The 18 percent pay raise for the insurer's top brass comes as Blue Cross and Blue Shield of North Carolina's profit and membership continues to grow.

Blue Cross, the state's largest health insurer, came under fire last year for its increasing rates, its high profits and corporate spending on trips to the Caribbean and the U.S. Open. Last week, it reported that its profit increased 7.5 percent to $167.6 million in 2005.

Blue Cross says the profits are necessary for its financial stability and are good not only for its members, but for the state as a whole.

But the salary increases are likely to add more fuel to consumers' ire.

Because Blue Cross is classified as nonprofit and insures more North Carolinians than any other company, "it's just kind of hard to swallow when you see the compensation," said Kristin Runger, a spokeswoman for the Department of Insurance. Blue Cross files information on executive pay as part of its annual report to state regulators.

Combined with Blue Cross' profits, the raises certainly make B.H. Ross mad.

The retired real estate agent pays $241.50 each month for Blue Cross Medicare supplemental policies for himself and his wife, and their premiums recently increased 4.5 percent. Blue Cross' premiums went up about 8 percent last year and the insurer expects to quote rate increases of about 11 percent to 13 percent this year.

"I'm really PO'ed with Blue Cross because they're plum taking advantage of the senior citizens, of the public, as far as I'm concerned," Ross said. "They give them [executives] another pay raise, still make that tremendous profit and they're not doing anything about premiums."

Blue Cross' business is so large that its executive salaries and profits have fairly insignificant effects on premiums, spokesman Mark Stinneford said. Blue Cross had revenue of $3.8 billion last year and its membership grew to 3.3 million North Carolinians.

"If we made no profit and the executives received no salary, it would make little or no difference in what customers are paying in premiums, which are largely driven by the cost of providing health care," he said.

Consumer advocate Adam Searing realizes the scale of the business means any cash benefits to consumers would be small. "But you have to think, for a nonprofit, where does it end?" he asked.

Financial results are one of several factors that go into setting executive compensation, Stinneford said. The company also considers corporate goals such as membership growth and technology improvements. Pay for Blue Cross' 4,000 employees across North Carolina also is based partially on the company's success at achieving those goals.

The insurer also increased executive compensation last year to bring it closer to the average of more than a dozen similar for-profit and nonprofit insurers across the country, Stinneford said. A 2005 study showed that Blue Cross' executive compensation "was significantly below the market average for comparable companies," he said.

Greczyn received $2.2 million in total compensation in 2004. Last year, his salary was $767,727 and he received a bonus of $1.7 million.

His compensation falls between that of the CEOs of Blue Cross' national for-profit competitors and those companies' leaders in North Carolina.

Aetna CEO John Rowe had total compensation of $30.6 million and Cigna CEO H. Edward Hanway received $12.3 million. That includes millions of dollars in stock compensation. Meanwhile, the president of Cigna HealthCare of North Carolina made a total of $279,526 last year.

Pay for Blue Cross' top 10 executives has increased 25 percent since 2003. The only other Blue Cross executive to have more than $1 million in total compensation was Senior Vice President James Broderick, who received $1.2 million. General counsel Maureen O'Connor had the lowest compensation at $484,397.

As executive pay rises, health costs are cutting into consumers' wages, said Searing, who is the executive director of the N.C. Health Access Coalition.

"Many people got a pay cut because their health insurance went up so much that they were making less than they were the year before," he said. "A lot of those people pay their money to Blue Cross."