2015 Report on Availability and Affordability of Health Care Medical Professional Liability Insurance in Maryland

Transcription

1 215 Report on Availability and Affordability of Health Care Medical Professional Liability Insurance in Maryland October 215 MSAR 2976

2 Table of Contents Executive Summary...1 Introduction...2 Medical Malpractice Insurance Market...2 Medical Malpractice Insurance Premiums...3 Closed Claims...5 Conclusion...5 Exhibit List...7

3 Executive Summary The availability and the cost of medical professional liability insurance (hereinafter medical malpractice insurance ) have far-reaching consequences for Maryland s health care system. When dramatic premium increases threatened to undermine Maryland s health care system, the General Assembly intervened in 24 and 25 to stabilize the medical malpractice insurance market and, in addition, directed the Maryland Insurance Administration ( MIA ) to collect pertinent data about medical malpractice insurance. The data is summarized in Exhibits A through L. Medical malpractice insurance is available from admitted insurers, surplus lines insurers and risk retention groups. The number of companies offering medical malpractice insurance in Maryland has remained relatively stable but highly concentrated. In 214, two insurer groups wrote just over 6 percent of all medical malpractice insurance premiums. Medical malpractice insurance can be a highly volatile line of business. The insurance premiums increased significantly between 22 and 25 then decreased or remained the same through 214. The largest writer of medical malpractice insurance has not requested any changes to its rates in

4 Introduction The availability and the cost of medical malpractice insurance have far-reaching consequences for Maryland s health care system. While health care providers are not required by law to purchase and maintain medical malpractice insurance, providers cannot participate in health care networks supporting preferred provider organizations, health maintenance organizations or managed care organizations unless they carry medical malpractice insurance. The cost of the insurance is a part of the overall practice costs for providers. Medical malpractice insurance premiums began to increase in 22 and jumped dramatically in 23 and 24. Due to the widespread implications of medical malpractice insurance, the General Assembly intervened in 24 and 25 to stabilize this market. In addition, the General Assembly directed the Maryland Insurance Administration ( MIA ) to collect data on closed claims and to report annually pertinent facts about this important line of insurance. This report provides information about the number of insurers actively writing medical malpractice insurance, the premium rates for selected medical specialties, and data regarding closed medical malpractice claims. Medical Malpractice Insurance Market Different types of companies are authorized to write medical malpractice insurance in the State. These include admitted insurers, surplus lines insurers and risk retention groups. These companies provide medical malpractice insurance for all types of health care providers. 1 In 214, 7 insurer groups wrote medical malpractice 1 Refer to the MIA s Comparison Guide to Medical Professional Liability Insurance Rates ( Comparison Guide ) for a detailed listing of insurers and premiums across the State. 2

5 insurance in Maryland. Exhibits A1 through A3 provide detailed information about these insurer groups. Two companies, Medical Mutual Liability Insurance Society of Maryland ( Medical Mutual ) and MCIC VT INC RRG ( MCIC ), wrote just over 6 percent of all medical malpractice insurance premiums in 214. Medical Mutual is an admitted insurer created by the General Assembly. 2 MCIC is a risk retention group organized under Vermont law and is a non-admitted insurer. 3 Medical Mutual wrote percent and MCIC wrote 19.9 percent of all medical malpractice insurance in 214. Exhibit A4 shows the percentage of medical malpractice insurance premium written by the top four companies from 2 through 214. Medical Mutual s market share has exceeded 4 percent every year from 24 through 214, but decreased by 6.5 percentage points from 213 to 214. Medical Malpractice Insurance Premiums Medical malpractice insurance premiums increased dramatically between 22 and 25. In response to these increases, the General Assembly created the Maryland Health Care Rate Stabilization Fund which operated to subsidize medical malpractice insurance premiums paid by eligible health care providers to admitted insurers that elected to participate in the program through calendar year 28. Exhibit A5 shows the percentage change in Medical Mutual s rates between 1996 and 215. Medical malpractice insurance premiums increased the most between 22 and 25 then decreased or remained the same through 211. Medical Mutual requested 2 See Chapter 544, Section 1, Laws of Maryland, Examples of the risks insured by risk retention groups are the Johns Hopkins Hospital network and the University of Maryland. 3

6 and implemented a rate increase (4 percent) for 212, but has made no changes to its rates since. Medical malpractice insurance premiums vary by specialty, policy limits and practice location. Exhibits B through E provide premium comparisons for 18 different specialties utilizing a base premium for policy limits of $1 million per incident/$3 million annual aggregate for the years 211 through 215. Although the premium may differ for a given company in a given specialty, overall these Exhibits indicate stability in medical malpractice insurance premiums over this time period. These Exhibits also highlight the differences in premiums between companies. To assist providers in shopping for medical malpractice insurance, the MIA annually updates the Comparison Guide. This guide is available on the Maryland Insurance Administration s website, as well as in brochure form. The Comparison Guide allows health care providers to compare general pricing among the major admitted insurers, surplus lines insurers and risk retention groups offering medical malpractice insurance in Maryland. Coverage terms, such as the deductible, impact the premium for medical malpractice insurance. By law, medical malpractice insurers are required to offer policies high deductibles: $25,, $5, and $1,. Exhibits H and I show that policies these deductibles have not been attractive to providers. However, these Exhibits also show that health care providers do, on occasion, purchase policies deductibles less than $25,. Typically, liability insurance policies, including medical malpractice insurance policies, are issued out deductibles. 4

7 Closed Claims One of the factors driving medical malpractice insurance premiums is claim frequency. Since 26, admitted insurers have been required to submit certain closed claim information on a quarterly basis to the MIA. 4 Exhibit J summarizes the data provided to the MIA by company and Exhibit K summarizes the data by specialty. While closed claims increased overall by 76.6% from 25 to 214, there are yearly fluctuations. Some of the fluctuation may be attributable to the manner in which this data has been collected by the MIA; 5 however, from 28 through 214, the period of time in which data has been collected uniformly, the number of closed claims increased overall by 29.2 percent. The percentage increase differs significantly among the types of insurers writing coverage: 2.8 percent for admitted insurers, percent for surplus lines insurers and 43.8 percent for risk retention groups. Surplus lines insurers generally provide coverage for higher-risk health care professionals (e.g. those prior or poor loss history); therefore, it is anticipated that more claims will be filed against these providers and more claims closed by these insurers.. The overall closed claim information shows a sharp rise in closed claim data for the period from 21 to 213; going from 789 closed claims in 21 to 1328 in 213. This increase was driven primarily by the number of closed cardiology claims during the same time period. The cardiology closed claims dropped off in 214 resulting in the 214 overall closed claim data decreasing to a level more reflective of year The total number of suits is also reported by company. See Exhibit L. As this Exhibit shows, the total number of suits filed are less than the total number of closed claims. 5 The MIA had initially used one form of on-line reporting, but that tool became unworkable. Since 29, the data has been collected using a different tool that enables the MIA to access and query the data more easily. This change in systems may have resulted in a change in data collection. 5

8 Conclusion The number of companies offering medical malpractice insurance in Maryland has remained relatively stable over time, and the premiums have remained relatively stable from 26 through 214. There was an average premium increase of 4 percent for the largest underwriter of medical malpractice insurance in the State in 212; however, no rate changes were made in 213, 214 or 215. Though it appears claims have increased significantly between 25 and 214, due to changes in data collection methodology, little credence can be given to the percentage increase over the entire period, however between the periods of 28 to 214, data was collected uniformly and the number of closed claims increased overall by 29.2 percent. The overall closed claim data shows a sharp rise in closed claim data for the period from 21 to 213; going from 789 closed claims in 21 to 1328 in 213 driven by the rise in cardiology claims during the same period. In 214, overall closed claim data decreased to a level more reflective of year 21. 6

9 EXHIBIT LIST Exhibit A1 Exhibit A2 Exhibit A3 Exhibit A4 - Page Medical Professional Liability Premiums by Insurance Group Change in Written Premium by Insurance Group by Type of License from 213 to Market Share of the Nine Largest Admitted Carriers 214 Market Share of the Top Nine Carriers (Including Surplus Lines and RRG's) Market Share of the Top Carriers from 2 to 214 (Based on 214 Market Share) Exhibit A4 - Page 2 Industry and MMLIS Written Premiums (in Millions) from 2 to 214 Includes Surplus Lines and RRG's Change in Written Premium from the Prior Year for the Industry and MMLIS Exhibit A4 - Page 3 Market Share by License Type from 2 to 214 Exhibit A5 Medical Mutual Rate Change History from 1996 to 215 Exhibit B Rate Comparison Charts for Certain Physician Classes from 211 to 215 Exhibit C Rate Comparison Charts for Certain Surgeon Classes from 211 to 215 Exhibit D Rate Comparison Charts for Psychiatrist (Including Child) Class from 211 to 215 Exhibit E Rate Comparison Charts for Certain Nursing Classes from 211 to 215 Exhibit F Rate Comparison Charts for Physical Therapists (Employed) from 211 to 215 Exhibit G Rate Comparison Charts for Dentist Class from 211 to 215 Exhibit H Exhibit I of Admitted Policies Amounts Mandated under Section of the Insurance Article of Policies All Other Types of s, Including Surplus Lines Policies Exhibit J Closed Claim Counts by Company from 25 to 214 Exhibit K of Closed Claims by Specialty from 25 to 214 Exhibit L of Suits Filed by Jurisdiction and Venue from 25 to 214

10 214 Medical Professional Liability Premiums by Insurance Group Exhibit A1 Page Premium Rank 214 Market Share 214 Admitted Premium 214 Surplus Lines Premiums 214 Group Code 214 Group Name 214 Insurance Group Premium 214 RRG Premium MEDICAL INS OF MD GRP 112,596, % 112,596,183 2 MCIC VT A RECIP RRG 52,142, % 52,142, DOCTORS CO GRP 22,655, % 2,72,629 1,952, PROASSURANCE CORP GRP 17,23, % 16,572, , BERKSHIRE HATHAWAY GRP 8,68, % 7,744,63 935, CNA INS GRP 8,288, % 7,152,27 1,136, AMERICAN INTL GRP 4,362, % 1,67,876 3,294, WHITE MOUNTAINS GRP 3,971, % 19,429 3,861, IRONSHORE GRP 3,81, % 3,81, ALLIED WORLD ASSUR HOLDING GRP 3,491, % 1,741,895 1,749,97 11 HEALTHCARE PROVIDERS INS EXCH 3,192, % 3,192, ALLEGHANY GRP 2,573,24.94% 1,682,258 89, ACE LTD GRP 2,52,127.92% 1,795,28 77,99 14 PREFERRED PHYSICIANS MEDICAL RRG 2,273,155.83% 2,273, MARKEL CORP GRP 2,238,513.82% 2,238, COVERYS GRP 1,842,381.67% 1,842, NORCAL GRP 1,74,14.64% 1,65, , NATIONAL GRP 1,679,93.62% 287,344 1,392, LIBERTY MUT GRP 1,384,839.51% 1,38, , RLI INS GRP 1,358,815.5% 1,358, ZURICH INS GRP 1,315,869.48% 1,315, WR BERKLEY CORP GRP 1,28,617.47% 47,84 1,232, ENSTAR GRP 1,188,242.44% 1,188, MUNICH RE GRP 1,87,947.4% 96, , ASPEN INS HOLDING GRP 1,68,38.39% 865,13 23, OPHTHALMIC MUT INS CO RRG 1,53,474.39% 1,53, ARCH INS GRP 837,118.31% 837, CINCINNATI FIN GRP 815,392.3% 88,591 6,81

11 214 Medical Professional Liability Premiums by Insurance Group Exhibit A1 Page Premium Rank 214 Market Share 214 Admitted Premium 214 Surplus Lines Premiums 214 Group Code 214 Group Name 214 Insurance Group Premium 214 RRG Premium NCMIC GRP 779,687.29% 779, CATLIN US INS GRP 7,358.26% 7, THE MUTUAL RRG INC 65,416.22% KINSALE INS CO 577,913.21% 577, CARING COMMUNITIES RECIP RRG 493,598.18% ORTHOFORUM INS CO RRG 35,31.13% 35,31 35 LANCET IND RRG INC 344,383.13% ALLIED PROFESSIONALS INS CO RRG 33,647.12% 33, OCEANUS INS CO A RRG 32,568.11% CAPSON PHYSICIANS INS CO 258,841.9% 258, AMERICAN ASSOC OF OTHODONTISTS RRG 23,64.7% APPLIED MEDICO LEGAL SOLUTIONS RRG 23,24.7% 23, JAMES RIVER GRP 155,146.6% 155, PEACE CHURCH RRG INC 146,784.5% 146, THE HANOVER INS GRP 114,274.4% 12,73 11, CHURCH MUT INS CO 12,772.4% 12, * NAVIGATORS GRP 74,472.3% 74, SUNLAND RRG INC 72,55.3% 72, CHUBB INC GRP 72,.3% 72, 48 CONTINUING CARE RRG INC 71,41.3% 71,41 49 CARE RRG INC 66,539.2% NATIONAL MEDICAL PROFESSIONAL RRG IN 66,26.2% 66,26 51 GREEN HILLS INS CO RRG 53,594.2% STATE FARM GRP 51,621.2% 51, HALLMARK FIN SERV GRP 45,869.2% 45, WESTERN WORLD GRP 45,349.2% 45, ALLIANZ INS GRP 44,939.2% 18,674 26, FAIRWAY PHYSICIANS INS CO RRG 4,148.1% 4,148

12 214 Medical Professional Liability Premiums by Insurance Group Exhibit A1 Page Premium Rank 214 Market Share 214 Admitted Premium 214 Surplus Lines Premiums 214 Group Code 214 Group Name 214 Insurance Group Premium 214 RRG Premium 57 * PHYSICIANS CAS RRG INC 38,86.1% PHARMACISTS MUT GRP 36,.1% 36, ARGONAUT GRP 17,35.1% 17, AFFILIATES RISK GRP 11,477.% 11, URGENT CARE ASSUR CO RRG INC 1,74.% * AMERICAN FINANCIAL GRP 7,929.% 7, WELLSPAN RRG 5,.% * TOKIO MARINE HOLDINGS INC GRP 4,215.% 4, * ACADEMIC MEDICAL PROFESSIONALS INS E 2,762.% 2, AMERICAN EXCESS INS EXCH RRG 95.% * NATIONAL GUARDIAN RRG INC 885.% * CENTRAL PA PHYSICIANS RRG INC 676.% FAIRFAX FIN GRP -3,566.% -3, DOCTORS & SURGEONS NATL RRG INC -8,37.% -8,37 * - Indicates company is new from 213 to 214 The following companies had premium in 213, but not in 214: CHRISTUS HLTH GRP (Merged Coverys Group - Rank 16) MEDSTAR HLTH GRP EVEREST REINS HOLDINGS GRP QBE INS GRP Industry Totals 273,133, ,744,271 31,116,73 6,272, % 12.5% 24.2%

13 Change in Written Premium by Insurance Group by Type of License from 213 to 214 Exhibit A2 Page Premium Rank Surplus Lines Premium 214 Group Code 214 Group Name 214 Insurance Group Premium Group Premium Admitted Premium RRG Premium MEDICAL INS OF MD GRP 112,596, % -5.19% n/a n/a 2 MCIC VT A RECIP RRG 52,142,89 8.4% n/a n/a 8.4% DOCTORS CO GRP 22,655, % -1.77% 65.98% n/a PROASSURANCE CORP GRP 17,23, % 3.93% 72.6% n/a 5 31 BERKSHIRE HATHAWAY GRP 8,68, % % -6.42% n/a CNA INS GRP 8,288, % 4.2% 6.69% n/a 7 12 AMERICAN INTL GRP 4,362, % 2.75% 7.48% n/a WHITE MOUNTAINS GRP 3,971,77 6.8% 55.5% 5.86% n/a IRONSHORE GRP 3,81, % n/a 6.39% n/a ALLIED WORLD ASSUR HOLDING GRP 3,491, % -6.59% 11.56% n/a 11 HEALTHCARE PROVIDERS INS EXCH 3,192, % 1.11% n/a n/a ALLEGHANY GRP 2,573, % 13.76% 1.64% n/a ACE LTD GRP 2,52, % -2.96% % n/a 14 PREFERRED PHYSICIANS MEDICAL RRG 2,273, % n/a n/a 9.66% MARKEL CORP GRP 2,238, % n/a -4.94% n/a COVERYS GRP 1,842, % % n/a n/a NORCAL GRP 1,74, % % n/a n/a NATIONAL GRP 1,679, % 9.92% n/a -1.96% LIBERTY MUT GRP 1,384, %.53% 26.65% n/a RLI INS GRP 1,358, % n/a 24.78% n/a ZURICH INS GRP 1,315, % -1.% % n/a WR BERKLEY CORP GRP 1,28, % 61.78% 36.4% n/a ENSTAR GRP 1,188, % n/a 51.3% n/a MUNICH RE GRP 1,87, % -5.73% 17.97% n/a ASPEN INS HOLDING GRP 1,68, % % 95.36% n/a 26 OPHTHALMIC MUT INS CO RRG 1,53, % n/a n/a 7.57% ARCH INS GRP 837, % n/a 2.91% n/a CINCINNATI FIN GRP 815, % -.65% 16.7% n/a

14 Change in Written Premium by Insurance Group by Type of License from 213 to 214 Exhibit A2 Page Premium Rank Surplus Lines Premium 214 Group Code 214 Group Name 214 Insurance Group Premium Group Premium Admitted Premium RRG Premium NCMIC GRP 779, % 3.12% n/a n/a CATLIN US INS GRP 7, % n/a % n/a 31 THE MUTUAL RRG INC 65, % n/a n/a % 32 KINSALE INS CO 577, % n/a -1.65% n/a 33 CARING COMMUNITIES RECIP RRG 493, % n/a n/a % 34 ORTHOFORUM INS CO RRG 35, % n/a n/a -2.53% 35 LANCET IND RRG INC 344, % n/a n/a 48.86% 36 ALLIED PROFESSIONALS INS CO RRG 33, % n/a n/a 6.88% 37 OCEANUS INS CO A RRG 32, % n/a n/a -7.53% 38 CAPSON PHYSICIANS INS CO 258, % % n/a n/a 39 AMERICAN ASSOC OF OTHODONTISTS RRG 23, % n/a n/a % 4 APPLIED MEDICO LEGAL SOLUTIONS RRG 23, % n/a n/a % JAMES RIVER GRP 155, % n/a -59.3% n/a 42 PEACE CHURCH RRG INC 146,784.42% n/a n/a.42% THE HANOVER INS GRP 114, % % % n/a 44 CHURCH MUT INS CO 12, % 33.15% n/a n/a * NAVIGATORS GRP 74,472 n/a n/a n/a n/a 46 SUNLAND RRG INC 72, % n/a n/a % CHUBB INC GRP 72, -3.24% n/a -1.% n/a 48 CONTINUING CARE RRG INC 71, % n/a n/a 21.18% 49 CARE RRG INC 66,539 6.% n/a n/a 6.% 5 NATIONAL MEDICAL PROFESSIONAL RRG IN 66, % n/a n/a % 51 GREEN HILLS INS CO RRG 53, % n/a n/a % STATE FARM GRP 51, % -.2% n/a n/a HALLMARK FIN SERV GRP 45, % n/a % n/a WESTERN WORLD GRP 45, % n/a 17.44% n/a ALLIANZ INS GRP 44, % 3.85% % n/a 56 FAIRWAY PHYSICIANS INS CO RRG 4, % n/a n/a %

15 Change in Written Premium by Insurance Group by Type of License from 213 to 214 Exhibit A2 Page Premium Rank Surplus Lines Premium 214 Group Code 214 Group Name 214 Insurance Group Premium Group Premium Admitted Premium RRG Premium 57 * PHYSICIANS CAS RRG INC 38,86 n/a n/a n/a n/a PHARMACISTS MUT GRP 36, 8.82% 8.82% n/a n/a ARGONAUT GRP 17, % n/a 28.97% n/a AFFILIATES RISK GRP 11, % n/a n/a -8.11% 61 URGENT CARE ASSUR CO RRG INC 1, % n/a n/a -49.5% * AMERICAN FINANCIAL GRP 7,929 n/a n/a n/a n/a 63 WELLSPAN RRG 5, -37.5% n/a n/a -37.5% * TOKIO MARINE HOLDINGS INC GRP 4,215 n/a n/a n/a n/a 65 * ACADEMIC MEDICAL PROFESSIONALS INS E 2,762 n/a n/a n/a n/a 66 AMERICAN EXCESS INS EXCH RRG 95.% n/a n/a.% 67 * NATIONAL GUARDIAN RRG INC 885 n/a n/a n/a n/a 68 * CENTRAL PA PHYSICIANS RRG INC 676 n/a n/a n/a n/a FAIRFAX FIN GRP -3, % -1.53% n/a n/a 7 DOCTORS & SURGEONS NATL RRG INC -8, % n/a n/a % Industry Totals 273,133, % -.54% 11.73% 57.94% * - Indicates company is new from 213 to 214 The following companies had premium in 213, but not in 214: CHRISTUS HLTH GRP (Merged Coverys Group - Rank 16) MEDSTAR HLTH GRP EVEREST REINS HOLDINGS GRP QBE INS GRP

16 Exhibit A3 214 Market Share of the Nine Largest Admitted Carriers 3.9% 4.3% 1.% 1.% 4.6% 1.% 1.8% MEDICAL INS OF MD GRP DOCTORS CO GRP PROASSURANCE CORP GRP BERKSHIRE HATHAWAY GRP CNA INS GRP 9.1% 11.4% HEALTHCARE PROVIDERS INS EXCH COVERYS GRP ACE LTD GRP 62.% ALLIED WORLD ASSUR HOLDING GRP REMAINING 214 Market Share of the Top Nine Carriers (Including Surplus Lines and RRG's) 1.5% 1.6% 1.4% 14.4% 3.% 3.2% 6.3% 41.2% MEDICAL INS OF MD GRP MCIC VT A RECIP RRG DOCTORS CO GRP PROASSURANCE CORP GRP BERKSHIRE HATHAWAY GRP CNA INS GRP AMERICAN INTL GRP 8.3% WHITE MOUNTAINS GRP IRONSHORE GRP 19.1% REMAINING

17 Exhibit A4 Page 1 Market Share of the Top Carriers from 2 to 214 (Based on 214 Market Share) 6.% 5.% 4.% 3.% 2.% 1.%.% MMLIS 42.9% 42.8% 34.7% 32.5% 4.9% 46.4% 44.1% 43.2% 42.3% 42.1% 43.6% 43.5% 44.6% 47.7% 41.2% MCIC 13.5% 12.2% 18.7% 22.1% 19.1% 17.8% 19.5% 18.4% 2.4% 21.1% 18.% 16.6% 16.1% 11.6% 19.1% Doctors 1.1% 2.% 4.% 5.7% 7.1% 7.5% 7.8% 8.5% 8.9% 7.8% 8.1% 8.1% 7.7% 8.9% 8.3% PRAIC 2.6% 1.3%.1% 3.4% 4.1% 4.2% 4.1% 4.8% 4.2% 5.4% 4.2% 3.8% 4.% 5.2% 6.3% MedPro 1.2% 3.7% 4.5% 6.7% 7.9% 5.4% 5.8% 5.1% 6.1% 5.1% 4.3% 4.1% 4.2% 3.9% 3.2% The four carriers listed above are the four of the five largest carriers based on 214 market share. This does not imply that they are the top 4 of 5 carriers for the entire time period shown above. MMLIS - Medical Mutual Group MCIC - MCIC RRG Vermont Doctors - The Doctors Company MedPro - Medical Protective Insurance Company PRAIC - ProAssurance Group

18 Industry and MMLIS Written Premiums (in Millions) from 2 to 214 Includes Surplus Lines and RRG's Exhibit A4 Page Industry MMLIS Change in Written Premium from the Prior Year for the Industry and MMLIS 4.% 3.% 2.% 1.%.% -1.% -2.% Industry 8.3% 3.8% 24.2% 7.7% 11.4% 8.% -4.4% -6.1% -2.6% -3.8% -1.1%.7% -12.1% 9.8% MMLIS 8.% 5.9% 16.5% 35.2% 26.5% 2.6% -6.3% -8.% -3.2% -.2% -1.4% 3.2% -5.9% -5.2%

19 Exhibit A4 Page 3 Market Share by License Type from % 8.% 7.% 6.% 5.% 4.% 3.% 2.% 1.%.% Admitted 79.6% 76.8% 65.6% 6.8% 65.9% 69.5% 68.7% 7.7% 68.7% 67.1% 67.3% 66.4% 67.9% 73.5% 73.1% Surplus 3.1% 4.9% 11.6% 14.8% 13.7% 11.3% 1.2% 9.3% 9.3% 1.% 12.3% 12.9% 13.4% 11.2% 12.5% RRG 15.1% 13.8% 19.8% 23.3% 2.4% 19.3% 21.% 2.% 22.% 23.% 2.4% 18.9% 18.7% 15.3% 24.2% Other 2.2% 4.5% 2.9% 1.2%.%.%.%.%.%.%.%.%.%.%.% Other License type includes carriers that no longer write medical professional liability and license type cannot, as of the last year of writing business, be determined. This also includes carriers that were in runoff or license suspended/revoked.

20 Exhibit A5 Medical Mutual Rate Change History from 1996 to % 35.% 3.% 28.% 33.% 25.% 2.% 15.% 1.% 9.7% 1.3% 5.%.%.% -1.2%.%.%.%.%.%.% -2.% 4.%.%.%.% -5.% -1.% -6.6% -8.% -8.% -15.% Rate Change -6.6%.% -1.2%.%.% 9.7%.% 1.3%28.%33.%.% -8.% -8.% -2.%.%.% 4.%.%.%.% The above reflects the effective rate change per year. The changes are effective January 1st of each year. There are no pending rate filings for Medical Mutual.

21 Notes for Rate Comparison Charts (Exhibits B through G) The company names have been abbreviated on the charts for readability purposes. Name on Charts Full Company Name Exhibits MMLIS Medical Mutual Liability Insurance Society of Maryland B to F ProAd Professional Advocates Insurance Company (1) G MedPro Medical Protective Insurance Company All TDC The Doctors Company B to E, G PRAIC ProAssurance Indemnity Company All PPIC Preferred Professional Insurance Company All HPIX Healthcare Providers Insurance Exchange B to F Medicus Medicus Insurance Company (2) B, C, D & E MagMut MAG Mutual Insurance Company B, C & D Proselect ProSelect Insurance Company B, C, D & E FAIRCO Fair American Insurance and Reinsurance Company C & D Aspen Aspen Insurance Company (2) B, C & D Capson Capson Insurance Company (2) B, C, D & E Galen Galen Insurance Company (5) All AWAC (3) Allied World Assurance Corporation D & F AIG (4) National Union Fire Insurance Company of Pittsburgh C, E & G Granite State Insurance Company F CNA American Casualty Co of Reading, PA E & F Continental Insurance Company G ACEUSA ACE American Insurance Company E, F & G

22 Notes for Rate Comparison Charts (Exhibits B through G) The company names have been abbreviated on the charts for readability purposes. Name on Charts Full Company Name Exhibits LibertyIU Liberty Insurance Underwriters E, F & G Campmed Campmed Casualty and Indemnity Company D Fortress Fortress Insurance Company G PSIC Professional Solutions Insurance Company G (1) - Member of the Medical Mutual Liability Insurance Society Group (2) - New to 213. (3) - Formerly Darwin National Assurance Company (4) - Known as Chartis in previous year's reports. (5) - New in 215 Notes to Charts 1) Company information not shown if it had no rates for ) Percentage change only shown if company had rates for the entire period 212 to 215.

23 Fam/Gen Prac (No OB) - Minor Surgery Exhibit B Page 1 Baltimore City & Baltimore County 35, 3, 25, 2, 15, 1, 5, MMLIS MedPro TDC PRAIC PPIC HPIX Medicus MAG Mut Proselect Aspen Capson Galen ,77 28,439 26,137 29,883 19,53 29, ,77 28,439 26,47 29,883 19,53 29,222 25,415 25, ,77 28,439 27,35 29,883 19,53 29,222 21,288 25,415 25,324 17,496 24, ,77 28,439 27,35 29,883 19,53 29,222 21,288 25,415 25,324 17,496 24,222 23,965 % chg 12 to 15.%.% 4.6%.%.%.%

24 Fam/Gen Prac (No OB) - Minor Surgery Exhibit B Page 2 Anne Arundel, Howard, Montgomery, Prince George's 3, 25, 2, 15, 1, 5, MMLIS MedPro TDC PRAIC PPIC HPIX Medicus MAG Mut Proselect Aspen Capson Galen ,95 25,276 24,271 27,351 17,752 26, ,95 25,276 24,187 27,351 17,752 26,564 23,237 23, ,95 25,276 25,397 27,351 17,752 26,564 19,351 23,237 23,2 16,38 22, ,95 25,276 25,397 27,351 17,752 26,564 19,351 23,237 23,2 16,38 22,9 21,968 % chg 12 to 15.%.% 4.6%.%.%.%

25 Fam/Gen Prac (No OB) - Minor Surgery Exhibit B Page 3 Rest of State 3, 25, 2, 15, 1, 5, MMLIS MedPro TDC PRAIC PPIC HPIX Medicus ,965 21,64 2,536 24,379 14,452 23, ,965 21,64 2,466 24,379 14,452 23,379 2,629 2,259 MAG Mut Proselect Aspen Capson Galen ,965 21,64 21,489 24,379 14,452 23,379 17,31 2,629 2,259 14,5 19, ,965 21,64 21,489 24,379 14,452 23,379 17,31 2,629 2,259 14,5 19,377 19,971 % chg 12 to 15.%.% 4.6%.%.%.%

26 Fam/Gen Prac (No OB) - No Surgery Exhibit B Page 4 Baltimore City and Baltimore County 25, 2, 15, 1, 5, MMLIS MedPro TDC PRAIC PPIC HPIX Medicus MAG Mut Proselect Aspen Capson Galen ,948 17,775 18,67 2,71 13,2 16, ,948 17,775 18,66 2,71 13,2 16,235 15,946 15, ,948 17,775 19,536 2,71 13,2 16,235 15,769 15,946 15,479 9,72 16, ,948 17,775 19,536 2,71 13,2 16,235 15,769 15,946 15,479 9,72 16,148 14,978 % chg 12 to 15.%.% 4.6%.%.%.%

27 Fam/Gen Prac (No OB) - No Surgery Exhibit B Page 5 Anne Arundel, Howard, Montgomery, Prince George's 2, 15, 1, 5, MMLIS MedPro TDC PRAIC PPIC HPIX Medicus ,498 15,798 16,335 19,22 11,835 14, ,498 15,798 16,279 19,22 11,835 14,758 14,585 14,71 MAG Mut Proselect Aspen Capson Galen ,498 15,798 17,93 19,22 11,835 14,758 14,334 14,585 14,71 8,91 14, ,498 15,798 17,93 19,22 11,835 14,758 14,334 14,585 14,71 8,91 14,727 13,73 % chg 12 to 15.%.% 4.6%.%.%.%

28 Fam/Gen Prac (No OB) - No Surgery Exhibit B Page 6 Rest of State 2, 15, 1, 5, MMLIS MedPro TDC PRAIC PPIC HPIX Medicus MAG Mut Proselect Aspen Capson Galen ,759 13,165 13,581 17,4 9,635 12, ,759 13,165 13,534 17,4 9,635 12,988 12,955 12, ,759 13,165 14,211 17,4 9,635 12,988 12,615 12,955 12,383 8,1 12, ,759 13,165 14,211 17,4 9,635 12,988 12,615 12,955 12,383 8,1 12,918 12,482 % chg 12 to 15.%.% 4.6%.%.%.%

29 Anesthesiology Exhibit B Page 7 Baltimore City and Baltimore County 4, 3, 2, 1, MMLIS MedPro TDC PRAIC PPIC HPIX Medicus MAG Mut Proselect Aspen Capson Galen ,948 19,196 22,54 34,654 2,528 16, ,948 19,196 21,978 34,654 2,528 16,235 18,932 26, ,948 19,196 23,77 34,654 2,528 16,235 18,923 18,932 26,84 17,496 17, ,948 19,196 23,77 34,654 2,528 16,235 18,923 18,932 26,84 17,496 17,44 14,978 % chg 12 to 15.%.% 4.6%.%.%.%

30 Anesthesiology Exhibit B Page 8 Anne Arundel, Howard, Montgomery, Prince George's 4, 3, 2, 1, MMLIS MedPro TDC PRAIC PPIC HPIX Medicus MAG Mut Proselect Aspen Capson Galen ,498 17,62 18,525 31,683 18,66 14, ,498 17,62 18,461 31,683 18,66 14,758 17,367 23, ,498 17,62 19,384 31,683 18,66 14,758 17,21 17,367 23,711 16,38 15, ,498 17,62 19,384 31,683 18,66 14,758 17,21 17,367 23,711 16,38 15,95 13,73 % chg 12 to 15.%.% 4.6%.%.%.%

31 Anesthesiology Exhibit B Page 9 Rest of State 3, 2, 1, MMLIS MedPro TDC PRAIC PPIC HPIX Medicus MAG Mut Proselect Aspen Capson Galen ,759 14,219 15,683 28,195 15,191 12, ,759 14,219 15,629 28,195 15,191 12,988 15,492 2, ,759 14,219 16,41 28,195 15,191 12,988 15,183 15,492 2,867 14,5 13, ,759 14,219 16,41 28,195 15,191 12,988 15,183 15,492 2,867 14,5 13,952 12,482 % chg 12 to 15.%.% 4.6%.%.%.%

32 Dermatology No Surgery Exhibit B Page 1 Baltimore City and Baltimore County 2, 15, 1, 5, MMLIS MedPro TDC PRAIC PPIC HPIX Medicus MAG Mut Proselect Aspen Capson Galen 212 1,47 11,375 14,429 11,536 1,416 1, ,47 11,375 14,379 11,536 1,416 1,227 11,459 14, ,47 11,375 15,98 11,536 1,416 1,227 13,44 11,459 14,75 9,72 12, ,47 11,375 15,98 11,536 1,416 1,227 13,44 11,459 14,75 9,72 12,111 1,484 % chg 12 to 15.%.% 4.6%.%.%.%

33 Dermatology No Surgery Exhibit B Page 11 Anne Arundel, Howard, Montgomery, Prince George's 15, 1, 5, MMLIS MedPro TDC PRAIC PPIC HPIX Medicus MAG Mut Proselect Aspen Capson Galen 212 9,133 1,111 13,115 1,692 9,468 9, ,133 1,111 13,7 1,692 9,468 9,298 1,57 13, ,133 1,111 13,724 1,692 9,468 9,298 12,184 1,57 13,367 8,91 11, ,133 1,111 13,724 1,692 9,468 9,298 12,184 1,57 13,367 8,91 11,45 9,611 % chg 12 to 15.%.% 4.6%.%.%.%

34 Dermatology No Surgery Exhibit B Page 12 Rest of State 15, 1, 5, MMLIS MedPro TDC PRAIC PPIC HPIX Medicus MAG Mut Proselect Aspen Capson Galen 212 8,38 8,426 1,677 9,71 7,78 8, ,38 8,426 1,64 9,71 7,78 8,182 9,365 11, ,38 8,426 11,172 9,71 7,78 8,182 1,723 9,365 11,764 8,1 9, ,38 8,426 11,172 9,71 7,78 8,182 1,723 9,365 11,764 8,1 9,689 8,737 % chg 12 to 15.%.% 4.6%.%.%.%

35 Internal Medicine No Surgery Exhibit B Page 13 Baltimore City and Baltimore County 25, 2, 15, 1, 5, MMLIS MedPro TDC PRAIC PPIC HPIX Medicus MAG Mut Proselect Aspen Capson Galen ,948 17,775 21,3 2,71 13,2 16, ,948 17,775 2,93 2,71 13,2 16,235 18,19 18, ,948 17,775 21,977 2,71 13,2 16,235 15,769 18,19 18,575 11,664 16, ,948 17,775 21,977 2,71 13,2 16,235 15,769 18,19 18,575 11,664 16,148 14,978 % chg 12 to 15.%.% 4.6%.%.%.%

36 Internal Medicine No Surgery Exhibit B Page 14 Anne Arundel, Howard, Montgomery, Prince George's 25, 2, 15, 1, 5, MMLIS MedPro TDC PRAIC PPIC HPIX Medicus MAG Mut Proselect Aspen Capson Galen ,498 15,798 19,64 19,22 11,835 14, ,498 15,798 19,536 19,22 11,835 14,758 16,624 16, ,498 15,798 2,513 19,22 11,835 14,758 14,334 16,624 16,885 1,692 14, ,498 15,798 2,513 19,22 11,835 14,758 14,334 16,624 16,885 1,692 14,727 13,73 % chg 12 to 15.%.% 4.6%.%.%.%

37 Internal Medicine No Surgery Exhibit B Page 15 Rest of State 2, 15, 1, 5, MMLIS MedPro TDC PRAIC PPIC HPIX Medicus MAG Mut Proselect Aspen Capson Galen ,759 13,165 15,87 17,4 9,635 12, ,759 13,165 15,815 17,4 9,635 12,988 14,75 14, ,759 13,165 16,66 17,4 9,635 12,988 12,615 14,75 14,86 9,72 12, ,759 13,165 16,66 17,4 9,635 12,988 12,615 14,75 14,86 9,72 12,918 12,482 % chg 12 to 15.%.% 4.6%.%.%.%

38 Pediatrics No Surgery Exhibit B Page 16 Baltimore City and Baltimore County 3, 25, 2, 15, 1, 5, MMLIS MedPro TDC PRAIC PPIC HPIX Medicus MAG Mut Proselect Aspen Capson Galen ,948 17,775 23,84 2,71 13,2 16, ,948 17,775 23,722 2,71 13,2 16,235 15,946 15, ,948 17,775 24,98 2,71 13,2 16,235 15,769 15,946 15,479 9,72 15, ,948 17,775 24,98 2,71 13,2 16,235 15,769 15,946 15,479 9,72 15,825 14,978 % chg 12 to 15.%.% 4.6%.%.%.%

39 Pediatrics No Surgery Exhibit B Page 17 Anne Arundel, Howard, Montgomery, Prince George's 25, 2, 15, 1, 5, MMLIS MedPro TDC PRAIC PPIC HPIX Medicus MAG Mut Proselect Aspen Capson Galen ,498 15,798 2,31 19,22 11,835 14, ,498 15,798 19,962 19,22 11,835 14,758 14,585 14, ,498 15,798 2,961 19,22 11,835 14,758 14,334 14,585 14,71 8,91 14, ,498 15,798 2,961 19,22 11,835 14,758 14,334 14,585 14,71 8,91 14,432 13,73 % chg 12 to 15.%.% 4.6%.%.%.%

40 Pediatrics No Surgery Exhibit B Page 18 Rest of State 2, 15, 1, 5, MMLIS MedPro TDC PRAIC PPIC HPIX Medicus MAG Mut Proselect Aspen Capson Galen ,759 13,165 16,932 17,4 9,635 12, ,759 13,165 16,874 17,4 9,635 12,988 12,955 12, ,759 13,165 17,718 17,4 9,635 12,988 12,615 12,955 12,383 8,1 12, ,759 13,165 17,718 17,4 9,635 12,988 12,615 12,955 12,383 8,1 12,66 12,482 % chg 12 to 15.%.% 4.6%.%.%.%

41 Radiology (Diagnostic) No Surgery Exhibit B Page 19 Baltimore City and Baltimore County 4, 3, 2, 1, MMLIS MedPro TDC PRAIC PPIC HPIX Medicus ,77 24,883 35,6 25,296 13,2 29, ,77 24,883 34,94 25,296 13,2 29,222 15,946 25,324 MAG Mut Proselect Aspen Capson Galen ,77 24,883 36,687 25,296 13,2 29,222 17,346 15,946 25,324 17,496 24, ,77 24,883 36,687 25,296 13,2 29,222 17,346 15,946 25,324 17,496 24,222 23,965 % chg 12 to 15.%.% 4.6%.%.%.%

42 Radiology (Diagnostic) No Surgery Exhibit B Page 2 Anne Arundel, Howard, Montgomery, Prince George's 4, 3, 2, 1, MMLIS MedPro TDC PRAIC PPIC HPIX Medicus ,95 22,116 31,279 23,186 11,835 26, ,95 22,116 31,171 23,186 11,835 26,564 14,585 23,2 MAG Mut Proselect Aspen Capson Galen ,95 22,116 32,73 23,186 11,835 26,564 15,768 14,585 23,2 16,38 22, ,95 22,116 32,73 23,186 11,835 26,564 15,768 14,585 23,2 16,38 22,9 21,968 % chg 12 to 15.%.% 4.6%.%.%.%

43 Radiology (Diagnostic) No Surgery Exhibit B Page 21 Rest of State 3, 2, 1, MMLIS MedPro TDC PRAIC PPIC HPIX Medicus MAG Mut Proselect Aspen Capson Galen ,965 18,431 26,44 2,71 9,635 23, ,965 18,431 26,35 2,71 9,635 23,379 12,955 2, ,965 18,431 27,667 2,71 9,635 23,379 13,877 12,955 2,259 14,5 19, ,965 18,431 27,667 2,71 9,635 23,379 13,877 12,955 2,259 14,5 19,377 19,971 % chg 12 to 15.%.% 4.6%.%.%.%

44 Emergency Medicine - Inc. Major Surgery Exhibit C Page 1 Baltimore City and Baltimore County 8, 7, 6, 5, 4, 3, 2, 1, MMLIS MedPro TDC PRAIC PPIC HPIX Medicus MagMut Proselect Aspen Capson Galen ,462 54,58 5,2 52,579 52,786 68,673 n/a ,462 54,58 49,83 52,579 52,786 68,673 n/a 47, ,462 54,58 52,322 52,579 52,786 68,673 52,827 n/a 47,973 61,236 61, ,462 54,58 52,322 52,579 52,786 68,673 52,827 n/a 47,973 61,236 61,363 61,411 % chg 12 to 15.%.% 4.6%.%.%.%

45 Emergency Medicine - Inc. Major Surgery Exhibit C Page 2 Anne Arundel, Howard, Montgomery, Prince George's 7, 6, 5, 4, 3, 2, 1, MMLIS MedPro TDC PRAIC PPIC HPIX Medicus MagMut Proselect Aspen Capson Galen ,323 48,447 44,68 47,959 47,982 62,425 n/a ,323 48,447 44,454 47,959 47,982 62,425 n/a 43, ,323 48,447 46,677 47,959 47,982 62,425 48,2 n/a 43,61 56,133 55, ,323 48,447 46,677 47,959 47,982 62,425 48,2 n/a 43,61 56,133 55,961 56,294 % chg 12 to 15.%.% 4.6%.%.%.%

46 Emergency Medicine - Inc. Major Surgery Exhibit C Page 3 Rest of State 6, 5, 4, 3, 2, 1, MMLIS MedPro TDC PRAIC PPIC HPIX Medicus MagMut Proselect Aspen Capson Galen ,97 4,374 37,76 42,536 39,61 54,938 n/a ,97 4,374 37,577 42,536 39,61 54,938 n/a 38, ,97 4,374 39,456 42,536 39,61 54,938 42,261 n/a 38,378 51,3 49, ,97 4,374 39,456 42,536 39,61 54,938 42,261 n/a 38,378 51,3 49,89 51,176 % chg 12 to 15.%.% 4.6%.%.%.%

47 Emergency Medicine (No Major Surgery) Exhibit C Page 4 Baltimore City and Baltimore County 6, 5, 4, 3, 2, 1, MMLIS MedPro TDC PRAIC PPIC HPIX Medicus MagMut Proselect Aspen Capson Galen ,872 48,452 5,2 2,71 28,643 4, ,872 48,452 49,83 2,71 28,643 4,587 35,631 36, ,872 48,452 52,322 2,71 28,643 4,587 26,88 35,631 36,68 31,59 3, ,872 48,452 52,322 2,71 28,643 4,587 26,88 35,631 36,68 31,59 3,682 41,94 % chg 12 to 15.%.% 4.6%.%.%.%

48 Emergency Medicine (No Major Surgery) Exhibit C Page 5 Anne Arundel, Howard, Montgomery, Prince George's 5, 45, 4, 35, 3, 25, 2, 15, 1, 5, MMLIS MedPro TDC PRAIC PPIC HPIX Medicus MagMut Proselect Aspen Capson Galen ,243 43,63 44,68 19,22 26,37 36, ,243 43,63 44,454 19,22 26,37 36,894 32,569 33, ,243 43,63 46,677 19,22 26,37 36,894 24,368 32,569 33,278 28,958 27, ,243 43,63 46,677 19,22 26,37 36,894 24,368 32,569 33,278 28,958 27,981 38,445 % chg 12 to 15.%.% 4.6%.%.%.%

49 Emergency Medicine (No Major Surgery) Exhibit C Page 6 Rest of State 45, 4, 35, 3, 25, 2, 15, 1, 5, MMLIS MedPro TDC PRAIC PPIC HPIX Medicus MagMut Proselect Aspen Capson Galen ,897 35,887 37,76 17,4 21,196 32, ,897 35,887 37,577 17,4 21,196 32,47 28,91 29, ,897 35,887 39,456 17,4 21,196 32,47 21,446 28,91 29,286 26,325 24, ,897 35,887 39,456 17,4 21,196 32,47 21,446 28,91 29,286 26,325 24,545 34,95 % chg 12 to 15.%.% 4.6%.%.%.%

50 Obstetrics/Gynecology - Surgery Exhibit C Page 7 Baltimore City and Baltimore County 18, 16, 14, 12, 1, 8, 6, 4, 2, MMLIS MedPro TDC PRAIC PPIC HPIX Medicus MagMut Proselect Aspen Capson Galen , , ,17 158,317 19,97 133, , , ,8 158,317 19,97 133, ,14 137, , , , ,317 19,97 133,127 71,75 115,14 137,97 139,725 14, , , , ,317 19,97 133,127 71,75 115,14 137,97 139,725 14, ,836 % chg 12 to 15.%.% 1.1%.%.%.%

51 Obstetrics/Gynecology - Surgery Exhibit C Page 8 Anne Arundel, Howard, Montgomery, Prince George's 16, 14, 12, 1, 8, 6, 4, 2, MMLIS MedPro TDC PRAIC PPIC HPIX Medicus MagMut Proselect Aspen Capson Galen ,876 1,929 19, ,969 99, , ,876 1,929 12,85 143,969 99, ,12 14, , ,876 1,929 17, ,969 99, ,12 65,221 14, , ,81 95, ,876 1,929 17, ,969 99, ,12 65,221 14, , ,81 95,724 14,349 % chg 12 to 15.%.% 1.1%.%.%.%

52 Obstetrics/Gynecology - Surgery Exhibit C Page 9 Rest of State 14, 12, 1, 8, 6, 4, 2, MMLIS MedPro TDC PRAIC PPIC HPIX Medicus MagMut Proselect Aspen Capson Galen ,622 84,111 88,68 127,126 81,378 16, ,622 84,111 83,51 127,126 81,378 16,51 92,76 19, ,622 84,111 87, ,126 81,378 16,51 57,4 92,76 19, ,438 83, ,622 84,111 87, ,126 81,378 16,51 57,4 92,76 19, ,438 83,968 94,863 % chg 12 to 15.%.% 1.1%.%.%.%

53 Neurology (including child) - Surgery Exhibit C Page 1 Baltimore City and Baltimore County 18, 16, 14, 12, 1, 8, 6, 4, 2, MMLIS MedPro TDC PRAIC PPIC HPIX Medicus MagMut Proselect Aspen Capson Galen AIG , , , ,869 19,97 1,981 n/a 26, , , , ,869 19,97 1,981 n/a 116,897 26, , ,641 17,39 118,869 19,97 1, ,538 n/a 116,897 16,434 14,963 26, , ,641 17,39 118,869 19,97 1, ,538 n/a 116,897 16,434 14, ,836 26,913 % chg 12 to 15.%.% 4.6%.%.%.%.%

54 Neurology (including child) - Surgery Exhibit C Page 11 Anne Arundel, Howard, Montgomery, Prince George's 16, 14, 12, 1, 8, 6, 4, 2, MMLIS MedPro TDC PRAIC PPIC HPIX Medicus MagMut Proselect Aspen Capson Galen AIG 212 9,172 19,4 145,198 18,151 99,963 91,792 n/a 24, ,172 19,4 144,7 18,151 99,963 91,792 n/a 16,264 24, ,172 19,4 151,935 18,151 99,963 91,792 13,26 n/a 16,264 97,565 95,724 24, ,172 19,4 151,935 18,151 99,963 91,792 13,26 n/a 16,264 97,565 95,724 14,349 24,464 % chg 12 to 15.%.% 4.6%.%.%.%.%

55 Neurology (including child) - Surgery Exhibit C Page 12 Rest of State 14, 12, 1, 8, 6, 4, 2, MMLIS MedPro TDC PRAIC PPIC HPIX Medicus MagMut Proselect Aspen Capson Galen AIG ,359 9, ,733 95,568 81,378 8,785 n/a 21, ,359 9, ,312 95,568 81,378 8,785 n/a 93,516 21, ,359 9, ,428 95,568 81,378 8,785 9,831 n/a 93,516 88,695 83,968 21, ,359 9, ,428 95,568 81,378 8,785 9,831 n/a 93,516 88,695 83,968 94,863 21,53 % chg 12 to 15.%.% 4.6%.%.%.%.%

56 Neurology (including child) - Minor Surgery Exhibit C Page 13 Baltimore City and Baltimore County 45, 4, 35, 3, 25, 2, 15, 1, 5, MMLIS MedPro TDC PRAIC PPIC HPIX Medicus MagMut Proselect Aspen Galen Capson FAIRCO AIG Series1 28,77 39,367 3,954 29,883 19,53 29,222 26,913 Series2 28,77 39,367 3,848 29,883 19,53 29,222 2,928 35,849 26,324 26,913 Series3 28,77 39,367 32,39 29,883 19,53 29,222 21,288 2,928 35,849 18,954 29,67 26,324 26,913 Series4 28,77 39,367 32,39 29,883 19,53 29,222 21,288 2,928 35,849 18,954 29,67 23,965 26,324 26,913 Series5.%.% 4.6%.%.%.%.%

57 Neurology (including child) - Minor Surgery Exhibit C Page 14 Anne Arundel, Howard, Montgomery, Prince George's 4, 35, 3, 25, 2, 15, 1, 5, MMLIS MedPro TDC PRAIC PPIC HPIX Medicus MagMut Proselect Aspen Galen Capson FAIRCO AIG Series1 26,95 34,99 27,614 27,351 17,752 26,564 24,464 Series2 26,95 34,99 27,519 27,351 17,752 26,564 19,159 32,588 23,875 24,464 Series3 26,95 34,99 28,895 27,351 17,752 26,564 19,351 19,159 32,588 17,375 26,58 23,875 24,464 Series4 26,95 34,99 28,895 27,351 17,752 26,564 19,351 19,159 32,588 17,375 26,58 21,968 23,875 24,464 Series5.%.% 4.6%.%.%.%.%

58 Neurology (including child) - Minor Surgery Exhibit C Page 15 Rest of State 35, 3, 25, 2, 15, 1, 5, MMLIS MedPro TDC PRAIC PPIC HPIX Medicus MagMut Proselect Aspen Galen Capson FAIRCO AIG ,965 29,159 23,342 24,379 14,452 23,379 21, ,965 29,159 23,262 24,379 14,452 23,379 17,39 28,679 2,894 21, ,965 29,159 24,426 24,379 14,452 23,379 17,31 17,39 28,679 15,795 23,253 2,894 21, ,965 29,159 24,426 24,379 14,452 23,379 17,31 17,39 28,679 15,795 23,253 19,971 2,894 21,53 % chg 12 to 15.%.% 4.6%.%.%.%.%

59 Cardiovascular Disease - Surgery Exhibit C Page 16 Baltimore City and Baltimore County 9, 8, 7, 6, 5, 4, 3, 2, 1, MMLIS MedPro TDC PRAIC PPIC HPIX Medicus MagMut Proselect Aspen Capson Galen ,462 6,564 32,799 81,257 58,651 68, ,462 6,564 32,687 81,257 58,651 68,673 25,415 67, ,462 6,564 34,322 81,257 58,651 68,673 52,827 25,415 67,344 61,236 61, ,462 6,564 34,322 81,257 58,651 68,673 52,827 25,415 67,344 61,236 61,363 61,411 % chg 12 to 15.%.% 4.6%.%.%.%

60 Cardiovascular Disease - Surgery Exhibit C Page 17 Anne Arundel, Howard, Montgomery, Prince George's 8, 7, 6, 5, 4, 3, 2, 1, MMLIS MedPro TDC PRAIC PPIC HPIX Medicus MagMut Proselect Aspen Capson Galen ,323 53,829 29,261 73,998 53,314 62, ,323 53,829 29,161 73,998 53,314 62,425 23,237 61, ,323 53,829 3,619 73,998 53,314 62,425 48,2 23,237 61,219 56,133 55, ,323 53,829 3,619 73,998 53,314 62,425 48,2 23,237 61,219 56,133 55,961 56,294 % chg 12 to 15.%.% 4.6%.%.%.%

61 Cardiovascular Disease - Surgery Exhibit C Page 18 Rest of State 7, 6, 5, 4, 3, 2, 1, MMLIS MedPro TDC PRAIC PPIC HPIX Medicus MagMut Proselect Aspen Capson Galen ,97 44,859 24,733 65,478 43,42 54, ,97 44,859 24,648 65,478 43,42 54,938 2,629 53, ,97 44,859 25,881 65,478 43,42 54,938 42,261 2,629 53,875 51,3 49, ,97 44,859 25,881 65,478 43,42 54,938 42,261 2,629 53,875 51,3 49,89 51,176 % chg 12 to 15.%.% 4.6%.%.%.%

62 Orthopedic Surgery Exhibit C Page 19 Baltimore City and Baltimore County 1, 9, 8, 7, 6, 5, 4, 3, 2, 1, MMLIS MedPro TDC PRAIC PPIC HPIX Medicus MagMut Proselect Aspen Capson Galen 212 6,64 6,564 63,844 66,579 58,651 61, ,64 6,564 6,123 66,579 58,651 61,692 59,38 87, ,64 6,564 63,13 75,752 58,651 61,692 52,827 59,38 87,689 51,3 61, ,64 6,564 63,13 75,752 58,651 61,692 52,827 59,38 87,689 51,3 61,363 67,43 % chg 12 to 15.%.% 1.1% 13.8%.%.%

63 Orthopedic Surgery Exhibit C Page 2 Anne Arundel, Howard, Montgomery, Prince George's 9, 8, 7, 6, 5, 4, 3, 2, 1, MMLIS MedPro TDC PRAIC PPIC HPIX Medicus MagMut Proselect Aspen Capson Galen ,89 53,829 58,86 6,671 53,314 56, ,89 53,829 55,378 6,671 53,314 56,79 54,136 79, ,89 53,829 58,147 69, 53,314 56,79 48,2 54,136 79,713 46,778 55, ,89 53,829 58,147 69, 53,314 56,79 48,2 54,136 79,713 46,778 55,961 61,786 % chg 12 to 15.%.% 1.1% 13.7%.%.%

64 Orthopedic Surgery Exhibit C Page 21 Rest of State 8, 7, 6, 5, 4, 3, 2, 1, MMLIS MedPro TDC PRAIC PPIC HPIX Medicus MagMut Proselect Aspen Capson Galen ,483 44,859 47,245 53,735 43,42 49, ,483 44,859 44,491 53,735 43,42 49,355 47,942 7, ,483 44,859 46,716 61,74 43,42 49,355 42,261 47,942 7,15 42,525 49, ,483 44,859 46,716 61,74 43,42 49,355 42,261 47,942 7,15 42,525 49,89 56,169 % chg 12 to 15.%.% 1.1% 13.7%.%.%

65 Radiology (incl dye) - Minor Surgery Exhibit C Page 22 Baltimore City and Baltimore County 4, 35, 3, 25, 2, 15, 1, 5, MMLIS MedPro TDC PRAIC PPIC HPIX Medicus MagMut Proselect Aspen Capson Galen ,77 32,75 34,94 34,654 19,53 29, ,77 32,75 34,94 34,654 19,53 29,222 28,653 35, ,77 32,75 36,687 34,654 19,53 29,222 17,346 28,653 35,849 18,954 24, ,77 32,75 36,687 34,654 19,53 29,222 17,346 28,653 35,849 18,954 24,222 23,965 % chg 12 to 15.%.% 5.%.%.%.%

66 Radiology (incl dye) - Minor Surgery Exhibit C Page 23 Anne Arundel, Howard, Montgomery, Prince George's 35, 3, 25, 2, 15, 1, 5, MMLIS MedPro TDC PRAIC PPIC HPIX Medicus MagMut Proselect Aspen Capson Galen ,95 29,67 31,171 31,683 17,752 26, ,95 29,67 31,171 31,683 17,752 26,564 26,24 32, ,95 29,67 32,73 31,683 17,752 26,564 15,768 26,24 32,588 17,375 22, ,95 29,67 32,73 31,683 17,752 26,564 15,768 26,24 32,588 17,375 22,9 21,968 % chg 12 to 15.%.% 5.%.%.%.%

67 Radiology (incl dye) - Minor Surgery Exhibit C Page 24 Rest of State 35, 3, 25, 2, 15, 1, 5, MMLIS MedPro TDC PRAIC PPIC HPIX Medicus MagMut Proselect Aspen Capson Galen ,965 24,224 26,35 28,195 14,452 23, ,965 24,224 26,35 28,195 14,452 23,379 23,269 28, ,965 24,224 27,667 28,195 14,452 23,379 13,877 23,269 28,679 15,795 19, ,965 24,224 27,667 28,195 14,452 23,379 13,877 23,269 28,679 15,795 19,377 19,971 % chg 12 to 15.%.% 5.%.%.%.%

68 Psychiatrist (Including Child) Exhibit D Page 1 of 3 Baltimore City & Baltimore County 2, 15, 1, 5, MMLIS MedPro TDC PRAIC PPIC HPIX Medicus 212 1,47 14,219 8,572 11,536 1,416 1, ,47 14,219 8,543 11,536 1,416 1, ,47 14,219 8,97 11,536 1,416 1,227 15, ,47 14,219 8,97 11,536 1,416 1,227 15,769 % chg 12 to 15.%.% 4.6%.%.%.% 2, Baltimore City & Baltimore County 15, 1, 5, Mag Mut Proselect FAIRCO Capson Galen AWAC AIG Campmed 212 6, 7, ,459 1,835 5,665 6, 7,475 5, ,459 1,835 5,665 12,111 6, 7,475 5, ,459 1,835 6,123 12,111 1,484 5,928 7,475 5,62 % chg 12 to %.%

69 Psychiatrist (Including Child) Exhibit D Page 2 of 3 Anne Arundel, Howard, Montgomery, Prince George's Counties 2, 15, 1, 5, MMLIS MedPro TDC PRAIC PPIC HPIX Medicus 212 9,133 12,638 7,648 1,692 9,468 9, ,133 12,638 7,622 1,692 9,468 9, ,133 12,638 8,2 1,692 9,468 9,298 14, ,133 12,638 8,2 1,692 9,468 9,298 14,334 % chg 12 to 15.%.% 4.6%.%.%.% 15, Anne Arundel, Howard, Montgomery, Prince George's 1, 5, 5, Mag Mut Proselect FAIRCO Capson Galen AWAC AIG Campmed 212 5,4 7, ,57 9,85 5,665 5,4 7,475 5, ,57 9,85 5,665 11,45 5,4 7,475 5, ,57 9,85 5,665 11,45 9,611 5,335 7,475 5,72 % chg 12 to %.%

70 Psychiatrist (Including Child) Exhibit D Page 3 of 3 Rest of State 2, 15, 1, 5, MMLIS MedPro TDC PRAIC PPIC HPIX Medicus 212 8,38 1,532 6,464 9,71 7,78 8, ,38 1,532 6,442 9,71 7,78 8, ,38 1,532 6,764 9,71 7,78 8,182 12, ,38 1,532 6,764 9,71 7,78 8,182 12,615 % chg 12 to 15.%.% 4.6%.%.%.% 15, Rest of State 1, 5, Mag Mut Proselect FAIRCO Capson Galen AWAC AIG Campmed 212 5,1 6, ,365 8,668 6,123 5,1 6,917 4, ,365 8,668 6,123 9,689 5,1 6,917 4, ,365 8,668 5,665 9,689 8,737 5,39 6,917 4,836 % chg 12 to %.%

71 Nurse Practitioner - Class A - Employed Exhibit E Page 1 of 5 Baltimore City and Baltimore County 1, 8, 6, 4, 2, mmlis medpro tdc praic ppic hpix medicus 212 7,975 3,19 2,81 1,45 5,28 8, ,975 3,19 2,791 1,45 5,28 8, ,975 3,19 2,93 1,45 5,28 8,118 3, ,975 3,19 2,93 1,45 5,28 8,118 3,942 % chg 12 to 15.%.% 4.6%.%.%.% Baltimore City and Baltimore County 8, 6, 4, 2, Proselect Capson Galen AIG CNA ACEUSA LibertyIU , , , , ,459 2, ,123 % chg 12 to %.%

72 Nurse Practitioner - Class A - Employed Exhibit E Page 2 of 5 Anne Arundel, Howard, Montgomery, Prince George's 8, 6, 4, 2, MMLIS MedPro TDC PRAIC PPIC HPIX Medicus 212 7,249 2,835 2,45 1,332 4,734 7, ,249 2,835 2,442 1,332 4,734 7, ,249 2,835 2,564 1,332 4,734 7,379 3, ,249 2,835 2,564 1,332 4,734 7,379 3,584 % chg 12 to 15.%.% 4.7%.%.%.% Anne Arundel, Howard, Montgomery, Prince George's 8, 6, 4, 2, Proselect Capson Galen AIG CNA ACEUSA LibertyIU , , , , ,891 2, ,123 % chg 12 to %.%