Two health insurers that do big business in other markets are stepping up their efforts in the region.

United Healthcare has relocated its Downtown office to the North Side and is hiring staff to sell health insurance policies locally. Meanwhile, Cigna HealthCare is continuing efforts to create a network of doctors and hospitals beyond 14 counties where it currently operates in Western Pennsylvania.

United Healthcare, part of Minneapolis-based United Health Group, insurers about 45,000 people in the six-county Pittsburgh area, although many of those people are covered through the company's national accounts. The company is actively courting local employers.

Pennsylvania and Delaware were the last two states in the country where United lacked a complete sales presence, said Tom Knox, chief executive officer for Philadelphia-based United Healthcare of Pennsylvania. That's changed during the last two years, primarily because of acquisitions.

Cigna has been marketing health insurance in the region for several years, and insures 95,000 in the region, said spokeswoman Patty Caballero. The company is working to create a network in Indiana, Cambria, Blair and Somerset counties, she said.

United Healthcare and Cigna are not the first companies to challenge the local dominance of Highmark Blue Cross Blue Shield. UPMC Health Plan, Health America and Aetna Inc. are among the largest other commercial health plans in Pittsburgh.

Knox, the United Healthcare official, estimated that Highmark -- which insured 2.8 million Western Pennsylvanians last year -- garners more than 60 percent of the region's health insurance market.