue and is organized as a Medicare-only preferred provider organization (PPO) to serve Medicare beneficiaries through a Medicare-only Medicare Advantage Part D (MAPD) Plan. BHIG's sole shareholder is Banner Health Insurance Companies, LLC (BHIC), which is disregarded for federal tax purposes as a single-member LLC of Banner Health, a tax-exempt hospital system under Section 501(c)(3). Banner Health is one of the nation's largest nonprofit health care systems, and the leading tax-exempt provider of hospital services in every community it serves and, in some cases, the only inpatient facility available in some of those rural and/or medically underserved communities. BHIG is integrated into Banner's continuum of care for Banner Health patients, thereby strengthening its ability to care for those patients and promote community health. BHIG embraces and seeks to further Banner Health's mission of making health care easier, so life can be better and leverages Banner Health's vast Arizona managed care expertise to improve its elderly members' access to care and quality of care. Care and coverage are part of Banner Health's vertically integrated system and the cornerstone of BHIG which is designed to promote more efficient and effective care coordination and provision. Formed in 2019, BHIG's health plan is based in Arizona and serves only Arizona counties All counties included in BHIG's service areas - Maricopa, Pima, Pinal, Santa Cruz, and Yuma - are designated as medically underserved areas by the Health Resources and Services Administration (HRSA). BHIG is the only MAPD health plan in Arizona that can offer a fully integrated continuum of care and coverage. In its service area, it is unique in its ability to integrate provider care and operate under the umbrella of a tax-exempt health system. Under BHIG, members receive both quality health care and comprehensive insurance coverage including prescription drug coverage in a single plan. Through Banner Health, BHIG offers its members a choice of 5000+ providers, 17 Arizona hospitals, and three renowned academic medical centers. BHIG offers several programs to improve member health care, including a medical management program, care management program, and condition management program. In addition, BHIG coordinates member health plan benefits including emergency services and emergency inpatient care, inpatient care, primary care, specialty care, diagnostic and therapeutic ancillary care services, outpatient care, preventive care and emergency ambulance services. BHIG's member experience is further differentiated by allowing over the counter health products, hearing aids, annual eye exams, telehealth visits, meals, free virtual waiting rooms, and behavioral-based smart phone apps that allow BHIG to reach its members in a creative and integrated way, meeting both the physical and behavioral health needs of its members. BHIG provides each member a personalized health navigator to further develop the integrated experience and meet the member's health needs. The health navigator is a trusted steward to help members with their health goals and needs including: - Assisting with doctors' appointments or member provider selection - Assisting with home health orders, home medical equipment or filling medications - Discharge navigation and care coordination - Connection with member health or social needs BHIG also provides additional member resources including: - Certified health coach and/or registered dietitian - Works with the member on health goals - Dial into Diabetes - Evidence-based and individualized education and support for diabetics - Advance Care Planning - Social workers help with advance care planning and completing advanced directives - Nurse Now - 24 hour/365-day hotline for registered nurse support. - Fall Risk Reduction Program

Financial Efficiency

• Mission deployment rate: 78.8%; rating input score 79
• Program expense ratio: 56%; rating input score 56
• Fundraising efficiency: Limited

Transparency & Controls

• Consistency checks: 92.3%; rating input score 92; 10th percentile among comparable filings
• Pay-setting controls: 1 of 6 controls in place; rating input score 17
  • Compensation committee: Missing
  • Independent consultant: Missing
  • Other Form 990s reviewed: Missing
  • Written employment contract: Missing
  • Compensation survey or study: Missing
  • Board or committee approval: Pass
• Foreign activity oversight: Limited
• Grant itemization coverage: Limited
• Major donor itemization: Limited
• Related-party transparency: Limited

Accountability

• Independent voting board: 0%; rating input score 0; 3rd percentile among comparable filings
• Governance controls: 5 of 9 controls in place; rating input score 56
  • Conflict-of-interest policy: Pass
  • Whistleblower policy: Pass
  • Document-retention policy: Fail
  • CEO compensation review process: Fail
  • Other executive compensation review process: Fail
  • Form 990 shared with the board: Fail
  • Board meeting minutes documented: Pass
  • Audit committee oversight: Pass
  • Independent financial-statement audit: Pass

Sustainability

• Operating margin: -40.2%; rating input score 3; 3rd percentile among comparable filings
• Total-asset coverage ratio: 3.8; rating input score 79; 79th percentile among comparable filings
• Liabilities to assets ratio: 0.6; rating input score 17; 17th percentile among comparable filings
• Officer compensation ratio: 71.8%; rating input score 0; 0th percentile among comparable filings

Growth

• Program expense growth: -50.9% per year; rating input score 0; 0th percentile among comparable filings
• Revenue growth: -23.9% per year; rating input score 0; 1st percentile among comparable filings
• Asset growth: 27% per year; rating input score 100; 91st percentile among comparable filings