Ranked by 2023 NPW, health carriers again dominate list of world’s largest insurers

In terms of net premiums written (NPW), health insurance companies continued to dominate in 2023 as four out of the top five were US-based health insurers, with UnitedHealth Group holding on to the top spot for the 10th year in a row with NPW growth of 13%.

Our ranking of the world’s largest insurance companies ranked by NPW and non-banking assets is based on research data from ratings agency AM Best and lists the top 25 insurers by both metrics in 2023.

Starting with the world’s largest insurers based on 2023 NPW, UnitedHealth remains number one with NPW of $291 billion.

In fact, the top four is unchanged from 2022, with Centene Corp in second place with NPW growth of 10% to $150 billion, followed by Elevance Health in third with 7% growth to $143 billion, and then 5% growth at Kaiser Foundation Group of Health Plans to $114 billion. These are all US-based health insurers.

For 2023, China Life Insurance Group moved up one place and took the fifth spot with NPW growth of 5% to $108 billion. US firms Humana and State Farm sit in sixth and seventh place, respectively, with NPW of $101 billion and $93 billion, respectively. This reflects strong growth at the companies in 2023, with Humana growing 16% and State Farm 19%.

Germany’s Allianz sits in eighth position in 2023 as the large insurer did in 2022, and this is despite a decline in NPW of 5% to $90 billion. In contrast, Berkshire Hathaway recorded strong NPW growth of 12% in 2023 to $85 billion, which took the re/insurer to ninth place compared with 13th in 2022. French insurer AXA completes the top 10 with NPW of $77 billion, although the insurer did drop three places from 2022 with NPW contraction of 20%.

Out of the top 25, Italian insurer Generali experienced the largest contraction in NPW year-on-year of 40% to $51 billion, which saw the firm drop from 12th in the ranking in 2022 to 18th in 2023. The strongest growth came from Japan’s Nippon Life Insurance, which at 22% took the firm’s NPW to $49 billion for 2023, putting the carrier 20th on the list when it did not feature in 2022.

In terms of 2023 non-banking assets, Allianz tops the list for the fifth consecutive year, with growth of 5% to $1.09 trillion. Out of the top 25, Berkshire Hathaway grew its non-banking assets the second most in 2023, by a robust 13% to $1.07 trillion, moving the company up one place to second on the list. Similarly, China Life Insurance moved from fourth in 2022 to third in 2023 with non-banking assets of $958 billion on the back of 11% growth.

China’s Ping An Insurance fell two places to fourth in the ranking for 2023 despite 5% growth to $848 billion, while US-based Prudential Financial moved from sixth to fifth place with growth of 5% to $721 billion.

France’s AXA sits in sixth place for 2023 with non-banking assets of $711 billion amid growth of 1%, followed by MetLife in seventh place, the same as in 2022, with growth of 4% to $688 billion, and then the UK’s L&G in eighth position for 2023 with non-banking assets of $665 billion after growth of 2%. Manulife sits in ninth place for the second year running with 5% growth to $661 billion, followed by Nippon Life Insurance in 10th with growth of 11% to $645 billion.

Life Insurance Corporation of India actually grew its non-banking assets the most in the year, by more than 16% to $634 billion. On the other end of the spectrum, Japan Post Insurance saw its non-banking assets contract by almost 3% to $402 billion, which saw the firm drop down to 19th on the list from 16th in 2022.

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