Harvard Pilgrim Health Care, one of the largest providers of health insurance in Maine, plans to merge with competitor Tufts Health Plan.

Both Harvard Pilgrim and Tufts Health are based in Massachusetts and serve that state, as well as New Hampshire and Rhode Island. Harvard Pilgrim also operates in Maine and Connecticut.

The combined entity, which is yet to be named, would serve nearly 2.4 million members in Massachusetts, Maine, Connecticut, New Hampshire and Rhode Island, offering employer-sponsored plans, Medicare and Medicaid plans, Affordable Care Act plans, and plans for those who are eligible for both Medicare and Medicaid, the organizations said in a news release.

Michael Carson, president and CEO of Harvard Pilgrim Health Care Courtesy Harvard Pilgrim Health Care

The board of directors would comprise equal representation from both organizations and would be chaired by Joyce Murphy, who currently serves as chair of the board for Harvard Pilgrim, they said. Tom Croswell, president and CEO of Tufts Health, would serve as CEO of the new organization. Michael Carson, who serves as president and CEO of Harvard Pilgrim, would serve as president.

“Through the combination of two strong organizations with a commitment to non-profit health care in New England, we will be able to provide even greater value to consumers, as well as improve access to care throughout the region,” Murphy said in the release.

The merger agreement, which was unanimously approved by both boards, is subject to multiple local and federal regulatory approvals, during with time both entities said they would continue to operate independently.

According to the Maine Bureau of Insurance, Harvard Pilgrim had 234,125 individual and group policyholders in Maine as of March 31, including 7,755 Medicare policyholders. It is one of only three insurers in the state that offers individual plans on the Affordable Care Act marketplace.

In July, all three insurers reduced their average rate requests for ACA individual plans in 2020. Lewiston-based Community Health Options went from a 7.7 percent increase to a 0.8 percent increase; Harvard Pilgrim from a 1.9 percent increase to a 7 percent decrease; and South Portland-based Anthem from a 1 percent increase to a 2 percent decrease. In recent years, the insurers have requested annual increases of up to 40 percent.

In its statement, the two organizations said a merger would allow them to deliver more affordable health plans to consumers through administrative savings and efficiencies of scale.


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