NAICS 524114 - Direct Health and Medical Insurance Carriers
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What is NAICS 524114
NAICS code 524114 encompasses establishments primarily engaged in initially underwriting health and medical insurance policies, including group hospitalization plans and Health Maintenance Organizations (HMOs) that offer insurance coverage without directly providing health care services. These businesses assume the risk associated with health insurance policies and determine premiums accordingly. Companies operating in this sector play a critical role in managing financial risk for individuals and organizations by providing access to health insurance products that help cover medical expenses. Government agencies contract with these entities to provide health insurance coverage for federal employees, veterans, military personnel, and other eligible populations. The sector is vital for ensuring that comprehensive health insurance solutions are available to support public health objectives and employee welfare programs. The underwriting process and risk management expertise offered by these carriers enable government buyers to deliver cost-effective and reliable insurance benefits while maintaining compliance with regulatory requirements.
Industry Classification for NAICS 524114
This U.S. industry comprises establishments primarily engaged in initially underwriting (i.e., assuming the risk and assigning premiums) health and medical insurance policies. Group hospitalization plans and HMO establishments that provide health and medical insurance policies without providing health care services are included in this industry.
Breakdown for NAICS 524114
- Primarily involves underwriting health and medical insurance policies including group and individual plans.
- Includes Health Maintenance Organizations (HMOs) that provide insurance without direct healthcare services.
- Businesses assume risk and assign premiums for health insurance coverage.
- Typical contract sizes range from mid-level to multi-million dollar government agreements.
- Supports federal and state government employee health benefits programs.
- Requires compliance with federal healthcare laws and regulations.
Included Activities for NAICS 524114
- Underwriting health and medical insurance policies and plans.
- Setting premiums based on risk assessment and actuarial analysis.
- Managing group hospitalization and HMO insurance contracts.
- Providing risk management and financial analysis for insurance products.
- Supporting compliance with healthcare regulations such as the ACA.
- Collaborating with government agencies on employee health insurance programs.
- Administering enrollment and eligibility services related to insurance plans.
- Analyzing claims data to adjust risk models and pricing.
Business Types for NAICS 524114
- Health insurance underwriters
- Health Maintenance Organizations (HMOs)
- Group hospitalization insurance carriers
- Specialized health insurance providers
- Actuarial consulting firms focused on health insurance
- Regional and national health insurance companies
Subcategories for NAICS 524114
- Dental insurance carriers, direct
- Group hospitalization plans without providing health care services
- Health insurance carriers, direct
- Hospital and medical service plans, direct, without providing health care services
- Hospitalization insurance carriers, direct, without providing health care services
- Insurance carriers, health, direct
- Insurance underwriting, health and medical, direct
- Medical insurance carriers, direct
- Medical service plans without providing health care services
Government Buyers for NAICS 524114
Federal government agencies such as the Office of Personnel Management (OPM), Department of Veterans Affairs (VA), and Department of Defense (DoD) are the primary purchasers of these health and medical insurance underwriting services. These agencies require comprehensive insurance plans to cover federal employees, military members, veterans, and their families. Additionally, state and local government entities may contract for group health insurance coverage for their workforce. These buyers seek carriers that can offer competitive premiums, manage risk effectively, and ensure compliance with healthcare regulations, including the Affordable Care Act. Reliable health insurance underwriting services help government agencies control costs and provide essential benefits that promote workforce health and morale.
Contract Types & Procurement for NAICS 524114
Contracts for NAICS 524114 typically include firm-fixed-price and performance-based agreements, often awarded through competitive bidding or negotiated procurements. Blanket purchase agreements (BPAs) and indefinite delivery/indefinite quantity (IDIQ) contracts are common to provide ongoing access to underwriting services. Contract values can vary widely based on the scope of covered populations and insurance plan complexity, ranging from hundreds of thousands to multi-million-dollar agreements. Agencies prioritize carriers with demonstrated financial stability, actuarial expertise, and compliance with federal healthcare standards. Requests for proposals (RFPs) and solicitations frequently emphasize risk management capabilities, customer service, and technology infrastructure supporting enrollment and claims processing.
Details for NAICS 524114
Explore the hierarchy and related codes for this industry
| NAICS Code | Industry Title |
|---|---|
| 52411 | Direct Life, Health, and Medical Insurance Carriers |
| 5241 | Insurance Carriers |
| 524 | Insurance Carriers and Related Activities |
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