2020. In a year of pandemic and social turmoil, Rhode Islanders pulled together to care for and support each other. Their actions inspired all of us at Blue Cross & Blue Shield of Rhode Island (BCBSRI) to play a lead role in helping businesses, members, healthcare providers, and other not-for-profit organizations navigate unprecedented times. We know that the many positive changes we saw last year will carry forward through the future.
There are no adequate words to describe the shock to the system that was 2020. A public health crisis led to an economic crisis. Heightened social unrest sprang from a backlash against longstanding racial injustice in our country. The crises of 2020 did not define Blue Cross & Blue Shield of Rhode Island as a company, however. Rather, we regarded them as an accelerating force for change and a call to action. While our 2020 Annual and Community Report cannot fully capture the impact of these monumental events on Rhode Islanders, what you will find here is cause for hope in a portrait of strength, resilience, and caring.
We saw the pandemic bring out the best in Rhode Islanders. Frontline workers — postal carriers, grocery clerks, pharmacists, delivery drivers, nursing home staff, directors of homeless shelters — and all healthcare professionals — were elevated to hero status, putting their lives on the line.
Blue Cross employees were inspired. They volunteered their time to sew masks and deliver meals with Meals on Wheels. They worked with the Rhode Island Coalition for the Homeless to get necessary supplies to dozens of homeless shelters and service providers across the state to keep people safe and mitigate community spread. Our company provided $25 million in premium relief to members and customers. We served as advisors to the Department of Health and collected and shared relevant data. We waived cost sharing for telehealth visits and for testing, visits, and care related to COVID-19. At the end of the year, we delivered groceries to our most vulnerable Medicare members.
And we reinforced our commitment to comprehensive health and well-being for all Rhode Islanders. Well before the pandemic and economic crisis that followed in its wake starkly underscored the inequities in our state, we had teamed up with the Brown University School of Public Health to address social factors influencing health outcomes, like poverty and structural racism. Armed with data from our RI Life Index confirming that lack of safe and affordable housing was a barrier to Rhode Islanders’ health and well-being, we made significant grants to organizations addressing this issue.
We treasure the trust you have placed in us. Going forward, we pledge to continue earning that trust. In the past year, we have learned valuable lessons about what it means to humbly listen, lead, and serve—as a resource, as a partner, and as a force for positive change. In the coming months, we look forward to welcoming new President and CEO Martha Wofford and starting our next chapter.
Our financial performance in 2020 allowed us to create a premium relief program of almost $30 million for medical and dental customers. We also contributed $10 million to our donor-advised fund at the Rhode Island Foundation, used for philanthropic investments like our BlueAngel Community Health grants focused on safe and affordable housing. The after-tax net gain of $42 million was driven by several factors: strong enrollment, a final installment of a federal tax refund, and lower-than-expected medical claims during the first half of the year as members deferred non-COVID-19-related care.
For the fourth consecutive year, we have shown positive financial results, allowing us to contribute $42 million into reserves, money we set aside for the protection of all our members to pay future claims.
In 2020, statutory reserves that we held for the protection of our members totaled $416 million at year end.
In 2020, we recorded $1.70 billion in premiums from members (individuals and employers). We also recorded an $8.8 million gain on investment revenue.
From total revenue, $1.40 billion was used for medical and dental claims for our members. This amount accounted for 82.2% of premium revenue collected. The company spent $232.2 million (including premium taxes) on expenses to support the core operations of our business, or 13.6% of premiums. An additional $74.3 million was spent on other expenses, including $33.6 million on assessments required by the Affordable Care Act. The company also recorded a $36.3 million offset to expenses for the final installment of the Federal Tax Refund.
Overall, total revenue stood at just over $1.71 billion, and expenses exceeded $1.67 billion in 2020, resulting in a net gain of $42.4 million.
This formulation represents unaudited results utilizing Statutory Accounting Principles. The Blue Cross and Blue Shield Association licenses Blue Cross & Blue Shield of Rhode Island to offer certain products and services under the Blue Cross and Blue Shield brand names. Blue Cross & Blue Shield of Rhode Island is an independent organization governed by its own Board of Directors and solely responsible for its own debts and other obligations. Neither the Association nor any other organization using the Blue Cross and Blue Shield brand names acts as a guarantor of Blue Cross & Blue Shield of Rhode Island’s obligations. A copy of Blue Cross & Blue Shield of Rhode Island’s most recent audited financial statements is available on request to: Blue Cross & Blue Shield of Rhode Island, 500 Exchange Street, Providence, RI 02903.