Ohio s Health Insuring. Corporations Report. Ohio s Health Insuring. Corporations Performance Report. Executive Summary. Overview AUGUST 2014

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1 Ohio s Health Insuring Corporations Performance Report Ohio s Health Insuring Corporations Report AUGUST 2014 Executive Summary During 2013, Ohio s Health Insuring Corporations (HICs) saw an increase in both the number of lives covered and profitability. from premiums grew 2 percent over the previous year, and enrollment increased by a similar percentage. The median total margin for Ohio s HICs was 4.2 percent. This report focuses on the 22 HICs licensed in Ohio to provide basic health care services. These services include the following: physician services, inpatient hospital services, outpatient medical services, emergency health services, urgent care services, diagnostic laboratory services, diagnostic and therapeutic radiologic services, diagnostic and treatment services (other than prescription drug services) for biologically-based mental illnesses, and preventive health care services. HICs, although collectively and universally profitable, for the first time in a number of years are not outperforming the market as a whole. Yet, even plans that are exiting the market have managed to profit from their industry. Aggregate total margin for plans participating in Ohio totaled 1.4%, 4.1%, 4.4%, 3.0%, and 2.98% over the past five years. This is in stark contrast to Ohio hospitals payment to cost ratios for services provided to : -16%, -18%, -18%, -17%, and -18% for the years 2009 through Health insurance is directly affected by economic and societal factors. As economic conditions improve, commercial and employer sponsored plans should show increases. Major provisions of the Affordable Care Act of 2010 create many opportunities for growth in the areas of expansion and the health insurance marketplace. However, participation in government programs may be a risk for providers as well as insurers. Overview s for HICs increased 2 percent in 2013 based on reports filed with the Ohio Department of Insurance (ODI). Total enrollment in 2013 was 6,151,277, making HICs, also referred as Health Maintenance Organizations, or HMOs, the dominant form of health insurance in Ohio. The aggregate underwriting margin for Ohio HICs was 4.2 percent in Each year, the Ohio Hospital Association (OHA) reviews financial statements filed by HICs with the ODI and other industry reports to assess trends and monitor the financial performance of the health insurance market. OHA s analysis includes several metrics and describes changes in the financial condition of individual health plans operating in Ohio. During 2013, many plans focused on areas of expansion newly available due to health care reform. The Affordable Care Act (ACA) created numerous opportunities for industry growth through Health insurance Exchanges, Expansion (or extension), and demonstration projects to improve coordination of care for Ohio s most vulnerable citizens. The result of plans efforts should begin to show up in financial statements filed in Rating agencies have acknowledged that the unstable and evolving regulatory environment may have an adverse effect on the health insurance industry, which has resulted in lowered earnings expectations. Nevertheless, most plans have maintained an investment grade rating, meaning that they are fundamentally credit-worthy. Basically, as plans adapt to changes in the marketplace, they are expected to grow, but increased reliance on government sponsorship of premium, and the associated oversight and scrutiny, may constrict plans ability to maintain margins at the current levels. 1 Ohio Hospital Association 155 East Broad Street, Suite 301 Columbus, OH phone fax

2 Ohio s Health Insuring Corporations Performance Report Health Insuring Corporations in Ohio 2013 The terms managed care, HMO, and Health Insuring Corporation are not synonymous in Ohio. Although related, these terms define different aspects of the continuum of product types and purchasers of those products. Chapter of the Ohio Revised Code defines a HIC as: a corporation, as defined in division (H) of this section, that, pursuant to a policy, contract, certificate, or agreement, pays for, reimburses, or provides, delivers, arranges for, or otherwise makes available, basic health care services, supplemental health care services, or specialty health care services, or a combination of basic health care services and either supplemental health care services or specialty health care services, through either an open panel plan or a closed panel plan. This report focuses on the 22 HICs that provide, at a minimum, basic health care services, including the following: physician services, inpatient hospital services, outpatient medical services, emergency health services, urgent care services, diagnostic laboratory services and diagnostic and therapeutic radiologic services, diagnostic and treatment services (other than prescription drug services) for biologicallybased mental illnesses, and preventive health care services. HICs in Ohio are a heterogeneous group: seven plans participated in Ohio s Managed Care Program; 14 participated in the federal Advantage (MA) program, a few were MA plans exclusively, while others included MA as one of several lines of business. Some insurance companies offer HICs along with Preferred Provider Organizations (PPOs) and other indemnity types of insurance in their portfolio. Health Insuring Corporation Community Insurance Company-Anthem 5,077,537,837 CareSource 4,154,066,540 Aetna Health Inc. (PA) 3,040,475,972 Medical Mutual of Ohio 2,473,581,183 Molina Health Care of Ohio, Inc. 1,244,167,735 UnitedHealthcare of Ohio, Inc. 1,037,016,418 HealthAmerica Pennsylvania, Inc. 809,510,130 Buckeye Community Health Plan, Inc. 795,033,635 UnitedHealthcare Community Plan of Ohio, Inc. 666,284,400 HealthSpan Integrated Care, FKA Kaiser 473,889,046 AultCare Insurance Company 454,121,147 Mount Carmel Health Plan, Inc. 405,202,597 Paramount Advantage 387,877,722 Humana Health Plan of Ohio, Inc. 367,085,772 The Health Plan of the Upper Ohio Valley, Inc. 364,585,255 SummaCare, Inc. 277,513,253 Paramount Health Care 212,770,047 WellCare of Ohio, Inc. 199,562,062 AmeriGroup Community Care 79,831,525 Paramount Insurance Company 79,182,204 Medical Health Insuring Corporation of Ohio 12,338,266 Gateway Health Plan of Ohio, Inc Ohio Hospital Association 155 East Broad Street, Suite 301 Columbus, OH phone fax

3 Ohio s Health Insuring Corporations Performance Report Enrollment As of December 31, 2013, there were 6,151,277 Ohioans enrolled in one of Ohio s 22 licensed HICs; 1,171,963 were in Managed Care Plans (MCPs) and 330,424 were in HICs that offer MA coverage (private companies that contract with to provide Part A and Part B benefits). Ohio Health Insurance Corporation Enrollment In 2013, growth in enrollment slowed to 2 percent, for an average annual growth rate of 1.9 percent over the previous three years. This contrasts with the years 2007 through 2009, when the average annual rate of growth was 6.4 percent, much of which can be attributed to increases in managed care coverage during the economic downturn. Enrollment Increases in Managed Care Enrollment Compared to Other Health Insurance Corporation 3 Ohio Hospital Association 155 East Broad Street, Suite 301 Columbus, OH phone fax

4 Ohio s Health Insuring Corporations Performance Report Industry Financials Net Underwriting Gain and Total Margin This report includes two measures of HIC profitability, net underwriting gain (or loss), and total margin. Net underwriting gain is calculated using the formula: Incurred Losses + Loss Adjustment Expense Earned s Documents available from ODI include a data field for Net Underwriting Gain or Loss. The total gain for Ohio HICs in 2013 was $939,226,261 on premiums of $22,611,633,734, or an aggregate 4.2 percent margin. The median was 2.9 percent, with a range of values from 14.9 percent to negative 4.5 percent. It is worth noting that plans reporting these extreme values were also undergoing significant transitions, either exiting major segments of the market or in the middle of merger or acquisition. Total margin is calculated using the formula: Net Income Total Ohio HICs reported gains of $834,448,823 in 2013, representing a total margin of 3.7 percent. The median total margin was 3.2 percent with a range of 10.4 percent (AmeriGroup) to negative 21.9 percent (HealthSpan Integrated Care, formerly known as Kaiser), plans undergoing major transitions. Only two plans reported a loss in 2013: Gateway, which has zero enrollment, and HealthSpan. All others show profit. Please refer to the index for plan-specific data. Ohio Health Insuring Corporation Profitability 4 Ohio Hospital Association 155 East Broad Street, Suite 301 Columbus, OH phone fax

5 Ohio s Health Insuring Corporations Performance Report Health Care Expense Ratio and Administrative Expense Ratio The Health Care Expense Ratio (HCER) is a key financial measure that shows the percentage of premium dollars a health insurer pays for medical care and quality improvement expenses, as opposed to the portion allocated to overhead in the form of profits, administrative costs, and sales expenses. HCER is calculated using the formula: Total Ohio Health Insuring Corporation Health Care Expense Ratio The Administrative Expense Ratio (AER) is the percent of revenue spent on overhead, salaries, commissions, marketing and other non-health services. It is calculated using the formula: Total Administrative Total Ohio Health Insuring Corporation Median Administrative Expense Ratio 5 Ohio Hospital Association 155 East Broad Street, Suite 301 Columbus, OH phone fax

6 Ohio s Health Insuring Corporations Performance Report Special Market Segments Managed Care Since the 1990s, Ohio has contracted with several HICs to arrange health care services for covered members, and the program has grown over the years. In 2013, MCPs covered 1,717,963 lives, most of which qualify for coverage in the category of Covered Families and Children (CFC) eligibility category. In addition, a significant portion of non-institutionalized individuals in the Aged, Blind, and Disabled (ABD) eligibility category may enroll in MCPs. The selected plans provide all services offered through traditional, and they may add additional services. Providers contract with and bill MCPs directly. Net Income AmeriGroup 3,200,443 9,237,266 6,806,787 13,483,951 8,368,852 Buckeye 3,514,526 21,028,613 15,560,516 12,998,217 13,140,305 CareSource 34,912, ,375,29 131,208,09 116,481,79 134,942,47 Molina (2,000,530) 37,921,933 45,343,065 18,762,516 34,003,852 Paramount Advantage Unison/UHC Community Care 2,575,547 9,148,733 6,400,691 9,635,305 5,459,399 15,219,430 32,753,268 23,266,753 36,241,293 22,182,950 Wellcare 11,530,069 (1,378,955) 8,000,903 6,792,038 7,530,885 Managed Care Plan Total Margin managed care functions differently from commercial managed care programs. With rates often tied to already inadequate fee-for-service rates, hospitals are not permitted to recover costs from MCP enrollees. Also, the state generally has the upper hand in determinations of network adequacy. In 2012, Ohio consolidated the managed care system from eight regions to three and rebid its MCP contracts. The new consolidated regions took effect in Two plans that formerly participated in Ohio s managed care program, AmeriGroup and WellCare, are no longer providers for CFC and ABD eligible individuals after Moving forward, the following HICs are MCPs for the program in all regions throughout Ohio: Buckeye Community Health Plan, Inc. CareSource Molina Healthcare of Ohio, Inc. Paramount Advantage United Healthcare Community Plan of Ohio, Inc. Over the past five years, premium revenues have increased significantly for MCPs operating in Ohio, from $4.7 billion in 2009 to $7.5 billion in Net income and operating margins have also increased. In 2013, MCPs earned $225,628,720 on premiums of $7,526,823,619. Advantage Advantage Plans are a form of health plan offered by private companies that contract with to provide Part A and Part B benefits. Services are covered through the plan and are not paid for under Original. Most MA plans offer prescription drug coverage. There are 33 MA plans in Ohio with combined enrollment of 775,179. Of that number, 42 percent, or 330,424, are in HICs. The number of beneficiaries in MA plans grew nearly 5.9 percent between 2012 and 2013; the percent of beneficiaries enrolled in MA HICs grew by nearly 13 percent. MA plans operate in a different environment from commercial HICs, particularly with regard to distribution. The Center for and Services tightly controls the manner in which MA plans market and enroll eligible individuals. Only a handful of HICs operate as MA plans exclusively: Mount Carmel Health Plan, Inc., Paramount Health Care, and SummaCare, Inc. The majority of MA enrollees are in HICs that offer MA as one of several lines of business. 6 Ohio Hospital Association 155 East Broad Street, Suite 301 Columbus, OH phone fax

7 Ohio s Health Insuring Corporations Performance Report Market Drivers and Stakeholders Health Insuring Corporations, as well as most other forms of health insurance, are directly affected by economic and societal factors. Participation in government programs is always a risk for providers as well as insurers. Investment income as a source of revenue for health insurers is a challenge due to low interest rates. On the other hand, improving employment levels affect the number of people enrolled in employer-sponsored health plans, which is a significant if not primary, business for many managed care organizations. Also, health care cost inflation has remained stable but continues to impact health care expense ratio. Opportunities and challenges to the market place created specifically by the ACA loom large in strategic business decisions most health plans face moving forward. Expansion is a key stakeholder in health care reform; expansion creates new opportunities and challenges for the HIC industry in Ohio. Ohio s managed care program underwent several significant changes in Beginning January 1, 2014, adults between the ages of 19 to 64, who are between percent of the Federal Poverty Level (FPL) and who are not eligible under another category of will be eligible for. Parents who are between percent of the Federal Poverty Level will also be eligible for. In addition, Ohio will launch MyCare Ohio in Approximately 114,000 Ohioans who are covered by both and and wholive in 29 select counties will be eligible to participate in this three-year demonstration which uses a managed care approach to better connect services available through each program. Health Insurance Exchanges Health Insurance Exchanges will dramatically change the process and transaction of purchasing health insurance for individuals. Enrollees will have an option to shop and conduct their own cost/benefit analysis of each product. Theoretically, exchanges will provide a significantly greater range of choice, with the assurance to the purchaser that the products offered meet minimum standards. All private health insurance plans offered on exchanges will offer the same set of essential health benefits, defined as emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, ambulatory patient services, prescription drugs, rehabilitative services, laboratory services, preventive and wellness services along with chronic disease management, and pediatric services. Plans may offer additional coverage. Purchasers who use the exchange may compare competing plans side by side. Provider Relationships Relationships between health plans and providers are not as adversarial as they were 15 to 20 years ago. However, the phrase managed care" tends to evoke strong reactions from health care providers even today. In theory, managed care uses a portfolio of tools designed to create incentives for cost -effective medicine, with minimal variation in clinical practice: in reality, this often means pressure to do more with less. In some communities, contracted providers are a market differentiator among HICs. However, in order to keep premiums low or to increase profits for shareholders many insurance companies have been tightening their provider networks. In 2013, patients covered by Advantage plans in several states lost access to their care provider, which prompted the federal government to issue additional guidelines on network adequacy. The Ohio Department of already includes broad definitions of network adequacy in its baseline agreement with MCPs. Moving forward, providers should monitor whether insurers do, in fact, maintain adequate access for consumers, and whether additional regulatory guidance is needed. (continued on page 8) 7 Ohio Hospital Association 155 East Broad Street, Suite 301 Columbus, OH phone fax

8 Ohio s Health Insuring Corporations Performance Report (continued from page 7) The ACA expands access to coverage and takes several steps toward delivery system reform. Thousands of Ohioans will gain access to health insurance, either through or through the newly created health care exchanges. The ACA also includes a number of important consumer protections, such as the provision allowing young adults up to the age of 26 to stay on their parents policies, and a number of changes that impact the benefits people receive: coverage of pre-existing conditions, a broader benefit package, and no out-of-pocket expense for many preventive services. The Ohio Governor s Office for Health Transformation (OHT) successfully competed for a planning grant to design new approaches for achieving better health, better care, and costs savings. An application to CMS for implementing new payment and delivery models is pending. Aetna, Anthem, Buckeye, CareSource, Medical Mutual, Paramount, United, and all other MCPs are part of the multi-payer Core Team for this initiative. References 1. Center for and Services. MA-Enrollment-by-SCC 2. Ohio Department of Insurance. Annual Statements for the Year Ending December 31, Ohio Department of, Cost Reports (JFS 02930). 4. Fitch Ratings. December 10, 2013 U.S Outlook 5. S&P Capitol IQ Industry Economic And Ratings Outlook, May 2014 For more information, contact Berna Bell, director, Health Economics and Policy, at bernab@ohanet.org. 155 East Broad Street, Suite 301 Columbus, OH Ohio Hospital Association 8/6/14 10:11 Ohio Hospital Association 155 East Broad Street, Suite 301 Columbus, OH phone fax

9 Ohio Hospital Association Ohio Health Insuring Corporations Report Appendix i PlanRatios Current Ratio Total Margin Administrative Expense Ratio Health Care Expense Ratio Average Payment Period Current /Current Net Income/Total Total Administrative Expense/Total Total Medical and Hospital Expense/Total Total Current /Total Expense/365 Aetna Health Inc % 12.9% 83.4% 54.3 AmeriGroup Ohio, Inc % 20.5% 64.3% 22.9 Aultcare Insurance Company % 12.9% 86.3% 42.6 Buckeye Community Health Plan, Inc % 19.6% 77.8% 44.0 CareSource % 13.4% 83.4% 47.2 Community Insurance Company % 7.4% 81.8% 57.0 Gateway Health Plan of Ohio, Inc Extreme Value Extreme Value 17.0% 2.0 HealthAmerica Pennsylvania, Inc % 10.5% 85.7% 65.7 The Health Plan of the Upper Ohio Valley, Inc % 6.3% 89.4% 51.0 Humana Health Plan of Ohio, Inc % 16.0% 81.9% 42.0 Kaiser Foundation Health Plan of Ohio DBA HealthSpan Integrated Care % 12.9% 109.0% 89.4 Medical Health Insuring Corporation of Ohio % 7.8% 75.9% Medical Mutual of Ohio % 12.6% 82.6% 57.3 Molina Healthcare of Ohio, Inc % 19.1% 76.7% 40.0 Mount Carmel Health Plan, Inc % 9.7% 80.5% 32.4 Paramount Advantage % 7.5% 89.4% 46.9 Paramount Health Care % 16.9% 80.9% 53.3 Paramount Insurance Company % 13.8% 82.2% 97.5 SummaCare, Inc % 10.9% 84.7% UnitedHealthcare Community Plan of Ohio, Inc % 18.0% 76.8% 65.9 UnitedHealthcare of Ohio, Inc % 10.4% 89.1% 55.5 Wellcare of Ohio, Inc % 14.3% 80.2% 41.4 Appendix i Plan Ratios

10 Ohio Hospital Association Ohio Health Insuring Corporations Report Appendix ii Median Ratios Enrollment No. Plans Md Total Margin Md Administrative Expense Ratio Md Health Care Expense Ratio ,697, % 15.2% 80.2% ,680, % 14.3% 84.5% ,173, % 14.6% 86.1% ,008, % 15.4% 91.0% ,777, % 13.5% 87.5% ,796, % 12.8% 90.7% ,287, % 11.0% 90.6% ,398, % 12.3% 88.5% ,073, % 11.6% 87.8% ,943, % 11.4% 85.7% ,804, % 11.1% 84.4% ,494, % 11.4% 85.1% ,845, % 12.8% 84.2% ,287, % 13.0% 80.9% ,537, % 12.6% 86.6% ,833, % 14.0% 83.2% ,819, % 14.3% 80.7% ,877, % 14.4% 80.6% ,115, % 12.8% 82.9% ,151, % 12.9% 82.1% Appendix ii Median Ratios

11 Ohio Hospital Association Ohio Health Insuring Corporations Report Aetna Health Inc. Aetna Health Inc. 16,888, ,343 Total Current 138,243, ,383,191 Total Other 638,180, ,249,693 Total 776,423, ,632,884 Total Current 401,012, ,793,189 Total Other 15,194,353 48,490,790 Total 416,206, ,283,979 Total 360,216, ,348,905 3,672,274,902 3,040,475,972 Other 55,555,515 1,512,790 Total 3,727,830,417 3,041,988,762 3,103,502,966 2,537,739,721 Total Administrative 407,612, ,927,122 Total 3,511,115,134 2,929,666, ,715, ,321,919 57,386,621 11,299, ,328, ,022, ,918,710 90,252, , ,817

12 Ohio Hospital Association Ohio Health Insuring Corporations Report AmeriGroup Ohio, Inc. AmeriGroup Ohio, Inc. 4,472,453 10,955,145 Total Current Total Other Total 31,683,559 15,525,314 26,567,394 23,195,140 1,713-58,252,666 38,720,454 Total Current Total Other Total 15,644,512 4,273, , ,255 16,245,800 4,880,650 Total 42,006,866 33,839,804 Other Total 169,589,135 79,831, , , ,055,929 80,418,039 Total Administrative Total 114,012,927 51,668,682 35,278,062 16,476, ,290,989 68,144,837 20,764,940 12,273,202 7,280,989 3,904,350 13,483,951 8,368,852 20,298,146 11,897,502 53,672 -

13 Ohio Hospital Association Ohio Health Insuring Corporations Report Aultcare Insurance Company Aultcare Insurance Company 8,713,866 17,236,926 Total Current Total Other Total 25,559,135 38,064,661 87,273,766 76,256, , ,832, ,201,301 Total Current Total Other Total 53,869,779 52,774, , ,336 54,468,637 53,502,401 Total 58,364,264 61,698,900 Other Total 468,467, ,121,147 2,279,160 2,234, ,747, ,355,729 Total Administrative Total 421,829, ,614,410 49,034,433 58,652, ,863, ,266,624 (116,480) 4,089, ,231 (658,843) (312,711) 4,747,948 (2,395,640) 1,854, , ,942

14 Ohio Hospital Association Ohio Health Insuring Corporations Report Buckeye Community Health Plan, Inc. Buckeye Community Health Plan, Inc. 18,978,904 48,115,140 Total Current Total Other Total 51,881,051 73,222, ,250, ,056, ,131, ,278,953 Total Current Total Other Total 69,080,046 93,564,462 1,316,536-70,396,582 93,564,462 Total 90,735, ,714,491 Other Total 728,263, ,033,635 2,006,711 2,034, ,270, ,068,288 Total Administrative Total 568,688, ,036, ,525, ,177, ,214, ,214,462 20,055,920 20,853,826 7,057,703 7,713,521 12,998,217 13,140,305 18,049,209 18,819, , ,208

15 Ohio Hospital Association Ohio Health Insuring Corporations Report CareSource CareSource 2,461, ,591,711 Total Current Total Other Total 474,232, ,560, ,706, ,568, ,939,711 1,129,129,397 Total Current Total Other Total 398,468, ,498,510 2,384, , ,852, ,270,342 Total 535,086, ,859,055 Other Total 3,682,585,418 4,154,066,540 35,150,084 28,510,959 3,717,735,502 4,182,577,499 Total Administrative Total 3,125,497,226 3,489,072, ,756, ,562,923 3,601,253,707 4,047,635, ,481, ,942, ,481, ,942, ,216, ,297, , ,010

16 Ohio Hospital Association Ohio Health Insuring Corporations Report Community Insurance Company Community Insurance Company (3,304,143,237) (328,422,768) Total Current Total Other Total 354,180, ,517,835 1,604,008,787 1,554,249,231 30,508,342 28,672,155 1,988,697,451 1,887,439,221 Total Current Total Other Total 830,496, ,583, ,382, ,473,079 1,233,878,958 1,109,056,437 Total 754,818, ,382,784 Other Total 5,214,779,738 5,077,537, ,523, ,538,728 5,322,303,298 5,204,076,565 Total Administrative Total 4,412,907,954 4,256,225, ,594, ,580,591 4,788,502,070 4,642,806, ,801, ,270, ,667, ,795, ,133, ,474, ,036, ,352,599 1,875,569 1,899,391

17 Ohio Hospital Association Ohio Health Insuring Corporations Report Gateway Health Plan of Ohio, Inc. Gateway Health Plan of Ohio, Inc. 2,323 2,773 Total Current Total Other Total 1,946,338 7,838, , ,034 2,401,520 8,290,978 Total Current Total Other Total 14,111 39,456-5,724,041 14,111 5,763,497 Total 2,387,409 2,527,481 Other Total 1, , Total Administrative Total ,663 7,110,749 1,717 7,110,917 (289) (7,109,929) (289) (7,109,929) (1,717) (7,110,917)

18 Ohio Hospital Association Ohio Health Insuring Corporations Report HealthAmerica Pennsylvania, Inc. HealthAmerica Pennsylvania, Inc. 17,691,528 6,195,363 Total Current Total Other Total 46,083,879 75,454, ,765, ,255, ,849, ,710,571 Total Current Total Other Total 86,948, ,919,278 4,133,492 3,824,851 91,082, ,744,129 Total 108,767,322 82,966,442 Other Total 563,033, ,510,130 5,448,022 4,116, ,481, ,626,294 Total Administrative Total 430,607, ,137,845 61,394,279 85,562, ,001, ,700,185 76,480,241 30,926,109 15,691,538 10,828,997 60,788,703 20,097,112 71,032,219 26,814,745 90, ,144

19 Ohio Hospital Association Ohio Health Insuring Corporations Report The Health Planof the Upper Ohio Valley, Inc. The Health Planof the Upper Ohio Valley, Inc. 12,557,897 15,586,021 Total Current Total Other Total 19,963,371 23,613, ,151, ,684,288 6,029,790 5,470, ,144, ,768,470 Total Current Total Other Total 47,810,309 49,749,637 4,864,343 3,010,448 52,674,652 52,760,085 Total 190,469, ,008,385 Other Total 376,855, ,585,255 10,615,621 7,630, ,471, ,215,767 Total Administrative Total 353,831, ,624,012 24,634,519 23,410, ,466, ,034,954 9,005,007 16,180,813 9,005,007 16,180,813 (1,610,614) 8,550,301 80,783 78,097

20 Ohio Hospital Association Ohio Health Insuring Corporations Report Humana Health Plan of Ohio, Inc. Humana Health Plan of Ohio, Inc. (376,449) 1,755,316 Total Current Total Other Total 8,138,588 12,050,361 69,226,584 78,677,750 15,838 6,402 77,381,010 90,734,513 Total Current Total Other Total 35,823,805 41,675, , ,187 36,141,823 42,134,664 Total 41,239,187 48,599,849 Other Total 284,583, ,085,772 2,571,417 2,689, ,154, ,775,644 Total Administrative Total 239,206, ,993,005 43,181,496 59,313, ,388, ,306,274 4,766,522 7,469,370 (662,262) 1,893,561 5,428,784 5,575,809 2,275,418 4,668,243 62,857 75,337

21 Ohio Hospital Association Ohio Health Insuring Corporations Report Total Current Total Other Total Total Current Total Other Total Total Kaiser Foundation Health Plan of Ohio DBA HealthSpan Integrated Care Kaiser Foundation Health Plan of Ohio DBA HealthSpan Integrated Care 17,095, ,180, ,155, ,319, ,617, ,417 62,570,899 82,387, ,343, ,108,088 92,794, ,998, ,241,166 31,798, ,035, ,796,981 68,308, ,311,107 Other Total Total Administrative Total 491,322, ,889,046 7,231,815 (65,289,644) 498,554, ,599, ,937, ,441,202 85,260,050 52,588, ,197, ,029,715 (59,643,389) (89,430,313) (59,643,389) (89,430,313) (63,568,995) (21,211,863) 86,338 81,606

22 Ohio Hospital Association Ohio Health Insuring Corporations Report Medical Health Insuring Corporation of Ohio Medical Health Insuring Corporation of Ohio 1,311, ,439 Total Current Total Other Total 18,911,934 14,558,904 71,363,130 77,807,443 90,275,064 92,366,347 Total Current Total Other Total 3,611,914 3,721,193 3,611,914 3,721,193 Total 86,663,150 88,645,154 Other Total 23,964,203 12,338,266 2,998,544 2,479,312 26,962,747 14,817,578 Total Administrative Total 20,580,605 11,250,194 1,781,264 1,153,504 22,361,869 12,403,698 4,600,878 2,413, , ,528 3,786,062 1,952,352 1,602,334 (141,432) 3,934 2,746

23 Ohio Hospital Association Ohio Health Insuring Corporations Report Total Current Total Other Total Medical Mutual of Ohio Medical Mutual of Ohio 38,850,687 16,935, ,569, ,554,188 1,447,784,362 1,500,034,060 1,634,353,695 1,684,588,248 Total Current Total Other Total 423,819, ,527,774 76,973,028 88,256, ,792, ,783,907 Total 1,133,560,810 1,221,804,341 Other Total 2,372,803,264 2,473,581,183 22,711,021 29,746,383 2,395,514,285 2,503,327,566 Total Administrative Total 2,041,311,942 2,068,746, ,753, ,780,793 2,347,065,896 2,384,527,132 48,448, ,800,434 5,030,455 21,060,267 43,417,934 97,740,167 24,796,191 88,925,265 1,159,793 1,111,733

24 Ohio Hospital Association Ohio Health Insuring Corporations Report Molina Healthcare of Ohio, Inc. Molina Healthcare of Ohio, Inc. (7,232,901) 14,865,745 Total Current Total Other Total 149,694, ,127,949 50,270,882 71,204,728 2, ,968, ,332,677 Total Current Total Other Total 102,698, ,013, ,147 7,421, ,545, ,434,029 Total 96,422, ,898,648 Other Total 1,198,651,395 1,244,167,735 (2,051,600) 4,363,999 1,196,599,795 1,248,531,734 Total Administrative Total 958,473, ,507, ,571, ,414,926 1,167,044,874 1,195,922,456 29,554,921 52,609,278 10,792,405 18,605,426 18,762,516 34,003,852 28,617,883 52,316, , ,164

25 Ohio Hospital Association Ohio Health Insuring Corporations Report Mount Carmel Health Plan, Inc. Mount Carmel Health Plan, Inc. (2,614,182) 5,883,240 Total Current Total Other Total 120,623, ,865, ,020, ,231,896-2, ,644, ,100,037 Total Current Total Other Total 27,598,526 35,677,812 2,303,256-29,901,782 35,677,812 Total 264,742, ,422,225 Other Total 359,730, ,202,597 10,680,388 40,293, ,410, ,495,673 Total Administrative Total 290,442, ,773,046 30,367,020 43,345, ,809, ,118,293 49,600,925 43,377,380 49,600,925 43,377,380 38,469,352 22,720,868 29,961 37,669

26 Ohio Hospital Association Ohio Health Insuring Corporations Report Paramount Advantage Paramount Advantage 21,783,200 50,326,746 Total Current Total Other Total 90,988,574 65,992,524 4,115,240 64,184,079 95,103, ,176,603 Total Current Total Other Total 36,645,682 55,735, ,895 10,719,000 37,102,577 66,454,656 Total 58,001,237 63,721,947 Other Total 294,763, ,877,722 11,703 2,344, ,774, ,222,456 Total Administrative Total 236,257, ,501,769 43,731,672 65,857, ,989, ,359,311 14,785,420 8,863,145 5,150,115 3,403,746 9,635,305 5,459,399 14,773,717 8,625,769 94, ,165

27 Ohio Hospital Association Ohio Health Insuring Corporations Report Paramount Health Care Paramount Health Care 7,944,582 12,936,832 Total Current Total Other Total 13,890,015 16,008,535 96,983,828 82,073, , , ,600,089 98,826,205 Total Current Total Other Total 46,715,138 27,022,650 6,719,640 7,422,945 53,434,778 34,445,595 Total 58,165,311 64,380,610 Other Total 270,343, ,770,047 3,645,376 4,399, ,989, ,169,145 Total Administrative Total 261,243, ,192,035 27,213,559 16,197, ,457, ,389,488 (14,468,386) 6,779,657 (5,868,329) (468,231) (8,600,057) 7,247,888 (18,113,762) 2,380,559 43,658 12,279

28 Ohio Hospital Association Ohio Health Insuring Corporations Report Paramount Insurance Company Paramount Insurance Company 16,701,081 27,572,595 Total Current Total Other Total 17,119,877 29,038,416 1,481,121 5,993,530 18,600,998 35,031,946 Total Current Total Other Total 5,789,985 20,335,395 29,145 88,262 5,819,130 20,423,657 Total 12,781,868 14,608,289 Other Total 26,909,243 79,182, ,707 26,910,141 79,217,911 Total Administrative Total 24,065,450 65,151,175 4,231,205 10,957,699 28,296,655 76,108,874 (1,386,514) 3,109,037 (490,210) 1,216,319 (896,304) 1,892,718 (1,387,412) 3,073,330 9,472 39,670

29 Ohio Hospital Association Ohio Health Insuring Corporations Report SummaCare, Inc. SummaCare, Inc. 6,798,514 25,680,910 Total Current Total Other Total 18,912,991 32,536,741 69,334,865 72,791,927 88,247, ,328,668 Total Current Total Other Total 35,962,347 74,114,367 88, ,988 36,050,540 74,746,355 Total 52,197,316 30,582,313 Other Total 255,417, ,513,253 29,315,201 1,420, ,732, ,934,164 Total Administrative Total 218,409, ,239,851 60,473,534 30,420, ,883, ,660,090 5,849,142 12,274,074 1,974,225 3,158,887 3,874,917 9,115,187 4,393,889 10,916,274 24,556 28,447

30 Ohio Hospital Association Ohio Health Insuring Corporations Report UnitedHealthcare Community Plan of Ohio, Inc. UnitedHealthcare Community Plan of Ohio, Inc. (3,974,297) 348,237 Total Current Total Other Total 99,858, ,776,452 63,548, ,933, ,407, ,709,888 Total Current Total Other Total 54,455, ,520,917 1,651, ,642 56,107, ,894,559 Total 107,299, ,815,329 Other Total 531,028, ,284,400-3,292,567 2,477, ,321, ,761,655 Total Administrative Total 392,390, ,806,915 85,860, ,131, ,251, ,938,586 56,069,629 34,823,069 19,828,336 12,640,119 36,241,293 22,182,950 54,422,120 33,420, , ,699

31 Ohio Hospital Association Ohio Health Insuring Corporations Report UnitedHealthcare of Ohio, Inc. UnitedHealthcare of Ohio, Inc. (3,263,294) (5,098,373) Total Current Total Other Total 81,835,214 63,840, ,540, ,499, ,376, ,340,105 Total Current Total Other Total 131,073, ,685,571 2,567,880 1,041, ,641, ,727,230 Total 122,734, ,612,875 Other Total 930,046,289 1,037,016,418 1,643,623 10,525, ,689,912 1,047,542,041 Total Administrative Total 782,361, ,634,154 98,326, ,427, ,687,977 1,043,061,192 51,001,935 4,480,849 16,676, ,304 34,324,988 3,935,545 45,393,291 (1,936,735) 95, ,436

32 Ohio Hospital Association Ohio Health Insuring Corporations Report Wellcare of Ohio, Inc. Wellcare of Ohio, Inc. 47,170,012 32,951,988 Total Current Total Other Total 92,549,240 60,972,629 3,476,749 2,730,917 96,025,989 63,703,546 Total Current Total Other Total 41,681,519 21,409, ,476 27,603 41,813,995 21,437,253 Total 54,211,994 42,266,293 Other Total 313,925, ,562, , , ,169, ,778,909 Total Administrative Total 245,897, ,235,844 57,993,398 28,585, ,891, ,821,042 10,277,797 10,957,867 3,485,759 3,426,982 6,792,038 7,530,885 10,033,979 10,741, ,150 4,717