2016 Supplemental Health Care Exhibit Report...Market share data are based on premiums earned...

2016 Supplemental Health Care Exhibit Report

VOLUME I

September 2017

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2016 Supplemental Health Care Exhibit Report Volume I

TABLE OF CONTENTS

INTRODUCTION..........................................................................................................................1 Aggregation and Calculation of Data ..............................................................................................1 Report Format ..................................................................................................................................1 Definitions........................................................................................................................................4 Qualifications ...................................................................................................................................6 Coverage Allocation Charts .............................................................................................................9

AGGREGATED ANNUAL STATEMENT DATA Part 1 Countrywide .................................................................................................................10 Part 1 by State .........................................................................................................................16 Part 2 Countrywide ...............................................................................................................307 Part 2 by State .......................................................................................................................311 Part 3 Countrywide ...............................................................................................................486 Part 3 by State .......................................................................................................................493

COMPREHENSIVE HEALTH COVERAGE – INDIVIDUAL Market Share Countrywide by Number of Covered Lives ...................................................838 Market Share Countrywide by Health Premium Earned ......................................................853 Market Share by State ............................................................................................................868 Top 10 Groups/Companies by State by Health Premium Earned..........................................940

© 2017 National Association of Insurance Commissioners

Supplemental Health Care Exhibit Report

INTRODUCTION

The passage of the federal Patient Protection and Affordable Care Act (PPACA) led to the development of the Supplemental Health Care Exhibit. The report provides more granular financial information by health plan, so that regulators and policymakers will be able to better evaluate health plan profitability. The purpose of the Supplemental Health Care Exhibit Report is to provide state and federal regulators with aggregated data, as well as market share data. The supplemental exhibit is intended to assist state and federal regulators in identifying and defining elements that make up the medical loss ratio (MLR). The report is also intended to track and compare financial results of health care business as reported in the annual financial statements. Thus, the numbers included in this supplemental exhibit are not the exact numbers that will be utilized for rebate purposes due to possible revisions for claim reserve run-off subsequent to year-end, statistical credibility concerns and other defined adjustments.

Aggregation and Calculation of Data

This report utilizes the term “aggregated” to describe data developed by summing the annual statements of individual companies. In order to represent more completely the data as reported on the annual statements, all data are aggregated directly from the numbers reported to the NAIC. The Supplemental Health Care Exhibit is included in the following NAIC annual statement blanks: property/casualty; life, accident & health; health; and fraternal.

The Preliminary MLR and Claims Adjustment Expense Ratio in the Aggregated Annual Statement Data section of this publication are calculated by aggregating each component of the ratio and then calculating the ratio as defined in the Supplemental Health Care Exhibit. The ratio results are shown in the same format as reported in the exhibit.

Report Format

This report contains the following sections:

Aggregated Annual Statement Data • This section reflects data reported in the Supplemental Health Care Exhibit on an

aggregated basis for the three Comprehensive Health Coverage columns (Individual,Small Group Employer, and Large Group Employer), the Mini-Med Plans (Individual,Small Group Employer, and Group Large Employer), Expatriate Plans (Small Group andLarge Group) and Student Health Plans.

© 2017 National Association of Insurance Commissioners 1

Comprehensive Health Coverage – Individual • This section contains Individual Comprehensive Health Coverage market share data.

Market share data are based on premiums earned reported in the Supplemental Health Care Exhibit. This allows the report to contain a more complete view of the market share information.

o Market Share by Legal Entity by Number of Covered Lives – This section includes a total market share by legal entity by number of covered lives, both nationwide and by state. Nationwide – Top 100 By State

o Market Share by Legal Entity by Health Premium Earned – This section includes a total market share by legal entity by premium earned, both nationwide and by state. Nationwide – Top 100 By State

o Market Share by Top 10 Groups/Companies by State by Health Premium Earned – This section includes a total market share, across all of the states, for the top 10 groups/companies. Insurance groups are made up of insurance companies that are related by common ownership. The market share reports show data by group for those insurers that are a member of a group.

Comprehensive Health Coverage – Small Group Employer • This section contains Small Group Employer Comprehensive Health Coverage market

share data. o Market Share by Legal Entity by Number of Covered Lives

Nationwide – Top 100 By State

o Market Share by Legal Entity by Health Premium Earned Nationwide – Top 100 By State

o Market Share by Top 10 Groups/Companies by State by Health Premium Earned Comprehensive Health Coverage – Large Group Employer • This section contains Large Group Employer Comprehensive Health Coverage market

share data. o Market Share by Legal Entity by Number of Covered Lives



o Market Share by Top 10 Groups/Companies by State by Health Premium Earned


Mini-Med Plans – Individual • This section contains Individual Mini-Med Plans market share data.

o Market Share by Legal Entity by Number of Covered Lives Nationwide – Top 100 By State



Mini-Med Plans – Small Group Employer • This section contains Small Group Employer Mini-Med Plans market share data




Mini-Med Plans – Large Group Employer • This section contains Large Group Employer Mini-Med Plans market share data




Expatriate Plans – Small Group • This section contains Small Group Expatriate Plan Health Coverage market share data.




Expatriate Plans – Large Group • This section contains Large Group Expatriate Plan Health Coverage market share data.


o Market Share by Legal Entity by Health Premium Earned




Student Health Plans • This section contains Student Health Plan Coverage market share data.




Company Index An index listing the insurer groups and individual companies included in the insurance groups reported in this publication has been added at the end of the report. Insurers continuously merge, change names, and buy and sell companies; however, the index gives a “snapshot” view of group structures as filed with the NAIC by the date this report was generated.

Definitions

The health insurance industry is broad and not all terminology carries the same definition. To avoid ambiguity and to help ensure this report is not misunderstood, some definitions have been provided. For more definitions within the Supplemental Health Care Exhibit, please use the NAIC Annual Statement Instructions (for property/casualty; life, accident & health; health; or fraternal).

Small Group Employer – Small group health plan means a health plan offered in the small group market as such term is defined in state law in accordance with the federal Public Health Service Act (PHSA). The Protecting Affordable Coverage for Employees Act as Public Law 114-36 (PACE Act) amended section 1304(b) of the ACA and section 2791(e) of PHSA on October 7, 2015, to revise the definition of small employer for the purposes of the market reforms under title I of the Affordable Care Act and title XXVII of the Public Health Service Act. In general, the PACE Act defines a small employer as an employer that employed an average of 1-50 employees on business days during the preceding calendar year. However, it provides States the option of extending the definition of small employer to include employers with up to 100 employees. States that elected to extend the small employer definition to up to 100 employees for coverage effective January 1, 2016, were requested to notify CMS of their election by October 30, 2015. States that elected to extend the small employer definition with another coverage effective date were requested to notify CMS as soon as soon as practicable. If a State made this election, the definition of small employer must have been applied uniformly to all health insurance issuers in the State, including those in the Small Business Health Options Program (SHOP). This definition of small group applies to the Comprehensive and Mini-Med coverage definitions for small group below.

Large Group Employer – Groups that do not fall under the definition of Small Group Employer under state law in accordance with PHSA, ACA, and PACE Act; i.e. the number of employees is


above the definition of small group employers as defined by state law in accordance with PHSA, ACA, and the PACE Act.

Health Premium Earned – Direct written premium plus the change in unearned premium reserves and the change in reserve for rate credits. Premiums earned on novated policies and on 100% assumption reinsurance where policyholders have consented (via opt-in or failure to opt-out) to the replacement of the original policy issuer (including cases where full servicing of premiums and claims have been transferred) by the assuming reinsurer.

Preliminary Medical Loss Ratio – Add Deductible Fraud and Abuse Detection/Recovery Expenses, Total Incurred Claims, and Total of Defined Expenses Incurred for Improving Health Care Quality, then divide by Adjusted Premiums Earned.

Comprehensive Health Coverage – Individual – A health insurance option whereas the policy is issued to an individual to cover the individual and/or their dependents in the individual market. This includes conversions from group policies.

Comprehensive Health Coverage – Small Group Employer – All policies issued to Small Group Employers. Includes small group health plans. Small group health plan means a health plan offered in the small group market as such term is defined in state law in accordance with the federal Public Health Service Act (PHSA).

Comprehensive Health Coverage – Large Group Employer – All policies issued to Large Group Employers (including the Federal Employees Health Benefit Plan (FEHBP), TRICARE plans, and similar fully insured state and local programs).

“Mini-Med” Plans, also referred to as “limited benefit indemnity health insurance plans,” include all policies that have a total annual limit of $250,000 or less. The definition of individual, small group employer and large group employer is the same definition as used for Comprehensive Health Coverage above.

Mini-Med Plans – Individual – A health insurance option whereas the policy is issued to an individual to cover the individual and/or their dependents in the individual market. This includes conversions from group policies.

Mini-Med Plans – Small Group Employer – All policies issued to Small Group Employers. Includes small group health plans. Small group health plan means a health plan offered in the small group market as such term is defined in state law in accordance with the federal Public Health Service Act (PHSA).

Mini-Med Plans – Large Group Employer – All policies issued to Large Group Employers (including the Federal Employees Health Benefit Plan (FEHBP) and similar fully insured state and local programs). Large group employer as defined for Comprehensive Health Coverage-Large Employer.


“Expatriate” Plans include policies referenced in Section 158.120(d)(4) of the MLR Interim Final Rule as policies that provide coverage for employees, substantially all of whom are: working outside their country of citizenship; working outside of their country of citizenship and outside the employer’s country of domicile; or non-U.S. citizens working in their home country.

Expatriate Plans – Small Group – All policies issued to small group employers that provide coverage for employees as defined as “Expatriate” above. These policies can be reported on a nationwide, aggregated basis, in the small group column. The amounts should be reported on the appropriate domiciliary state page.

Expatriate Plans – Large Group – All policies issued to large group employers that provide coverage for employees as defined as “Expatriate” above. These policies can be reported on a nationwide, aggregated basis, in the large group column. The amounts should be reported on the appropriate domiciliary state page.

Student Health Plans – A type of individual health insurance coverage that is provided pursuant to a written agreement between an institution of higher education and a health carrier and provided to students enrolled in that institution of higher education and their dependents.

Qualifications

The accuracy of the reports included in this publication depends on the accuracy of the information contained in the Supplemental Health Care Exhibits filed by insurers. Even though the data elements used to prepare the reports are extracted from exhibits filed with the NAIC, the NAIC cannot verify or guarantee the accuracy of every data element.

While the NAIC exercises a great deal of care in capturing data from the annual financial statements and producing various reports, as with any statistical project of a significant magnitude, errors can occur. Consequently, the NAIC makes no representations or warranties with respect to the accuracy of the data and statistics in this report.

Filing Requirements of the Supplemental Health Care Exhibit, as per the Annual Statement Instructions

A schedule must be prepared and submitted for each jurisdiction in which the company has written direct comprehensive major medical health business, or has direct amounts paid, incurred or unpaid for provisions of health care services. In addition, a schedule must be prepared and submitted that contains the grand total (GT) for the company. However, insurers that have no business that would be included in Part 1, Column 1 through Column 9 for ANY of the states are not required to complete this supplement at all. If an insurer is required to file the supplement, then the insurer must complete Part 1 and Part 2 for each state in which the insurer has any health business, even if a particular state will show $0 business reported in Part 1, Column 1 through Column 9 (see the 2% instruction below). Also, Part 3 must be completed for any state in which there are non-zero amounts in Part 1, Column 1 through Column 9.


Run-Off and Reinsurance Business

Similarly, insurers in run-off (major medical claims incurred with zero major medical earned premiums) or that only has assumed and no direct written major medical business in any of the states are not required to complete this supplement. However, 100% assumption reinsurance with novation (or 100% indemnity reinsurance for administration of a block of business entered into prior to March 23, 2010 – see HHS Reg. 158.130 (a)(3)) is treated as direct business for purposes of this supplement (included as direct business for the assuming reinsurer and excluded from direct business for the ceding insurer). Otherwise, the reinsurance data required in this supplement is only for use if an insurer writes direct major medical business and also assumes and/or cedes such insurance. If an insurer has direct earned premiums to include in Columns 1 through 9 or 12 of Part 1, but also has some business in run off (major medical claims incurred for 2016 policy year and prior, with zero major medical earned premiums or no coverage in place), the run-off claims and expenses results should be reported in Part 1, Columns 1 through 9 or 12. (If an insurer files the supplement and has a state in which the only Columns 1 through 9 or 12 business is run-off business as defined above, the insurer can report the run-off business for that state as if it was other health business; i.e., because the MLR is meaningless for that state, report zero for Columns 1 through 9 or 12 and include the run-off business along with any other health insurance reported in the Other Health Business columns of Parts 1 and 2.)

The allocation of premium and claims between jurisdictions should be based upon situs of the contract. For purpose of this exhibit, situs of the contract is defined as “the jurisdiction in which the contract is issued or delivered as stated in the contract.” For individual business sold through an association, the allocation shall be based on the issue state of the certificate of coverage. When the association is made up of employers, it should be reported as large group or small group depending on the size of each employer. For employer business issued through a group trust, the allocation shall be based on the location of each employer. For employer business issued through a multiple employer welfare association the allocation should be based on the location of each employer. Include only in this schedule the business issued by this reporting entity. Business that is written by an unaffiliated entity as part of a package provided to the consumer (e.g., inpatient written by this legal entity, outpatient written by unaffiliated separate entity) should not be included in this exhibit. Similarly, business written by an affiliated legal entity as part of a package provided as an option to the group employer (e.g., out of network coverage written by an affiliated entity and in network coverage written via this legal entity) should not be included in this exhibit. Comprehensive health coverage, Columns 1 through 3, includes business that provides for medical coverages including hospital, surgical and major medical. Include risk contracts and Federal Employees Health Benefit Plan (FEHBP), stand-alone plan and any other comprehensive plan addressed in PPACA and not excluded. Exclude mini-med plans, expatriate plans and student health plans, as these are reported in Columns 4 through 9. Stand-alone plans (e.g., stand-alone pharmacy)


excluding Medicare Part D stand-alone addressed in PPACA and not excluded should be reported in the appropriate column that corresponds to the details of the plan. Do not include business specifically identified in other columns (e.g., uninsured business, Medicare Title XVIII, Medicaid Title XIX, vision only, dental only business, Insurance Program (SCHIP), Medicaid Program Title XXI risk contracts and short-term limited duration insurance). Stop-loss coverage for self-insured groups should be reported in Part 1, Column 11 (Other Health Business).. Other Qualifications Please Note: This only includes insurers that are required to file to the NAIC. This data is not supplemented with health premium information from health insurers that are exempt from filing to the NAIC. For example, some insurers are regulated by the California Department of Managed Health Care, which does not provide data in this level of detail. Further, ERISA plans exempt from state-based insurance regulation are not included. The data may not match data in other publications or exhibits of the NAIC because the Supplemental Health Care Exhibit has a specific purpose, as stated above. Any questions about the report may be referred to Bill Rivers (NAIC) at (816) 783-8142 or Jane Koenigsman (NAIC) at (816) 783-8145. Additional copies can be obtained from an NAIC representative at:

NAIC Central Office 1100 Walnut Street, Suite 1500 Kansas City, MO 64106-2197

Telephone: (816) 783-8300 Email: [email protected]


mailto:[email protected]

Supplemental Health Care Exhibit

Individual 26%

Small Group Employer

11%

Large Group Employer

63%

Number of Covered Lives

Individual9%

Small Group Employer

13%

Large Group Employer

78%

Health Premiums Earned



Aggregated Annual Statement Data

Part I Countrywide


SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 FOR 2016Aggregated Totals Nationwide

EmployerLarge Group

EmployerSmall Group

Individual

Comprehensive Health Coverage

Individual EmployerSmall Group

EmployerLarge Group Small

Group

Mini-Med Plans

Business Subject to MLR

(Includes States and U. S. Territories)

Expatriate Plans

GroupLarge

PlansHealth

Student

1. Premium:

66,103,946,932

1.1 Health premiums earned (from Part 2, Line 1.11)

172,143,343,25664,363,295,394 33,641,073 14,134 2,052,68210,892,175 1,099,016,290 2,042,137,780

-3,563,714

1.2 Federal high risk pools

1,89514,908 0 0 00 0 0

-3,390,648

1.3 State high risk pools

-27,817,422-19,859,619 43,472 0 066 -469 -249,219

66,096,992,560

1.4 Premiums earned including state and federal high risk programs

172,115,527,73164,343,450,678 33,684,546 14,134 2,052,68210,892,241 1,099,015,821 2,041,888,561

712,384,664

1.5 Federal taxes and federal assessments

5,454,981,6712,458,588,776 475,568 -34,227 0515,878 13,686,457 91,191,573

899,092,506

1.6 State insurance, premium and other taxes

2,091,701,9081,036,618,237 632,660 1,127 59,921186,595 6,357,885 36,562,250

18,884,352

1.6a Community benefit expenditures (informational only)

177,959,23220,695,806 0 0 00 0 214,146

512,475,997

1.7 Regulatory authority licenses and fees

329,411,784129,912,103 561,701 7 1,60834,156 627,602 5,475,023

63,973,038,416

1.8 Adjusted premiums earned (Lines 1.4 - 1.5 - 1.6 - 1.7)

164,239,422,27460,718,331,560 32,014,617 47,225 1,991,15310,155,611 1,078,343,878 1,908,659,712

-831,641,036

1.9 Net assumed less ceded reinsurance premiums earned

-6,338,602,889-1,813,934,178 -68,535 0 -1,781,188-2,023 -719,143,381 -138,912,058

77,813,590

1.10 Other adjustments due to MLR calculations - premiums

25,977,95727,813,931 0 0 00 20,959 -550,000

6,801,029

1.11 Risk revenue

1,786,129655,039 158,797 0 00 0 0

63,226,011,990

1.12 Net adjusted premiums earned after reinsurance (Lines 1.8+1.9+1.10+1.11)

157,928,583,47058,932,866,349 32,104,879 47,225 209,96510,153,588 359,221,457 1,769,197,653



EmployerLarge Group

EmployerSmall Group

Individual




Group

Mini-Med Plans



Expatriate Plans

GroupLarge

PlansHealth

Student

2. Claims:

51,335,382,783

2.1 Incurred claims excluding prescription drugs

120,310,565,70041,970,271,535 25,741,390 -26,816 1,214,4314,586,701 659,774,983 1,402,141,196

13,917,818,531

2.2 Prescription drugs

31,069,099,39811,597,639,299 7,003 143,482 26,71669,090 81,914,602 277,757,202

1,829,982,201

2.3 Pharmaceutical rebates

4,606,214,0981,920,936,365 1,453 0 0-30 13,072,556 32,374,421

124,652,440

2.4 State stop loss, market stabilization and claim/census based assessments (informational only)

43,023,00269,012,379 918 0 0-512 129,382 -3,306,561

195,232,605

3. Incurred medical incentive pools and bonuses

716,031,978230,237,233 145 0 00 14,099 721,911

16,872,446

4. Deductible Fraud and Abuse Detection Recovery Expense (for MLR use only)

30,598,02614,519,920 0 0 00 0 47,383

63,621,760,935

5. Total incurred claims (Lines 2.1 + 2.2 - 2.3 - 2.4 + 3)

147,486,074,66751,877,310,378 25,747,086 116,665 1,241,1474,655,822 728,631,126 1,648,245,888

-3,504,405,027

5.1 Net assumed less ceded reinsurance claims incurred

-5,572,347,574-1,662,323,118 -60,963 0 -1,130,009-27,577 -465,966,759 -110,170,951

-821,443,316

5.2 Other adjustments due to MLR calculations - claims

-301,840,715-204,240,991 -417,261 0 00 0 768,316

100,355,235

5.3 Rebates paid

125,680,679137,179,900 7,094,079 0 03,106,985 0 1,767,767

138,663,908

5.4 Estimated rebates unpaid prior year

107,311,217133,177,455 3,241,126 0 05,220,797 0 869,172

76,538,511

5.5 Estimated rebates unpaid current year

216,346,798140,039,661 2,660,631 0 05,856,464 0 2,134,181

684,770

5.6 Fee for service and co-pay revenue

11,489,8211,473,179 0 0 00 0 7,792



EmployerLarge Group

EmployerSmall Group

Individual




Group

Mini-Med Plans



Expatriate Plans

GroupLarge

PlansHealth

Student

59,333,457,654

5.7 Net incurred claims after reinsurance (Lines 5.0+5.1+5.2+5.3-5.4+5.5-5.6)

141,835,112,81550,153,315,209 31,782,439 116,665 111,1388,370,897 262,664,367 1,541,868,236

6. Improving Health Care Quality Expenses Incurred

251,746,887

6.1 Improve Health Outcomes

549,466,370205,362,376 3,758 1 0-303 2,008,911 8,170,371

63,977,317

6.2 Activities to prevent hospital readmissions

125,191,61848,766,143 0 0 0-58 180,938 793,650

77,952,474

6.3 Improve patient safety and reduce medical errors

161,326,98771,392,626 0 0 0-41 141,764 947,018

104,703,140

6.4 Wellness and health promotion activities

223,705,83498,638,660 0 0 0-72 1,288,493 1,089,058

89,853,809

6.5 Health information technology expenses related to health improvement

182,388,21464,404,635 0 0 0-39 185,526 982,263

588,233,615

6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5)

1,242,078,993488,564,430 3,758 1 0-509 3,805,630 11,982,361

100.4

7. Preliminary medical loss ratio: MLR (Lines 4 + 5.0 + 6.6 - Footnoe 2.0) / Line 1.8

90.686.3 80.4 247.0 62.345.8 67.9 87.0

8. Claims Ajustment Expenses:

617,101,384

8.1 Cost containment expenses not included in quality of care expenses in Line 6.6

1,429,482,869616,037,445 33,139 3 0-2,617 19,435,962 31,943,779

1,236,278,327

8.2 All other claims adjustment expenses

2,066,837,941866,972,282 200,759 0 01,799 6,930,083 33,727,497

1,853,379,714

8.3 Total claims adjustment expenses (Lines 8.1 + 8.2)

3,496,320,8211,483,009,721 233,898 3 0-818 26,366,046 65,671,277

2.90

9. Claims adjustment expense ratio (Line 8.3 divided by Line 1.8)

2.132.44 0.73 0.01 0.00-0.01 2.45 3.44



EmployerLarge Group

EmployerSmall Group

Individual




Group

Mini-Med Plans



Expatriate Plans

GroupLarge

PlansHealth

Student

10. General and Administrative (G&A) Expenses:

479,422,577

10.1 Direct sales salaries and benefits

922,755,708411,904,338 24,678 1 0272,218 4,384,692 35,235,193

1,500,373,780

10.2 Agents and brokers fees and commissions

2,940,564,4292,627,636,470 4,876,357 111 -471,694192,752 -14,846,176 26,731,570

97,321,448

10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below)

167,396,67271,912,106 142,555 0 0167 1,136,043 1,936,172

4,064,771,762

10.4 Other general and administrative expenses

5,666,096,8082,619,832,875 8,928,284 24,427 548,511691,890 56,208,358 110,083,063

7,605,469

10.4a Community benefit expenditures (informational only)

23,186,2436,587,752 0 0 00 0 211,667

6,141,889,567

10.5 Total general and administrative (Lines 10.1 + 10.2 + 10.3 + 10.4)

9,696,813,6075,731,285,797 13,971,874 24,539 76,8171,157,026 46,882,916 173,985,999

-4,690,948,520

11. Underwriting gain/(loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5)

1,658,257,2271,076,691,206 -13,887,086 -93,990 22,010626,998 19,502,498 -24,310,219

xxx

12. Income from fees of uninsured plans

xxxxxx xxx xxx xxxxxx xxx xxx

xxx

13. Net investment and other gain/(loss)


xxx

14. Federal income taxes (excluding taxes on Line 1.5 above)


xxx

15. Net gain or (loss) (Lines 11 + 12 + 13 - 14)


1,784,226

16. ICD-10 implementation expenses (informational only; already included in general expenses and Line 6.5)

1,819,988987,201 0 0 00 0 648

822,397

16a ICD-10 implementation expenses (informational only; already included in Line 6.5)

1,516,742846,071 0 0 00 0 2,289



EmployerLarge Group

EmployerSmall Group

Individual




Group

Mini-Med Plans



Expatriate Plans

GroupLarge

PlansHealth

Student

OTHER INDICATORS

9,247,594

1. Number of Certificates/Policies

17,986,0497,204,218 26,757 15 754532 39,488 1,026,329

14,059,007

2. Number of Covered Lives

34,651,00812,759,721 38,731 26 1,05036,367 108,020 1,173,494

xxx

3. Number of Groups

237,8171,098,766 n/a 15 105386 7,402 1,078

181,953,703

4. Member Months

415,200,858153,620,489 488,004 312 11,991418,792 1,406,274 13,660,476

$222,626,426

$14,343,479

Amount of run-off claims included in report Columns 1 through 9:

Amount of run-off premiums reported in report Columns 1 through 9:



Aggregated Annual Statement Data

Part I by State


SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 FOR 2016Aggregated Totals by State

ALABAMA

Business Subject to MLRComprehensive Health Coverage Mini-Med Plans

IndividualSmall Group

EmployerLarge Group

Employer Individual

StudentHealthPlansLarge GroupEmployer

Small GroupEmployer

Expatriate Plans

SmallGroup

LargeGroup

1. Premium:

1.1 Health premiums earned (from Part 2, Line 1.11)1,087,974,533 2,389,149,657 40,113 36,19981,116,191,393 1,344,155 451,645 3,649,177

1.2 Federal high risk pools0 0 0 000 0 0 0

1.3 State high risk pools11,339 -26,166 0 00-508 0 0 0

1.4 Premiums earned including state and federal high risk programs1,087,985,873 2,389,123,491 40,113 36,19981,116,190,885 1,344,155 451,645 3,649,177

1.5 Federal taxes and federal assessments26,403,217 64,311,861 398 4,420340,888,335 0 -54 188,657

1.6 State insurance, premium and other taxes16,966,823 22,606,245 855 71205,784,069 35,955 12,083 9,177

1.6a Community benefit expenditures (informational only)22 1 0 007 0 0 0

1.7 Regulatory authority licenses and fees2,163,567 47,703 1,202 6602,243 1,140 476 81

1.8 Adjusted premiums earned (Lines 1.4 - 1.5 - 1.6 - 1.7)1,042,452,263 2,302,157,683 37,658 31,00151,069,516,236 1,307,060 439,140 3,451,262

1.9 Net assumed less ceded reinsurance premiums earned-5,634,681 -4,212,796 -493 -500-1,322,861 -1,344,155 -451,645 -62,792

1.10 Other adjustments due to MLR calculations - premiums370,755 -1,299,024 0 0013,895 0 0 0

1.11 Risk revenue0 0 0 000 0 0 0

1.12 Net adjusted premiums earned after reinsurance (Lines 1.8+1.9+1.10+1.11)1,037,188,338 2,296,645,864 37,165 30,95151,068,207,269 -37,095 -12,505 3,388,470



ALABAMA



EmployerLarge Group

Employer Individual


Small GroupEmployer

Expatriate Plans

SmallGroup

LargeGroup

2. Claims:

2.1 Incurred claims excluding prescription drugs791,605,165 1,607,203,258 32,603 18,7580719,168,234 925,025 243,300 1,508,074

2.2 Prescription drugs319,716,219 607,708,227 0 00293,207,880 0 0 1,084,724

2.3 Pharmaceutical rebates43,650,003 52,506,641 0 0046,366,949 0 0 181,151

2.4 State stop loss, market stabilization and claim/census based assessments (informational only)3,729 3,883 0 001,025 0 0 0

3. Incurred medical incentive pools and bonuses-23,883 -46,978 0 00-23,607 0 0 0

4. Deductible Fraud and Abuse Detection Recovery Expense (for MLR use only)340,442 285,842 0 00174,667 0 0 0

5. Total incurred claims (Lines 2.1 + 2.2 - 2.3 - 2.4 + 3)1,067,647,499 2,162,357,866 32,603 18,7580965,985,559 925,025 243,300 2,411,647

5.1 Net assumed less ceded reinsurance claims incurred-51,246,411 -3,617,738 -278 620-21,260 -925,025 -243,300 0

5.2 Other adjustments due to MLR calculations - claims-1,355,954 -1,299,024 0 0042,000 0 0 0

5.3 Rebates paid1,251,208 0 0 000 0 0 0

5.4 Estimated rebates unpaid prior year1,219,248 0 0 19,92800 0 0 0

5.5 Estimated rebates unpaid current year954,313 0 0 20,70500 0 0 0

5.6 Fee for service and co-pay revenue0 0 0 000 0 0 0

5.7 Net incurred claims after reinsurance (Lines 5.0+5.1+5.2+5.3-5.4+5.5-5.6)1,016,031,407 2,157,441,104 32,325 19,5970966,006,299 0 0 2,411,647



ALABAMA



EmployerLarge Group

Employer Individual


Small GroupEmployer

Expatriate Plans

SmallGroup

LargeGroup


6.1 Improve Health Outcomes1,921,191 2,572,197 24 -701,259,106 0 0 11,157

6.2 Activities to prevent hospital readmissions889,348 1,458,102 0 -10583,766 0 0 8

6.3 Improve patient safety and reduce medical errors660,573 500,566 0 -10206,568 0 0 6,588

6.4 Wellness and health promotion activities433,927 625,866 0 -20326,820 0 0 25

6.5 Health information technology expenses related to health improvement952,156 1,335,815 0 -10743,100 0 0 0

6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5)4,857,195 6,492,547 24 -1103,119,361 0 0 17,778


8.1 Cost containment expenses not included in quality of care expenses in Line 6.69,486,010 29,354,781 0 0015,709,833 0 0 86,176

8.2 All other claims adjustment expenses9,081,473 15,056,199 139 1104,894,789 0 0 92,607

8.3 Total claims adjustment expenses (Lines 8.1 + 8.2)18,567,482 44,410,980 139 11020,604,622 0 0 178,783

9. Claims adjustment expense ratio (Line 8.3 divided by Line 1.8)1.78 1.93 0.37 0.040.001.93 0 0.00 5.18



ALABAMA



EmployerLarge Group

Employer Individual


Small GroupEmployer

Expatriate Plans

SmallGroup

LargeGroup


10.1 Direct sales salaries and benefits2,558,284 8,209,224 74 96503,112,549 0 0 245,920

10.2 Agents and brokers fees and commissions5,301,296 2,132,828 6,649 6200722,348 -377,052 -143,748 26,620

10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below)388,109 98,576 177 0033,672 0 0 0

10.4 Other general and administrative expenses49,484,490 63,025,555 8,268 2,381034,656,179 387,004 138,782 180,034

10.4a Community benefit expenditures (informational only)0 3,682 0 000 0 0 0

10.5 Total general and administrative (Lines 10.1 + 10.2 + 10.3 + 10.4)57,732,177 73,466,181 15,168 3,966038,524,745 9,952 -4,966 452,574

11. Underwriting gain/(loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5)-59,999,924 14,835,052 -10,491 7,389539,952,239 -47,047 -7,539 327,688

12. Income from fees of uninsured plansxxx xxx xxx xxxxxxxxx xxx xxx xxx

13. Net investment and other gain/(loss)xxx xxx xxx xxxxxxxxx xxx xxx xxx

14. Federal income taxes (excluding taxes on Line 1.5 above)xxx xxx xxx xxxxxxxxx xxx xxx xxx

15. Net gain or (loss) (Lines 11 + 12 + 13 - 14)xxx xxx xxx xxxxxxxxx xxx xxx xxx

16. ICD-10 implementation expenses (informational only; already included in general expenses and Line 6.5)0 0 0 000 0 0 0

16a ICD-10 implementation expenses (informational only; already included in Line 6.5)0 0 0 000 0 0 0



ALABAMA



EmployerLarge Group

Employer Individual


Small GroupEmployer

Expatriate Plans

SmallGroup

LargeGroup

OTHER INDICATORS

1. Number of Certificates/Policies145,119 264,074 22 30126,765 286 284 1,732

2. Number of Covered Lives213,280 513,333 30 1070232,498 329 329 1,809

3. Number of Groupsxxx 1,648 0 3018,126 xxx xxx xxx

4. Member Months2,807,129 6,148,460 364 1,56902,854,853 4,150 4,113 20,273

-$51,360

$4,067





ALASKA



EmployerLarge Group

Employer Individual


Small GroupEmployer

Expatriate Plans

SmallGroup

LargeGroup

1. Premium:

1.1 Health premiums earned (from Part 2, Line 1.11)218,600,988 547,856,109 0 00140,263,253 0 436,204 0


1.3 State high risk pools-1,861,322 -1,871,916 133 00-1,282,866 0 0 0

1.4 Premiums earned including state and federal high risk programs216,739,664 545,984,194 133 00138,980,387 0 436,204 0

1.5 Federal taxes and federal assessments13,911,760 12,061,578 6,288 -318153,642,780 0 -73 0

1.6 State insurance, premium and other taxes4,482,454 3,596,117 0 002,451,533 0 11,668 0

1.6a Community benefit expenditures (informational only)46 13,193 0 004,212 0 0 0

1.7 Regulatory authority licenses and fees3,778,242 -160,331 0 0045,621 0 3,792 0

1.8 Adjusted premiums earned (Lines 1.4 - 1.5 - 1.6 - 1.7)194,567,209 530,486,831 -6,155 318-15132,840,453 0 420,818 0

1.9 Net assumed less ceded reinsurance premiums earned-825,670 -20,404,702 0 00-6,876,775 0 -436,204 0

1.10 Other adjustments due to MLR calculations - premiums26,587 -474 0 00-737 0 0 0

1.11 Risk revenue0 0 0 000 0 0 0

1.12 Net adjusted premiums earned after reinsurance (Lines 1.8+1.9+1.10+1.11)193,768,126 510,081,655 -6,155 318-15125,962,942 0 -15,386 0



ALASKA



EmployerLarge Group

Employer Individual


Small GroupEmployer

Expatriate Plans

SmallGroup

LargeGroup

2. Claims:

2.1 Incurred claims excluding prescription drugs155,733,047 456,343,809 -23,208 859-57107,814,283 0 117,821 0

2.2 Prescription drugs19,228,036 59,277,543 0 0012,749,490 0 0 0

2.3 Pharmaceutical rebates1,377,079 9,197,282 0 001,847,514 0 0 0

2.4 State stop loss, market stabilization and claim/census based assessments (informational only)-1,205 -29,449 0 007,691 0 0 0

3. Incurred medical incentive pools and bonuses1 55,696 0 0013,238 0 0 0


5. Total incurred claims (Lines 2.1 + 2.2 - 2.3 - 2.4 + 3)173,584,003 506,479,765 -23,208 859-57118,729,499 0 117,821 0

5.1 Net assumed less ceded reinsurance claims incurred-10,238,469 -16,730,348 0 150-6,831,639 0 -117,821 0

5.2 Other adjustments due to MLR calculations - claims2 0 0 000 0 0 0

5.3 Rebates paid55,840 0 0 000 0 0 0

5.4 Estimated rebates unpaid prior year56,157 0 0 000 0 0 0

5.5 Estimated rebates unpaid current year0 0 0 000 0 0 0


5.7 Net incurred claims after reinsurance (Lines 5.0+5.1+5.2+5.3-5.4+5.5-5.6)163,345,220 489,749,417 -23,208 874-57111,897,860 0 0 0



ALASKA



EmployerLarge Group

Employer Individual


Small GroupEmployer

Expatriate Plans

SmallGroup

LargeGroup


6.1 Improve Health Outcomes632,493 1,822,144 0 00560,392 0 0 0

6.2 Activities to prevent hospital readmissions42,967 51,269 0 0031,368 0 0 0

6.3 Improve patient safety and reduce medical errors299,177 754,114 0 00294,067 0 0 0

6.4 Wellness and health promotion activities47,128 458,218 0 00559,004 0 0 0

6.5 Health information technology expenses related to health improvement121,722 306,555 0 00139,289 0 0 0

6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5)1,143,488 3,392,300 0 001,584,120 0 0 0


8.1 Cost containment expenses not included in quality of care expenses in Line 6.6505,689 1,820,007 0 -70527,348 0 0 0

8.2 All other claims adjustment expenses4,294,505 9,226,617 0 002,265,972 0 0 0

8.3 Total claims adjustment expenses (Lines 8.1 + 8.2)4,800,194 11,046,624 0 -702,793,320 0 0 0

9. Claims adjustment expense ratio (Line 8.3 divided by Line 1.8)2.47 2.08 0.00 -2.200.002.10 0 0.00 0.00



ALASKA



EmployerLarge Group

Employer Individual


Small GroupEmployer

Expatriate Plans

SmallGroup

LargeGroup


10.1 Direct sales salaries and benefits572,687 996,666 0 -201,208,129 0 0 0

10.2 Agents and brokers fees and commissions3,200,144 7,578,411 0 005,974,896 0 -138,834 0

10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below)319,318 720,833 0 00285,774 0 0 0

10.4 Other general and administrative expenses2,428,785 5,992,756 0 -1302,951,228 0 134,037 0


10.5 Total general and administrative (Lines 10.1 + 10.2 + 10.3 + 10.4)6,520,934 15,288,666 0 -15010,420,027 0 -4,797 0

11. Underwriting gain/(loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5)17,958,290 -9,395,354 17,053 -53441-732,386 0 -10,589 0









ALASKA



EmployerLarge Group

Employer Individual


Small GroupEmployer

Expatriate Plans

SmallGroup

LargeGroup

OTHER INDICATORS

1. Number of Certificates/Policies12,647 35,754 0 0010,621 0 127 0

2. Number of Covered Lives19,461 70,402 0 0016,972 0 153 0

3. Number of Groupsxxx 281 0 001,541 xxx xxx xxx

4. Member Months266,538 851,217 0 00202,614 0 1,702 0

-$3,047

$2





ARIZONA



EmployerLarge Group

Employer Individual


Small GroupEmployer

Expatriate Plans

SmallGroup

LargeGroup

1. Premium:

1.1 Health premiums earned (from Part 2, Line 1.11)1,099,222,736 2,264,097,940 445,105 329,4915755,134,084 0 228,607 0


1.3 State high risk pools-4,116 -126,753 0 00-18,473 0 0 0

1.4 Premiums earned including state and federal high risk programs1,099,218,620 2,263,971,187 445,105 329,4915755,115,611 0 228,607 0

1.5 Federal taxes and federal assessments-71,503,462 85,960,014 5,203 94,732428,532,929 0 -36 0

1.6 State insurance, premium and other taxes26,901,138 47,443,906 10,934 6,438012,326,468 0 6,116 0


1.7 Regulatory authority licenses and fees3,580,174 2,270,448 12,507 5690-1,877,759 0 1,236 0

1.8 Adjusted premiums earned (Lines 1.4 - 1.5 - 1.6 - 1.7)1,140,240,774 2,128,296,818 416,461 227,7521716,133,974 0 221,291 0

1.9 Net assumed less ceded reinsurance premiums earned-13,578,403 -118,882,308 -1,129 -50-57,391,376 0 -228,607 0

1.10 Other adjustments due to MLR calculations - premiums185,088 74,283 0 0031,105 0 0 0

1.11 Risk revenue0 0 0 000 0 0 0

1.12 Net adjusted premiums earned after reinsurance (Lines 1.8+1.9+1.10+1.11)1,126,847,460 2,009,488,794 415,332 227,7471658,773,703 0 -7,316 0



ARIZONA



EmployerLarge Group

Employer Individual


Small GroupEmployer

Expatriate Plans

SmallGroup

LargeGroup

2. Claims:

2.1 Incurred claims excluding prescription drugs1,063,836,439 1,577,749,746 219,139 21,702-6510,985,591 0 115,162 0

2.2 Prescription drugs241,093,839 398,032,450 0 -30118,005,525 0 0 0



3. Incurred medical incentive pools and bonuses1,118,493 4,986,107 0 002,424,299 0 0 0


5. Total incurred claims (Lines 2.1 + 2.2 - 2.3 - 2.4 + 3)1,272,985,382 1,909,083,039 219,138 21,699-6610,494,561 0 115,162 0

5.1 Net assumed less ceded reinsurance claims incurred-54,911,764 -102,909,749 -5,266 200-46,535,967 0 -115,162 0

5.2 Other adjustments due to MLR calculations - claims-81,035,587 -14,595,014 0 00-7,224,975 0 0 0

5.3 Rebates paid1,467,390 2,691,685 56,140 001,450,737 0 0 0

5.4 Estimated rebates unpaid prior year2,039,510 2,670,881 0 182,5000953,634 0 0 0

5.5 Estimated rebates unpaid current year0 5,466,738 59,022 178,4520979,395 0 0 0


5.7 Net incurred claims after reinsurance (Lines 5.0+5.1+5.2+5.3-5.4+5.5-5.6)1,136,465,910 1,797,065,819 329,033 17,671-6558,210,118 0 0 0



ARIZONA



EmployerLarge Group

Employer Individual


Small GroupEmployer

Expatriate Plans

SmallGroup

LargeGroup


6.1 Improve Health Outcomes7,233,777 13,468,548 122 004,898,575 0 0 0

6.2 Activities to prevent hospital readmissions1,730,054 2,374,737 0 00992,100 0 0 0

6.3 Improve patient safety and reduce medical errors1,885,464 3,117,426 0 001,081,485 0 0 0

6.4 Wellness and health promotion activities811,439 5,152,277 0 001,478,588 0 0 0

6.5 Health information technology expenses related to health improvement988,394 2,617,254 0 00672,090 0 0 0



8.1 Cost containment expenses not included in quality of care expenses in Line 6.612,538,950 13,312,415 490 -3106,893,175 0 0 0

8.2 All other claims adjustment expenses42,383,539 58,719,137 1,338 1015,981,603 0 0 0

8.3 Total claims adjustment expenses (Lines 8.1 + 8.2)54,922,489 72,031,554 1,828 -30022,874,779 0 0 0




ARIZONA



EmployerLarge Group

Employer Individual


Small GroupEmployer

Expatriate Plans

SmallGroup

LargeGroup


10.1 Direct sales salaries and benefits4,573,770 9,156,595 154 8,31002,589,331 0 0 0

10.2 Agents and brokers fees and commissions33,135,840 35,073,385 82,228 5,307029,113,866 0 -72,760 0

10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below)2,895,578 2,572,229 2,475 00855,533 0 0 0

10.4 Other general and administrative expenses63,428,762 71,607,298 105,126 20,330032,955,023 0 70,246 0

10.4a Community benefit expenditures (informational only)30,482 197,256 0 0036,900 0 0 0

10.5 Total general and administrative (Lines 10.1 + 10.2 + 10.3 + 10.4)104,033,949 118,409,510 189,984 33,946065,513,755 0 -2,514 0

11. Underwriting gain/(loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5)-181,224,017 -4,748,325 -105,635 176,16083,052,213 0 -4,802 0





16. ICD-10 implementation expenses (informational only; already included in general expenses and Line 6.5)5,047 7,918 0 001,270 0 0 0

16a ICD-10 implementation expenses (informational only; already included in Line 6.5)5,047 7,917 0 001,270 0 0 0



ARIZONA



EmployerLarge Group

Employer Individual


Small GroupEmployer

Expatriate Plans

SmallGroup

LargeGroup

OTHER INDICATORS


2. Number of Covered Lives302,190 563,030 264 1,1100195,347 0 42 0


4. Member Months3,978,941 6,776,574 3,416 12,12402,303,686 0 492 0

$66,093,663

)$(12,874,807





ARKANSAS



EmployerLarge Group

Employer Individual


Small GroupEmployer

Expatriate Plans

SmallGroup

LargeGroup

1. Premium:

1.1 Health premiums earned (from Part 2, Line 1.11)1,604,520,378 990,690,200 1,048,824 308,3791449,541,282 0 94,675 0


1.3 State high risk pools-645 -16,614 0 00-12,600 0 0 0

1.4 Premiums earned including state and federal high risk programs1,604,519,734 990,673,586 1,048,824 308,3791449,528,682 0 94,675 0

1.5 Federal taxes and federal assessments28,598,489 25,546,836 10,814 45,242016,436,061 0 -42 0

1.6 State insurance, premium and other taxes28,864,615 7,646,889 19,861 6,02705,434,509 0 2,550 0


1.7 Regulatory authority licenses and fees106,786 117,873 29,146 534024,909 0 316 0

1.8 Adjusted premiums earned (Lines 1.4 - 1.5 - 1.6 - 1.7)1,546,949,844 957,361,990 989,004 256,5771427,633,201 0 91,851 0

1.9 Net assumed less ceded reinsurance premiums earned-11,053,954 -21,819,505 -998 00-1,544,498 0 -94,675 0


1.11 Risk revenue0 0 0 000 0 0 0

1.12 Net adjusted premiums earned after reinsurance (Lines 1.8+1.9+1.10+1.11)1,536,064,743 935,572,966 988,006 256,5771426,814,968 0 -2,824 0



ARKANSAS



EmployerLarge Group

Employer Individual


Small GroupEmployer

Expatriate Plans

SmallGroup

LargeGroup

2. Claims:

2.1 Incurred claims excluding prescription drugs1,148,571,781 677,524,361 881,630 61,9750279,863,530 0 44,116 0

2.2 Prescription drugs395,162,695 226,534,091 0 0090,323,861 0 0 0



3. Incurred medical incentive pools and bonuses7,096,457 -914,032 0 00-2,097,008 0 0 0


5. Total incurred claims (Lines 2.1 + 2.2 - 2.3 - 2.4 + 3)1,514,206,162 866,660,301 881,630 61,9750352,538,483 0 44,116 0

5.1 Net assumed less ceded reinsurance claims incurred-52,682,382 -16,624,958 -1,745 00-818,425 0 -44,116 0

5.2 Other adjustments due to MLR calculations - claims-580,237 -515,091 0 001,104,336 0 0 0

5.3 Rebates paid827,462 2,085,774 106,351 00938,596 0 0 0

5.4 Estimated rebates unpaid prior year4,114,943 1,602,217 0 88,27401,041,519 0 0 0

5.5 Estimated rebates unpaid current year0 -54 0 167,02400 0 0 0


5.7 Net incurred claims after reinsurance (Lines 5.0+5.1+5.2+5.3-5.4+5.5-5.6)1,457,656,064 850,003,756 986,236 140,7250352,721,470 0 0 0



ARKANSAS



EmployerLarge Group

Employer Individual


Small GroupEmployer

Expatriate Plans

SmallGroup

LargeGroup



6.2 Activities to prevent hospital readmissions427,679 278,765 0 00228,498 0 0 0

6.3 Improve patient safety and reduce medical errors3,306,284 2,428,298 0 00973,017 0 0 0

6.4 Wellness and health promotion activities2,080,006 921,800 0 00348,468 0 0 0

6.5 Health information technology expenses related to health improvement1,125,531 1,509,649 0 00444,289 0 0 0





8.3 Total claims adjustment expenses (Lines 8.1 + 8.2)27,575,997 24,351,865 2,973 -3010,018,570 0 0 0




ARKANSAS



EmployerLarge Group

Employer Individual


Small GroupEmployer

Expatriate Plans

SmallGroup

LargeGroup


10.1 Direct sales salaries and benefits17,347,161 2,619,649 7 7,78501,547,457 0 0 0

10.2 Agents and brokers fees and commissions13,859,354 12,084,369 152,887 4,967016,254,470 0 -30,133 0

10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below)299,071 185,253 3,982 00123,090 0 0 0

10.4 Other general and administrative expenses82,690,974 47,320,172 194,197 19,073027,838,909 0 29,092 0


10.5 Total general and administrative (Lines 10.1 + 10.2 + 10.3 + 10.4)114,196,559 62,209,441 351,073 31,825045,763,924 0 -1,041 0

11. Underwriting gain/(loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5)-77,460,496 -10,790,767 -352,324 84,029114,863,050 0 -1,783 0









ARKANSAS



EmployerLarge Group

Employer Individual


Small GroupEmployer

Expatriate Plans

SmallGroup

LargeGroup

OTHER INDICATORS




4. Member Months4,785,688 2,863,533 6,599 9,10001,234,866 0 699 0

-$66,141

$223





CALIFORNIA



EmployerLarge Group

Employer Individual


Small GroupEmployer

Expatriate Plans

SmallGroup

LargeGroup

1. Premium:

1.1 Health premiums earned (from Part 2, Line 1.11)949,611,204 4,474,926,321 404,235 59,939141,489,021,973 1,742 20,130,918 50,826,048


1.3 State high risk pools-16,215 -263,236 0 00-54,973 0 0 0

1.4 Premiums earned including state and federal high risk programs949,594,988 4,474,663,085 404,235 59,939141,488,967,000 1,742 20,130,918 50,826,048

1.5 Federal taxes and federal assessments-13,240,242 211,188,123 517 2,6114556,595,989 0 181,445 3,867,488

1.6 State insurance, premium and other taxes11,060,590 99,848,467 2,149 836032,201,053 47 507,528 566,870


1.7 Regulatory authority licenses and fees3,070,430 9,360,417 6,981 -303,136,753 2 18,351 14,050

1.8 Adjusted premiums earned (Lines 1.4 - 1.5 - 1.6 - 1.7)948,704,212 4,154,266,076 394,588 56,496-311,397,033,206 1,693 19,423,593 46,377,640

1.9 Net assumed less ceded reinsurance premiums earned-74,110,469 -806,337,245 106 00-461,449,918 -1,742 -15,400,415 -2,011,227


1.11 Risk revenue0 0 0 000 0 0 0

1.12 Net adjusted premiums earned after reinsurance (Lines 1.8+1.9+1.10+1.11)874,597,033 3,348,483,429 394,694 56,496-31935,812,753 -49 4,023,178 44,366,413



CALIFORNIA



EmployerLarge Group

Employer Individual


Small GroupEmployer

Expatriate Plans

SmallGroup

LargeGroup

2. Claims:

2.1 Incurred claims excluding prescription drugs916,688,229 3,019,617,050 1,145,693 43,733-1491,012,026,230 3,185 12,537,806 34,087,777

2.2 Prescription drugs131,242,214 735,395,492 0 1440220,993,036 0 143,514 4,345,279

2.3 Pharmaceutical rebates15,352,433 119,278,568 0 0032,275,432 0 42,107 396,468

2.4 State stop loss, market stabilization and claim/census based assessments (informational only)200 339,469 0 00143,355 0 0 0



5. Total incurred claims (Lines 2.1 + 2.2 - 2.3 - 2.4 + 3)1,035,350,724 3,649,037,571 1,145,693 43,878-1491,202,243,264 3,185 12,639,212 38,036,588

5.1 Net assumed less ceded reinsurance claims incurred-204,299,643 -723,329,227 0 -2130-388,176,186 -3,185 -9,009,058 -1,314,182

5.2 Other adjustments due to MLR calculations - claims-17,286,329 -20,197,812 0 00-3,299,795 0 0 0

5.3 Rebates paid456,032 10,839,873 277,371 000 0 0 0

5.4 Estimated rebates unpaid prior year192,336 10,553,829 0 000 0 0 0

5.5 Estimated rebates unpaid current year0 16,742,626 0 0087,507 0 0 0


5.7 Net incurred claims after reinsurance (Lines 5.0+5.1+5.2+5.3-5.4+5.5-5.6)814,028,448 2,922,539,205 1,423,064 43,665-149810,854,789 0 3,630,154 36,722,406



CALIFORNIA



EmployerLarge Group

Employer Individual


Small GroupEmployer

Expatriate Plans

SmallGroup

LargeGroup


6.1 Improve Health Outcomes2,865,890 12,040,029 0 18904,409,460 0 9,574 260,933

6.2 Activities to prevent hospital readmissions945,889 4,397,125 0 3701,052,075 0 4,787 25,344

6.3 Improve patient safety and reduce medical errors1,189,894 4,957,033 0 2501,254,869 0 4,547 33,224

6.4 Wellness and health promotion activities510,741 5,518,879 0 460893,262 0 11,309 15,029

6.5 Health information technology expenses related to health improvement1,400,971 4,854,626 0 250856,872 0 1,282 28,751

6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5)6,913,383 31,767,692 0 32108,466,538 0 31,498 363,281


8.1 Cost containment expenses not included in quality of care expenses in Line 6.611,627,678 42,359,098 3 -188013,022,471 0 99,996 421,631

8.2 All other claims adjustment expenses13,505,677 31,511,285 713 0015,789,259 0 76,156 596,567

8.3 Total claims adjustment expenses (Lines 8.1 + 8.2)25,133,356 73,870,383 716 -188028,811,730 0 176,152 1,018,198




CALIFORNIA



EmployerLarge Group

Employer Individual


Small GroupEmployer

Expatriate Plans

SmallGroup

LargeGroup


10.1 Direct sales salaries and benefits5,907,576 21,476,024 256 -5704,389,201 0 64,287 48,063

10.2 Agents and brokers fees and commissions47,695,437 107,259,600 16,431 0082,627,029 -489 -4,687,224 108,594

10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below)334,616 3,527,929 101 00784,185 0 0 20

10.4 Other general and administrative expenses47,079,376 82,235,011 19,780 1,0921-1,734,854 502 4,934,439 1,797,396


10.5 Total general and administrative (Lines 10.1 + 10.2 + 10.3 + 10.4)101,017,004 214,498,566 36,568 1,035186,065,562 13 311,503 1,954,073

11. Underwriting gain/(loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5)-72,495,162 105,807,587 -1,065,654 11,6631171,614,135 -62 -126,129 4,308,455






16a ICD-10 implementation expenses (informational only; already included in Line 6.5)12,520 3,749 0 000 0 0 0



CALIFORNIA



EmployerLarge Group

Employer Individual


Small GroupEmployer

Expatriate Plans

SmallGroup

LargeGroup

OTHER INDICATORS

1. Number of Certificates/Policies119,948 641,579 197 00118,883 24 2,545 12,993

2. Number of Covered Lives196,929 1,222,672 245 00223,117 51 5,111 13,023


4. Member Months2,499,891 14,228,015 3,172 002,980,171 459 62,003 176,696

$11,249,380

)$(1,453,698





COLORADO



EmployerLarge Group

Employer Individual


Small GroupEmployer

Expatriate Plans

SmallGroup

LargeGroup

1. Premium:

1.1 Health premiums earned (from Part 2, Line 1.11)1,324,552,070 3,588,491,422 1,261,612 16531,234,543,301 0 333,965 0


1.3 State high risk pools-54,948 -189,872 11,239 00-80,665 0 0 0

1.4 Premiums earned including state and federal high risk programs1,324,497,121 3,588,301,549 1,272,851 16531,234,462,636 0 333,965 0

1.5 Federal taxes and federal assessments-1,848,775 90,004,978 8,954 -3,789256,200,322 0 -38 0

1.6 State insurance, premium and other taxes36,968,779 83,572,259 28,158 -1038,317,405 0 8,933 0

1.6a Community benefit expenditures (informational only)10,558,490 50,633,845 0 007,098,153 0 0 0

1.7 Regulatory authority licenses and fees5,645,443 1,949,997 9,867 001,662,127 0 2,275 0

1.8 Adjusted premiums earned (Lines 1.4 - 1.5 - 1.6 - 1.7)1,283,731,672 3,412,774,317 1,225,873 3,95511,138,282,780 0 322,795 0

1.9 Net assumed less ceded reinsurance premiums earned-8,318,547 -80,977,608 -5,199 -820-7,428,320 0 -333,965 0


1.11 Risk revenue98,218 0 0 001,757,835 0 0 0

1.12 Net adjusted premiums earned after reinsurance (Lines 1.8+1.9+1.10+1.11)1,275,540,415 3,331,861,883 1,220,674 3,87311,132,930,687 0 -11,170 0



COLORADO



EmployerLarge Group

Employer Individual


Small GroupEmployer

Expatriate Plans

SmallGroup

LargeGroup

2. Claims:

2.1 Incurred claims excluding prescription drugs1,132,849,910 2,657,615,442 1,015,851 7,862-5773,233,922 0 171,541 0

2.2 Prescription drugs217,261,122 507,555,454 0 -20168,080,041 0 0 0


2.4 State stop loss, market stabilization and claim/census based assessments (informational only)157 373,014 0 0087,475 0 0 0


4. Deductible Fraud and Abuse Detection Recovery Expense (for MLR use only)966,106 2,830,816 0 00532,820 0 0 0

5. Total incurred claims (Lines 2.1 + 2.2 - 2.3 - 2.4 + 3)1,331,107,569 3,107,294,220 1,015,851 7,860-5914,907,104 0 171,541 0

5.1 Net assumed less ceded reinsurance claims incurred-63,552,182 -71,140,357 -4,057 00-7,210,245 0 -171,541 0

5.2 Other adjustments due to MLR calculations - claims-21,396,841 44,002 0 00-1,054,924 0 0 0

5.3 Rebates paid148,101 767,619 63,372 00821,318 0 0 0

5.4 Estimated rebates unpaid prior year149,993 -2,236,738 35,218 1,76005,293,274 0 0 0

5.5 Estimated rebates unpaid current year279,746 1,763,441 20,278 002,578,262 0 0 0


5.7 Net incurred claims after reinsurance (Lines 5.0+5.1+5.2+5.3-5.4+5.5-5.6)1,246,436,400 3,040,965,661 1,060,226 6,100-5904,748,239 0 0 0



COLORADO



EmployerLarge Group

Employer Individual


Small GroupEmployer

Expatriate Plans

SmallGroup

LargeGroup



6.2 Activities to prevent hospital readmissions704,961 1,847,809 0 001,090,135 0 0 0

6.3 Improve patient safety and reduce medical errors1,001,668 2,227,927 0 001,533,480 0 0 0

6.4 Wellness and health promotion activities2,506,047 5,035,946 0 003,224,776 0 0 0

6.5 Health information technology expenses related to health improvement1,789,014 2,688,830 0 001,245,366 0 0 0





8.3 Total claims adjustment expenses (Lines 8.1 + 8.2)32,490,953 59,031,802 1,711 5028,168,356 0 0 0




COLORADO



EmployerLarge Group

Employer Individual


Small GroupEmployer

Expatriate Plans

SmallGroup

LargeGroup


10.1 Direct sales salaries and benefits13,539,997 16,615,014 117 -405,775,000 0 0 0

10.2 Agents and brokers fees and commissions41,347,411 41,212,657 216,549 6055,695,043 0 -106,293 0

10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below)4,379,742 6,666,405 8,249 004,078,452 0 0 0

10.4 Other general and administrative expenses86,668,710 122,951,630 279,530 2061,609,724 0 102,621 0


10.5 Total general and administrative (Lines 10.1 + 10.2 + 10.3 + 10.4)145,935,861 187,445,706 504,445 40127,158,218 0 -3,672 0

11. Underwriting gain/(loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5)-162,175,661 12,881,578 -345,708 -2,236659,510,837 0 -7,498 0





16. ICD-10 implementation expenses (informational only; already included in general expenses and Line 6.5)33,841 29,917 0 0062,788 0 0 0

16a ICD-10 implementation expenses (informational only; already included in Line 6.5)31,873 20,581 0 0043,297 0 0 0



COLORADO



EmployerLarge Group

Employer Individual


Small GroupEmployer

Expatriate Plans

SmallGroup

LargeGroup

OTHER INDICATORS




4. Member Months3,625,929 7,983,241 8,401 003,071,305 0 597 0

-$712,774

$144,746





CONNECTICUT



EmployerLarge Group

Employer Individual


Small GroupEmployer

Expatriate Plans

SmallGroup

LargeGroup

1. Premium:

1.1 Health premiums earned (from Part 2, Line 1.11)829,195,360 2,018,816,467 1,195 -3,07815948,627,431 0 405,757,769 1,218,185,210


1.3 State high risk pools-504,798 -456,615 0 00-6,947,448 0 -469 -184,729

1.4 Premiums earned including state and federal high risk programs828,690,561 2,018,359,852 1,195 -3,07815941,679,982 0 405,757,300 1,218,000,481

1.5 Federal taxes and federal assessments-24,541,790 -4,133,982 5 -5,8846215,255,516 0 13,766,972 70,503,533

1.6 State insurance, premium and other taxes20,021,088 45,540,806 9 -116023,950,500 0 3,639,470 21,868,349

1.6a Community benefit expenditures (informational only)7,947 74,038 0 0058,844 0 0 208,030

1.7 Regulatory authority licenses and fees11,470,891 9,625,049 11 -17012,715,839 0 214,836 2,594,101

1.8 Adjusted premiums earned (Lines 1.4 - 1.5 - 1.6 - 1.7)821,740,372 1,967,327,979 1,170 2,939-47889,758,125 0 388,136,022 1,123,034,497

1.9 Net assumed less ceded reinsurance premiums earned-124,180,224 -135,739,915 -682 00-114,004,185 0 -42,482,632 29,982,950

1.10 Other adjustments due to MLR calculations - premiums27,884,729 596 0 0016,548,593 0 20,958 0

1.11 Risk revenue0 0 0 000 0 0 0

1.12 Net adjusted premiums earned after reinsurance (Lines 1.8+1.9+1.10+1.11)725,444,874 1,831,588,660 488 2,939-47792,302,534 0 345,674,349 1,153,017,446



CONNECTICUT



EmployerLarge Group

Employer Individual


Small GroupEmployer

Expatriate Plans

SmallGroup

LargeGroup

2. Claims:

2.1 Incurred claims excluding prescription drugs695,386,563 1,456,961,644 -23 18,670-215659,943,536 0 255,807,390 794,974,068

2.2 Prescription drugs177,624,483 365,881,649 0 00175,565,219 0 42,028,513 164,993,344

2.3 Pharmaceutical rebates22,262,687 61,361,248 0 0028,099,338 0 5,982,700 22,857,940

2.4 State stop loss, market stabilization and claim/census based assessments (informational only)42,824 2,577,055 0 -101,774,556 0 45,246 -3,308,002

3. Incurred medical incentive pools and bonuses2,646,141 6,878,817 0 003,295,737 0 14,050 84,786


5. Total incurred claims (Lines 2.1 + 2.2 - 2.3 - 2.4 + 3)853,394,499 1,768,3

2016 Supplemental Health Care Exhibit Report...Market share data are based on premiums earned...

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Transcript of 2016 Supplemental Health Care Exhibit Report...Market share data are based on premiums earned...