North America Group Health Insurance Market Size, Share & Trends Analysis Report By Plan Type (HMO, PPO, POS, HDHP/SO, Conventional (Indemnity Plans)), By Firm Size (Small Firm, Large Firm), By Country, And Segment Forecasts, 2023 - 2030

Report Overview

The North America group health insurance market size was estimated at USD 1.38 trillion in 2022 and is expected to expand at a compound annual growth rate (CAGR) of 2.3% from 2023 to 2030. Compared to individual health insurance, the market revenue for group health insurance in North America has increased significantly because of growing group health insurance demand and rising insurance premiums collection. Furthermore, in Canada, while government programs cover basic hospital and physician fees for all Canadians, most of them are also covered by extended health care (Ext. health), disability, and other insurance offered by insurers. The majority of these health insurance policies are acquired through a group plan. For instance, according to the 2022 edition of Canadian Life & Health Insurance Facts, group plans accounted for 90% of health insurance purchases in 2021, with premiums totaling C$51.1 billion.

In 2020, the COVID-19 pandemic decreased total employment, which had a detrimental effect on the employer-sponsored insurance market in North America. For instance, the 2021 edition of Canadian Life & Health Insurance Data stated that while health insurance premiums totaled C$47.3 billion in Canada in 2020, including nearly 90% of premiums from group plans, when compared to C$48.3 billion in 2019, showed an approximately 2% year-over-year reduction. Moreover, the 2022 edition of Canadian Life & Health Insurance Data indicated that as the COVID-19 pandemic situation improved, health insurance premiums totaled C$51.1 billion, indicating a recovery in premiums collected during the year.

Furthermore, it is anticipated that the market will be negatively impacted to some extent by the growing peak of inflation. For instance, as mentioned in the Employer Health Benefits Survey 2022 report, although many of the 2022 premium rates didn't have much impact, average premiums are anticipated to increase in 2023 as long as inflation remains above average levels.

Moreover, the adoption of group health insurance and increased awareness of its benefits is anticipated to support the growth of the North America group health insurance market in the forecast period. For instance, in Canada, compared to individual health insurance, where premiums collected accounted for C$4.88 billion, group health insurance accounted for C$46.25 billion premium collection in 2021, showcasing the increased acceptance of group health insurance, resulting in positively supporting the market growth.

Plan Type Insights

Based on plan type, the market is segmented into five types - Preferred provider organization (PPO), High-deductible plan with a savings option (HDHP/SO), Health maintenance organization (HMO), Conventional (also known as indemnity plan), and Point of service (POS) plans. The PPO plan's revenue accounted for the majority of the market share of more than 45% in 2022. Its domination is further aided by PPO plans' rising acceptance in the US. For instance, according to the KFF Employer Health Benefits Survey 2022 report, PPO plans accounted for 49% of the enrollment of insured workers in 2022.

The HDHP/SO plan is anticipated to expand fastest during the forecast period, with a CAGR of 2.7%. One factor influencing the increased acceptance of HDHP/SO plans is their premium cost, which is relatively lower than the PPO plan. For instance, the annual premium for single coverage under a PPO plan in the U.S. is USD 8,092, according to the KFF Workplace Health Benefits Survey 2021 study. However, the HDHP/SO plan premium is relatively less at USD 7,016.

By Firm Size Insights

Based on firm size, the market is segmented into two types - large (employee size more than 200) and small (employee size less than 199 or equal to 199) firms. The large firm segment dominated the market in 2022 and is expected to maintain its dominance throughout the forecast period. Publicly sponsored health insurance is uncommon to cover dental, paramedical, eye, and prescription drug costs (which vary by province and state). As a result, the majority of people could obtain insurance through their employers. This enables companies to utilize employee insurance as one of their attraction and retention strategies. For instance, according to the July 2022 blog post by Third Party Payor (TPP) Simply Benefits, titled "Mandatory Employee Benefits in Canada," over 70% of small businesses provide benefits packages, compared to 90% of large to mid-size businesses. Because the majority of large and medium-sized businesses in North America provide employer-sponsored insurance, this segment held the majority of the revenue share in 2022.

Furthermore, the small firm category is further divided into fully insured plans and self-funded or level-funded plans. In North America, the level-funded plan segment would experience substantial growth during the predicted period. Level-funded plans are becoming more widely accepted in the U.S. and have contributed to the rapid growth increase. For instance, according to the Employer Health Benefits 2021 Annual Survey Report from KFF, 42% of small businesses that provide health benefits offered level coverage.

Country Insights

The U.S. accounted for the majority of the revenue share in North America, with the South region holding the highest portion of the U.S. market in 2022. Furthermore, important insurance plans and a large population covered by group health insurance will support market expansion in the U.S. during the forecast period.

Canada is anticipated to show the fastest expansion during the forecast period, with a CAGR of 2.4%. Its growth is supported by increased revenue-sharing contributions from Quebec (QC) and Ontario (ON) governments. For instance, according to the 2022 edition of Canadian Life & Health Insurance Data, Ontario (ON) contributed C$19007 million in group health premium revenue in 2021, demonstrating a significant revenue contribution compared to other provinces and territories. Furthermore, increased strategic initiatives by Canadian companies, such as providing end-to-end digital health insurance benefits, are aiding the market growth. Simply Benefits, for example, offers entire employee health benefits digitally from start to finish through its Canadian Advisor partners.

Key Companies & Market Share Insights

Key players’ strategic initiatives, such as introducing new products, collaborations, acquisitions, and partnerships with rising businesses, all contribute to market growth. For instance, in August 2020, Livelii launched an inclusionary policy with Manulife, making it the first Canadian firm to give self-employed individuals group health, dental, and life insurance coverage.

Furthermore, in January 2023, Manulife chose Cleveland Clinic Canada as its new Medical Director. This relationship promotes improved health outcomes by assisting Canadians in navigating an often-confusing and highly-stretched healthcare system, thereby assisting the company to strengthen its market presence. Some prominent players in the North America group health insurance market include:

• HEALTH CARE SERVICE CORPORATION

• UNITEDHEALTH GROUP

• KAISER FOUNDATION HEALTH PLAN, INC.

• THE MANUFACTURERS LIFE INSURANCE COMPANY (MANULIFE)

• BLUE CROSS BLUE SHIELD ASSOCIATION

• ANTHEM, INC. (NOW ELEVANCE HEALTH)

• THE IHC GROUP

• CANADA LIFE (FORMERLY GREAT-WEST LIFE)

• HEALTH PARTNERS GROUP LTD

• MISSISSIPPI INSURANCE GROUP, LLC

• PROVIDENCE HEALTH PLAN

• HARVARD PILGRIM HEALTH CARE, INC.

North America Group Health Insurance Market Report Scope     

North America Group Health Insurance Market Report Segmentation

This report forecasts revenue growth at regional & country levels and provides an analysis of the latest industry trends in each of the sub-segments from 2018 to 2030. For the purpose of this study, Grand View Research has segmented the North America group health insurance market report on the basis of plan type, firm size, and country:

• Plan Type Outlook (Revenue, USD Billion, 2018 - 2030)

  • Health Maintenance Organization (HMO)

  • Preferred Provider Organization (PPO)

  • Point Of Service (POS)

  • High-Deductible Health Plans With A Savings Option (HDHP/SO)

  • Conventional (Indemnity Plans)

• Firm Size Outlook (Revenue, USD Billion, 2018 - 2030)

  • Small Firm

    • Self-funded or Level-funded Plan

    • Fully Insured

  • Large Firm

• Country Outlook (Revenue, USD Billion, 2018 - 2030)

  • U.S.

    • Northeast

      • Connecticut

      • Massachusetts

      • Pennsylvania

      • New Jersey

      • New York

      • Others

      • New Hampshire

      • Rhode Island

      • Vermont

      • Maine

    • Midwest

      • Illinois

      • Indiana

      • Michigan

      • Ohio

      • Wisconsin

      • Iowa

      • Kansas

      • Minnesota

      • Missouri

      • Nebraska

      • Others

        • North Dakota

        • South Dakota

    • West

      • Arizona           

      • Colorado         

      • Nevada           

      • Utah    

      • California        

      • Oregon

      • Washington     

      • Others

        • Idaho

        • Montana

        • New Mexico

        • Wyoming

        • Alaska

        • Hawaii

    • South

      • Florida

      • Georgia

      • Maryland

      • North Carolina

      • South Carolina

      • Virginia

      • Alabama

      • Kentucky

      • Tennessee

      • Louisiana

      • Oklahoma

      • Texas

      • Others

        • Delaware

        • West Virginia

        • Mississippi

        • Arkansas 

  • Canada

    • Newfoundland and Labrador (NL)

    • Prince Edward Island (PE)

    • Nova Scotia (NS)

    • New Brunswick (NB)

    • Quebec (QC)

    • Ontario (ON)

    • Manitoba (MB)

    • Saskatchewan (SK)

    • Alberta (AB)

    • British Columbia (BC)

    • Others