200 St. Paul Place, Suite 2700, Baltimore, Maryland TTY:

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1 LAWRENCE J. HOGAN, JR. Governor BOYD K. RUTHERFORD Lt. Governor INSURANCE ADMINISTRATION 2 St. Paul Place, Suite 27, Baltimore, Maryland TTY: AL REDMER, JR. Commissioner NANCY GRODIN Deputy Commissioner Robert Baron Associate Commissioner Property and Casualty September 1, 217 The Honorable Thomas V. Mike Miller, Jr. President of the Senate State House, Room H-17 1 State Circle Annapolis, Maryland The Honorable Michael E. Busch Speaker of the House of Delegate State House, H-11 1 State Circle Annapolis, Maryland Re: Report Required by Insurance Article 4-45 (MSAR #2976) President Miller and Speaker Busch: On behalf of the Maryland Insurance Administration, I am pleased to submit our Annual Report entitled, "Availability & Affordability of Health Care Professional Liability Insurance." This report originated in 24 as a result of a Special Session of the Maryland State Legislature that was convened to deal the medical malpractice insurance coverage crisis. Section 4-45 of the Insurance Article requires the Commissioner to report his findings annually as to the impact of Chapter 5 of the Acts of the 24 Special Session of the General Assembly and Chapter 477 of the Acts of the General Assembly of 1994 on the availability of health care malpractice and other liability insurance to the Legislative Policy Committee. Five printed copies of this report have also been mailed to the DLS Library for their records. Don't hesitate to reach out should you have any questions. cc: Sarah Albert, Department of Legislative Service (5 copies) Legislative Policy Committee (4 copies)

2 LARRY HOGAN Governor BOYD K. RUTHERFORD Lt. Governor AL REDMER, JR. Commissioner NANCY GRODIN Deputy Commissioner 2 St. Paul Place, Suite 27, Baltimore, Maryland 2122 Phone: Fax: TTY: ROBERT BARON Associate Commissioner Property and Casualty MSAR # Report on the Availability & Affordability of Health Care Professional Liability Insurance Submitted to the Legislative Policy Committee by the Maryland Insurance Administration Al Redmer, Jr. Commissioner September 1, 217

3 For further information concerning this document contact: Robert Baron, Associate Commissioner Maryland Insurance Administration 2 St. Paul Place, Suite 27 Baltimore, Maryland This document is available in alternative format upon request from a qualified individual a disability. TTY The Administration s website address is:

4 Table of Contents Executive Summary 1 Introduction... 1 Maryland s Medical Malpractice Insurance Market. 2 Medical Malpractice Insurance Premiums in Maryland... 2 Closed Claims 3 Conclusion. 4 Exhibit List. 5

5 EXECUTIVE SUMMARY Healthcare professional liability insurance (hereinafter medical malpractice insurance ) covers doctors and other healthcare professionals for liability claims arising from the treatment and care of patients. This annual report is based on data supplied by insurer groups to the Maryland Insurance Administration ( MIA ). The continuous availability and affordability of medical malpractice insurance to practitioners in Maryland is a vital and necessary component of Maryland s health care system. In 22 and 23, rapid and substantial increase in medical malpractice insurance premiums threatened to weaken access to high-quality health care in Maryland. The General Assembly acted in 24 and 25 to stabilize the medical malpractice insurance market and to require the MIA to collect relevant data and report annually to the General Assembly on the state of Maryland s medical malpractice market. This data is summarized in Exhibits A through L. In Maryland, medical malpractice insurance is available to be purchased from admitted insurers, non-admitted (surplus lines) insurers and risk retention groups. All writers of medical malpractice insurance are licensed or authorized by the MIA to conduct business in the state. In 216, 76 insurer groups wrote medical malpractice insurance policies in Maryland for all types of health care providers. Total medical malpractice premium collected by these insurer groups was $283,371,985 representing an increase of 2.4% from the prior year. Admitted insurers accounted for 59.5% of the total written premium, while surplus lines insurers and risk retention groups accounted for 1.3% and 3.2% respectively. While the number of insurer groups engaged in the medical malpractice market in Maryland is substantial and has not fluctuated significantly over the past ten (1) years, the marketplace remains highly concentrated respect to premium volume. The leading admitted insurer and the leading risk retention group account for 62.5% of the total premium volume collectively. That said, the market s premiums remained stable over the past year as evidenced by the fact that only four (4) insurers made a rate impact filing during fiscal year 217 (July 1, 216 through June 3, 217). These four (4) filings ranged from a decrease of 1.7% to an increase of 3.9% and affected about 5,5 policyholders. The remaining 74 insurer groups, including the two (2) largest, had no rate impact filings in fiscal year 217. Thus, medical malpractice insurance premiums have again remained affordable and stable in Maryland s market over the past year. INTRODUCTION Health care providers are not required by law to purchase and maintain medical malpractice insurance. Providers who elect to not purchase this coverage cannot participate in health care networks supporting preferred provider organizations, health maintenance organizations or managed care organizations. Medical malpractice insurance premiums began to escalate in 22 and increased substantially in 23 and 24. The General Assembly intervened in 24 and 25, including directing the MIA to collect data and report back to the General Assembly on this critical insurance market segment annually. In response, the MIA provides this report each year, 1

6 including among other metrics, information about the number of active insurers in the medical malpractice insurance market in Maryland, premium rates for selected medical specialties and data for closed medical malpractice claims. MARYLAND S MEDICAL MALPRACTICE INSURANCE MARKET Admitted insurers, surplus lines insurers and risk retention groups all provide medical malpractice insurance policies to a wide variety of health care professionals in Maryland. 1 Exhibits A1 through A5 provide detailed information about these insurer groups. As in the previous year, in 216, the top two (2) insurer groups operating in Maryland were an admitted insurer created by the General Assembly 2, Medical Mutual Liability Insurance Society of Maryland (MMLIS); and, MCIC Vermont (MCIC), a risk retention group organized under Vermont law operating in Maryland as a non-admitted insurer. These two insurers captured percent (62.56%) of the market by premium volume, an increase of 1.54 percent (1.54%) over 215. Exhibit A1 illustrates the 216 premium and market share data for each insurer group. Exhibit A2 lists the change in written premium for each insurer group by type of license from 215 to 216. Exhibit A3 is a pie chart showing the 216 market share of the top nine (9) admitted insurers and a pie chart of the top nine (9) insurers including surplus lines insurers and risk retention groups. Exhibit A4 shows the change in market share of the current top five (5) insurers over the period from MMLIS share of the market dropped by 1.9 percent (1.9%) to 36.3 percent (36.3%), which is its lowest market share since 23. MCIC s share of the market increased by 3.5 percent (3.5%) to 26.3 percent (26.3%), representing its highest market share at any time during the seventeen (17) year period. MEDICAL MALPRACTICE INSURANCE PREMIUMS IN MARYLAND In response to an increase in medical malpractice insurance premium rates between 21 and 25, the General Assembly created the Maryland Health Care Provider Rate Stabilization Fund ( Fund ). Insurance Article, Section of the Annotated Code of Maryland established the Fund, effective April 1, The Fund subsidized 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 history of MMLIS rate changes from 1996 through 216. Of note is that the insurer made no rate changes in eight (8) of the past twelve (12) years, including the immediate past five (5) years and had rate reductions in four of the past twelve (12) years. The sole rate increase over the past twelve (12) years was four percent (4%) in 212. The premium rates of MMLIS, the State s largest writer of medical malpractice insurance by premium volume, have remained stable over the past twelve (12) years. 1 Refer to MIA s Comparison Guide to Medical Professional Liability Insurance Rates ( Comparison Guide ) for a detailed listing of insurers and premiums across the State. 2 See Chapter 544, Section 1, Laws of Maryland, The Fund consists primarily of revenues generated by annual premium tax imposed on health maintenance organizations and managed care organizations pursuant to 6-12 of the Insurance Article. 2

7 Medical malpractice insurance premiums vary by specialty, policy limits and practice location. Exhibits B through G provide premium rate comparisons for eighteen (18) different specialties utilizing a base premium for policy limits of $1MM per incident / $3MM annual aggregate for the years Although the premium rates may differ among companies in a specialty, these Exhibits indicate stability in medical malpractice insurance premiums during this time period. Exhibits B through G also highlight the differences in premiums among insurers. To assist providers in comparing medical malpractice insurance premiums, the MIA publishes the Comparison Guide to Maryland Medical Professional Liability Insurance Rates ( Comparison Guide ) on an annual basis. The Comparison Guide is available on the MIA s website ( using the following link: e.pdf The Comparison Guide compares general pricing among the major admitted insurers, surplus lines insurers and risk retention groups offering medical malpractice insurance in Maryland. By law, medical malpractice insurers are required to offer policies high deductibles: $25,, $5, and $1,. 4 Exhibits H and I illustrate that high deductible options are not popular among providers. Although policies having a deductible of less than $25, are sold, liability insurance policies, including medical malpractice insurance policies, are routinely issued no deductible. CLOSED CLAIMS One factor affecting medical malpractice insurance premium rates is the number of claims filed, also known as claim frequency. Admitted insurers are required to submit certain closed claim information on a quarterly basis to the MIA. A claim is a demand for compensation arising from the alleged malpractice of a health care provider or facility. Exhibit J summarizes the closed claim data provided to the MIA by insurer and Exhibit K summarizes the data by specialty. Between 29 and 213 closed claims generally increased among all insurer types (admitted, non-admitted and risk retention groups). 5 The number of closed claims hit a peak for admitted insurers and risk retention groups in 213 at 957 and 1,328 respectively. The number of closed claims hit a peak for non-admitted insurers in 212 at 425. The closed claim totals for 216 were - 34%, -54% and 35% off these peak totals for admitted insurers, non-admitted insurers and risk retention groups respectively. Only the admitted carriers experienced an increase in closed claims over last year (+13%). 4 Insurance Article, of the Annotated Code of Maryland. 5 In 25, the MIA 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. 3

8 Exhibit L summarizes the number of lawsuits filed by jurisdiction and venue. The number of lawsuits peaked in 213 and decreased by 41% in 214 and again by 7% in 215. In 216, the number of lawsuits rose by 2% (22 lawsuits). CONCLUSION The MIA continues to monitor concentration, availability and affordability trends for the key medical malpractice insurance market in Maryland. The market continues to be relatively stable but remains concentrated 6% of the written premium acquired by two (2) insurers. Premium rates were level again this year across the market as a whole and in the two (2) largest market share insurers. The eight (8) new insurers that entered the Maryland market in acquired a collective 1.3% market share ($3.75 MM written premium) in their first year of operation. An additional five (5) insurers entered the market in The stable rate environment and the continuing availability of coverage in the Maryland market are positive indicators for health care providers. Likewise, the closed claim and filed lawsuit numbers remain substantially below peak levels of This should encourage potential risk bearers that have previously declined to enter or expand their presence in the Maryland market during the previous times of less stability to take advantage of growth opportunities in the State. 4

9 EXHIBIT LIST Exhibit A1 Exhibit A2 215 to 216 Exhibit A3 Exhibit A4 - Page 1 Share) 216 Medical Professional Liability Premiums by Insurance Group Change in Written Premium by Insurance Group by Type of License from 216 Market Share of the Nine Largest Admitted Carriers 216 Market Share of the Top Nine Carriers (Including Surplus Lines and RRG's) Market Share of the Top Carriers from 2 to 216 (Based on 216 Market Exhibit A4 - Page 2 Industry and MMLIS Written Premiums (in Millions) from 2 to 216 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 216 Exhibit A5 Medical Mutual Rate Change History from 1996 to 217 Exhibit B Rate Comparison Charts for Certain Physician Classes from 214 to 217 Exhibit C Rate Comparison Charts for Certain Surgeon Classes from 214 to 217 Exhibit D Rate Comparison Charts for Psychiatrist (Including Child) Class from 214 to 217 Exhibit E Rate Comparison Charts for Certain Nursing Classes from 214 to 217 Exhibit F 217 Rate Comparison Charts for Physical Therapists (Employed) from 214 to Exhibit G Rate Comparison Charts for Dentist Class from 214 to 217 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 216 Exhibit K of Closed Claims by Specialty from 25 to 216 Exhibit L of Suits Filed by Jurisdiction and Venue from 25 to 216 5

10 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 215 to Market Share of the Nine Largest Admitted Carriers 216 Market Share of the Top Nine Carriers (Including Surplus Lines and RRG's) Market Share of the Top Carriers from 2 to 216 (Based on 216 Market Share) Exhibit A4 - Page 2 Industry and MMLIS Written Premiums (in Millions) from 2 to 216 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 216 Exhibit A5 Medical Mutual Rate Change History from 1996 to 217 Exhibit B Rate Comparison Charts for Certain Physician Classes from 214 to 217 Exhibit C Rate Comparison Charts for Certain Surgeon Classes from 214 to 217 Exhibit D Rate Comparison Charts for Psychiatrist (Including Child) Class from 214 to 217 Exhibit E Rate Comparison Charts for Certain Nursing Classes from 214 to 217 Exhibit F Rate Comparison Charts for Physical Therapists (Employed) from 214 to 217 Exhibit G Rate Comparison Charts for Dentist Class from 214 to 217 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 216 Exhibit K of Closed Claims by Specialty from 25 to 216 Exhibit L of Suits Filed by Jurisdiction and Venue from 25 to 216

11 216 Medical Professional Liability Premiums by Insurance Group Exhibit A1 Page Premium Rank 216 Group Code 216 Market Share 216 Surplus Lines Premiums 216 Group Name 216 Insurance Group Premium 216 Admitted Premium 216 RRG Premium MEDICAL INS OF MD GRP 12,917, % 12,917,559 2 MCIC VT A RECIP RRG 74,348, % 74,348, DOCTORS CO GRP 22,41, % 2,967,141 1,74, PROASSURANCE CORP GRP 11,953, % 11,26, , BERKSHIRE HATHAWAY GRP 9,632,7 3.4% 7,248,61 2,384, CNA INS GRP 8,95, % 7,418,659 1,487, * MEDICAL INS GRP 4,85, % 4,85, IRONSHORE GRP 4,711, % 4,711, NORCAL GRP 3,361, % 1,653,7 1,78, AMERICAN INTL GRP 2,987,56 1.5% 865,34 2,122, COVERYS GRP 2,868, % 2,239,33 629, ALLEGHANY GRP 2,833,626 1.% 1,685,119 1,148, CONNECTICUT MEDICAL GRP 2,33,849.81% 2,33, PREFERRED PHYSICIANS MEDICAL 2,299,646.81% 2,299, WHITE MOUNTAINS GRP 2,173,137.77% 2,173, MARKEL CORP GRP 2,,38.71% 2,, ALLIED WORLD ASSUR HOLDING GR 1,955,285.69% 1,41,18 554, NATIONAL GRP 1,725,562.61% 348,245 1,377, ENSTAR GRP 1,585,598.56% 1,585, LIBERTY MUT GRP 1,517,316.54% 1,23,84 314, CINCINNATI FIN GRP 1,488,67.53% 1,47,794 17, CHUBB LTD GRP 1,427,627.5% 1,9, , ZURICH INS GRP 1,388,9.49% 1,388, RLI INS GRP 1,173,28.41% 1,173, WR BERKLEY CORP GRP 1,96,39.39% 46,322 1,5,68 26 THE MUTUAL RRG INC 1,14,914.36% 1,14, OPHTHALMIC MUT INS CO RRG 921,492.33% 921, NCMIC GRP 817,248.29% 817, LONE STAR ALLIANCE RRG 647,668.23% 647,668 3 CARING COMMUNITIES RECIP RRG 615,887.22% 615, HALLMARK FIN SERV GRP 55,312.19% 55, POSITIVE PHYSICIANS INS EXCH 545,882.19% 545,882

12 216 Medical Professional Liability Premiums by Insurance Group Exhibit A1 Page Premium Rank 216 Group Code 216 Market Share 216 Surplus Lines Premiums 216 Group Name 216 Insurance Group Premium 216 Admitted Premium 216 RRG Premium ARCH INS GRP 455,129.16% 455, ORTHOFORUM INS CO RRG 376,77.13% 376,77 35 KINSALE INS CO 349,152.12% 349, ALLIED PROFESSIONALS INS CO RR 323,623.11% 323, OCEANUS INS CO A RRG 311,844.11% 311, LANCET IND RRG INC 3,566.11% 3, CAPSON PHYSICIANS INS CO 248,846.9% 248, JAMES RIVER GRP 248,775.9% 248, AMERICAN ASSOC OF OTHODONTIS 223,424.8% 223, XL AMER GRP 212,33.7% 212, THE HANOVER INS GRP 17,286.6% 6,93 163, MAG MUT INS GRP 149,619.5% 149, ASPEN INS HOLDING GRP 148,663.5% 122,613 26, CHURCH MUT GRP 148,541.5% 148, PEACE CHURCH RRG INC 134,277.5% 134, CONTINUING CARE RRG INC 127,499.4% 127, PHARMACISTS MUT GRP 116,849.4% 116, NAVIGATORS GRP 81,31.3% 81,31 51 SUNLAND RRG INC 79,4.3% 79,4 52 GALEN INS CO 59,682.2% 59, MUNICH RE GRP 55,384.2% 5,86 4, STATE FARM GRP 52,47.2% 52,47 55 FAIRWAY PHYSICIANS INS CO RRG 51,885.2% 51, CARE RRG INC 49,31.2% 49,31 57 HEALTH CARE INDUSTRY LIAB RECI 43,341.2% 43, GREEN HILLS INS CO RRG 34,259.1% 34, NATIONWIDE CORP GRP 31,32.1% 31, * QBE INS GRP 28,95.1% 28, WESTERN WORLD GRP 27,838.1% 27, * PHYSICIANS INS A MUT GRP 26,27.1% 26,27 63 PHYSICIANS CAS RRG INC 21,93.1% 21,93 64 * ACADEMIC MEDICAL PROFESSIONA 15,194.1% 15,194

13 216 Medical Professional Liability Premiums by Insurance Group Exhibit A1 Page Premium Rank 216 Group Code 216 Market Share 216 Surplus Lines Premiums 216 Group Name 216 Insurance Group Premium 216 Admitted Premium 216 RRG Premium AFFILIATES RISK GRP 12,186.% 12, IRONSHORE RRG (DC) INC 1,346.% 1, VIRGINIA PHYSICIANS RRG INC 8,458.% 8, WELLSPAN RRG 8,.% 8, 69 URGENT CARE ASSUR CO RRG INC 4,653.% 4, ARGONAUT GRP 4,.% 4, AMERICAN FINANCIAL GRP 2,296.% 324 1, ALLIANZ INS GRP 1,35.% 1, FAIRFAX FIN GRP 1,134.% 1, AMERICAN EXCESS INS EXCH RRG 95.% * HOUSTON INTL INS GRP 718.% HEALTHCARE PROVIDERS INS EXCH -8,783.% -8,783 Industry Totals 283,371, ,647,52 29,9,59 85,633, % 1.27% 3.22% * - Indicates company is new from 215 to 216 The following companies had premium in 215, but not in 216: DOCTORS & SURGEONS NATL RRG INC 3416 AXIS CAPITAL GRP NATIONAL GUARDIAN RRG INC

14 Change in Written Premiums by Insurance Group by Type of License from 215 to 216 Exhibit A2 Page Premium Rank 216 Group Code 216 Insurance Group Premium Group Admitted Surplus Lines 216 Group Name Premium Premium Premium RRG Premium MEDICAL INS OF MD GRP 12,917, % -2.7% n/a n/a 2 MCIC VT A RECIP RRG 74,348, % n/a n/a 18.2% DOCTORS CO GRP 22,41, % 5.98% % n/a PROASSURANCE CORP GRP 11,953, % -36.6% % n/a 5 31 BERKSHIRE HATHAWAY GRP 9,632,7-8.25% % 1.91% n/a CNA INS GRP 8,95, % 3.52% -4.28% n/a * MEDICAL INS GRP 4,85,381 n/a n/a n/a n/a IRONSHORE GRP 4,711, % n/a 33.29% n/a NORCAL GRP 3,361, % 15.28% 4.74% n/a 1 12 AMERICAN INTL GRP 2,987, % -7.62% % n/a COVERYS GRP 2,868, % 12.88% % n/a ALLEGHANY GRP 2,833, % 7.23% 8.97% n/a CONNECTICUT MEDICAL GRP 2,33, % n/a n/a 178.1% 14 PREFERRED PHYSICIANS MEDICAL 2,299, % n/a n/a 7.53% WHITE MOUNTAINS GRP 2,173, % -1.% % n/a MARKEL CORP GRP 2,, % n/a % n/a ALLIED WORLD ASSUR HOLDING GR 1,955, % -12.8% % n/a NATIONAL GRP 1,725, % 1.64% -1.% n/a ENSTAR GRP 1,585, % n/a 67.26% n/a LIBERTY MUT GRP 1,517, % 1.81% 15.5% n/a CINCINNATI FIN GRP 1,488, % 61.% % n/a CHUBB LTD GRP 1,427, % -35.2% -2.72% n/a ZURICH INS GRP 1,388, % n/a % n/a RLI INS GRP 1,173, % n/a -7.48% n/a WR BERKLEY CORP GRP 1,96, % -6.19% 48.99% n/a 26 THE MUTUAL RRG INC 1,14, % n/a n/a 18.86% 27 OPHTHALMIC MUT INS CO RRG 921, % n/a n/a % NCMIC GRP 817, % -.2% n/a n/a 29 LONE STAR ALLIANCE RRG 647, % n/a n/a 28.47% 3 CARING COMMUNITIES RECIP RRG 615, % n/a n/a 19.26% HALLMARK FIN SERV GRP 55, % n/a 134.2% n/a 32 POSITIVE PHYSICIANS INS EXCH 545, % % n/a n/a

15 Change in Written Premiums by Insurance Group by Type of License from 215 to 216 Exhibit A2 Page Premium Rank 216 Group Code 216 Insurance Group Premium Group Admitted Surplus Lines 216 Group Name Premium Premium Premium RRG Premium ARCH INS GRP 455, % n/a % n/a 34 ORTHOFORUM INS CO RRG 376,77.52% n/a n/a.52% 35 KINSALE INS CO 349, % n/a -12.% n/a 36 ALLIED PROFESSIONALS INS CO RR 323, % n/a n/a -2.26% 37 OCEANUS INS CO A RRG 311, % n/a n/a 13.26% 38 LANCET IND RRG INC 3, % n/a n/a 35.71% 39 CAPSON PHYSICIANS INS CO 248, % -3.6% n/a n/a JAMES RIVER GRP 248, % n/a 12.3% n/a 41 AMERICAN ASSOC OF OTHODONTIS 223, % n/a n/a 6.2% XL AMER GRP 212, % n/a % n/a THE HANOVER INS GRP 17, %.% 4.56% n/a MAG MUT INS GRP 149, % n/a 141.8% n/a ASPEN INS HOLDING GRP 148, % % % n/a CHURCH MUT GRP 148, % 34.36% n/a n/a 47 PEACE CHURCH RRG INC 134, % n/a n/a -4.67% 48 CONTINUING CARE RRG INC 127, % n/a n/a 23.25% PHARMACISTS MUT GRP 116, % % n/a n/a 5 51 NAVIGATORS GRP 81, % n/a 4.97% n/a 51 SUNLAND RRG INC 79, % n/a n/a 17.36% 52 GALEN INS CO 59, % 47.59% n/a n/a MUNICH RE GRP 55, % -.77% % n/a STATE FARM GRP 52, % 2.19% n/a n/a 55 FAIRWAY PHYSICIANS INS CO RRG 51, % n/a n/a 1.37% 56 CARE RRG INC 49, % n/a n/a % 57 HEALTH CARE INDUSTRY LIAB RECI 43, % -5.14% n/a n/a 58 GREEN HILLS INS CO RRG 34, % n/a n/a -36.8% NATIONWIDE CORP GRP 31, % -3.54% n/a n/a * QBE INS GRP 28,95 n/a n/a n/a n/a WESTERN WORLD GRP 27, % n/a % n/a * PHYSICIANS INS A MUT GRP 26,27 n/a n/a n/a n/a 63 PHYSICIANS CAS RRG INC 21, % n/a n/a % 64 * ACADEMIC MEDICAL PROFESSIONA 15,194 n/a n/a n/a n/a

16 Change in Written Premiums by Insurance Group by Type of License from 215 to 216 Exhibit A2 Page Premium Rank 216 Group Code 216 Insurance Group Premium Group Admitted Surplus Lines 216 Group Name Premium Premium Premium RRG Premium AFFILIATES RISK GRP 12, % n/a n/a 3.81% 66 IRONSHORE RRG (DC) INC 1, % n/a n/a 1.62% 67 VIRGINIA PHYSICIANS RRG INC 8, % n/a n/a % 68 WELLSPAN RRG 8, 1.% n/a n/a 1.% 69 URGENT CARE ASSUR CO RRG INC 4, % n/a n/a % ARGONAUT GRP 4, 25.% n/a 25.% n/a AMERICAN FINANCIAL GRP 2, % % % n/a ALLIANZ INS GRP 1, % % -1.% n/a FAIRFAX FIN GRP 1,134 n/a n/a n/a n/a 74 AMERICAN EXCESS INS EXCH RRG 95.% n/a n/a.% * HOUSTON INTL INS GRP 718 n/a n/a n/a n/a 76 HEALTHCARE PROVIDERS INS EXCH -8, % -1.3% n/a n/a Industry Totals 283,371, % -2.9% -6.17% 21.83% * - Indicates company is new from 215 to 216 The following companies had premium in 215, but not in 216: DOCTORS & SURGEONS NATL RRG INC 3416 AXIS CAPITAL GRP NATIONAL GUARDIAN RRG INC

17 Exhibit A3 216 Market Share of the Nine Largest Admitted Carriers 4.1% 4.2% 1.%.9% 5.% 1.3% 2.7% 6.3% MEDICAL INS OF MD GRP DOCTORS CO GRP PROASSURANCE CORP GRP CNA INS GRP BERKSHIRE HATHAWAY GRP MEDICAL INS GRP COVERYS GRP 12.% ALLEGHANY GRP 58.7% NORCAL GRP REMAINING 216 Market Share of the Top Nine Carriers (Including Surplus Lines and RRG's) 1.2% 14.7% 1.7% 1.7% 3.2% 3.5% 4.3% 8.% 37.2% MEDICAL INS OF MD GRP MCIC VT A RECIP RRG DOCTORS CO GRP PROASSURANCE CORP GRP BERKSHIRE HATHAWAY GRP CNA INS GRP MEDICAL INS GRP IRONSHORE GRP NORCAL GRP 26.9% REMAINING

18 Exhibit A4 Page 1 Market Share of the Top Carriers from 2 to 215 (Based on 215 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% 38.2% 36.3% 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% 22.8% 26.3% 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% 7.8% 7.8% 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% 6.4% 4.2% 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% 3.8% 3.4% The four carriers listed above are the four of the five largest carriers based on 216 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 (member of the Berkshore/Hathaway Group) PRAIC - ProAssurance Group

19 Industry and MMLIS Written Premiums (in Millions) from 2 to 215 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% 1.3% 2.5% 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% -6.1% -2.7%

20 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% 66.5% 63.4% 61.7% 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% 11.4% 11.2% 1.6% 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% 22.1% 25.4% 31.3% 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.

21 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.

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 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 NORCAL NORCAL Mutual Insurance Company All MagMut MAG Mutual Insurance Company B, C & D Proselect ProSelect Insurance Company B, C, D & E FAIRCO Fair American Insurance and Reinsurance Company D Aspen Aspen Insurance Company B, C Capson Capson Insurance Company B, C, D & E MMICNC Medical Mutual Insurance Company of North Carolina B, C, D, E, F PPIE Positive Physicians Insurance Exchange B, C, D, E, F AWAC Allied World Specialty Insurance Company D & F AIG National Union Fire Insurance Company of Pittsburgh D, 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

23 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 B, D & G Fortress Fortress Insurance Company G PSIC Professional Solutions Insurance Company G Colony Colony Insurance Company D, E & G (1) - Member of the Medical Mutual Liability Insurance Society Group 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 214 to 217.

24 Fam/Gen Prac (No OB) - Minor Surgery Exhibit B Page 1 Baltimore City & Baltimore County 35, 3, 25, 2, 15, 1, 5, -5, MMLIS MedPro TDC PRAIC PPIC NORCAL MAGMut Proselect Aspen Capson MMICNC PPIE Campmed ,77 28,439 27,35 29,883 19,53 25,415 25,324 17,496 24, ,77 28,439 27,35 29,883 19,53 25,415 25,324 17,496 24, ,77 28,439 27,35 29,883 19,53 24,442 25,415 25,324 17,496 24,221 29,222 28, ,77 28,439 27,35 29,883 19,53 24,442 25,415 25,324 17,496 24,221 29,222 28,439 31,69 % chg 13 to 16.%.%.%.%.%.%.%.%.%

25 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 NORCAL MagMut Proselect Aspen Capson MMICNC PPIE Campmed ,95 25,276 25,397 27,351 17,752 23,237 23,2 16,38 22, ,95 25,276 25,397 27,351 17,752 23,237 23,2 16,38 22, ,95 25,276 25,397 27,351 17,752 22,218 23,237 23,2 16,38 22,9 26,564 25, ,95 25,276 25,397 27,351 17,752 22,218 23,237 23,2 16,38 22,9 26,564 25,276 28,319 % chg 13 to 16.%.%.%.%.%.%.%.%.%

26 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 NORCAL MagMut Proselect Aspen Capson MMICNC PPIE Campmed ,965 21,64 21,489 24,379 14,452 2,629 2,259 14,5 19, ,965 21,64 21,489 24,379 14,452 2,629 2,259 14,5 19, ,965 21,64 21,489 24,379 14,452 19,553 2,629 2,259 14,5 19,377 23,379 21, ,965 21,64 21,489 24,379 14,452 19,553 2,629 2,259 14,5 19,377 23,379 21,64 22,475 % chg 13 to 16.%.%.%.%.%.%.%.%.%

27 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 NORCAL MagMut Proselect Aspen Capson MMICNC PPIE Campmed ,948 17,775 19,536 2,71 13,2 15,946 15,479 9,72 16, ,948 17,775 19,536 2,71 13,2 15,946 15,479 9,72 16, ,948 17,775 19,536 2,71 13,2 15,769 15,946 15,479 9,72 16,148 16,235 17, ,948 17,775 19,536 2,71 13,2 15,769 15,946 15,479 9,72 16,148 16,235 17,775 21,855 % chg 13 to 16.%.%.%.%.%.%.%.%.%

28 Fam/Gen Prac (No OB) - No Surgery Exhibit B Page 5 Anne Arundel, Howard, Montgomery, Prince George's 25, 2, 15, 1, 5, MMLIS MedPro TDC PRAIC PPIC NORCAL MagMut Proselect Aspen Capson MMICNC PPIE Campmed ,498 15,798 17,93 19,22 11,835 14,585 14,71 8,91 14, ,498 15,798 17,93 19,22 11,835 14,585 14,71 8,91 14, ,498 15,798 17,93 19,22 11,835 14,334 14,585 14,71 8,91 14,727 14,758 15, ,498 15,798 17,93 19,22 11,835 14,334 14,585 14,71 8,91 14,727 14,758 15,798 19,53 % chg 13 to 16.%.%.%.%.%.%.%.%.%

29 Fam/Gen Prac (No OB) - No Surgery Exhibit B Page 6 Rest of State 2, 15, 1, 5, MMLIS MedPro TDC PRAIC PPIC NORCAL MagMut Proselect Aspen Capson MMICNC PPIE Campmed ,759 13,165 14,211 17,4 9,635 12,955 12,383 8,1 12, ,759 13,165 14,211 17,4 9,635 12,955 12,383 8,1 12, ,759 13,165 14,211 17,4 9,635 12,615 12,955 12,383 8,1 12,918 12,988 13, ,759 13,165 14,211 17,4 9,635 12,615 12,955 12,383 8,1 12,918 12,988 13,165 15,5 % chg 13 to 16.%.%.%.%.%.%.%.%.%

30 Anesthesiology Exhibit B Page 7 Baltimore City and Baltimore County 4, 3, 2, 1, MMLIS MedPro TDC PRAIC PPIC NORCAL MagMut Proselect Aspen Capson MMICNC PPIE ,948 19,196 23,77 34,654 2,528 18,932 26,84 17,496 17, ,948 19,196 23,77 34,654 2,528 18,932 26,84 17,496 17, ,948 19,196 23,77 34,654 2,528 18,923 18,932 26,84 17,496 17,439 16,235 19, ,948 19,196 23,77 34,654 2,528 18,923 18,932 26,84 17,496 17,439 16,235 19,196 % chg 13 to 16.%.%.%.%.%.%.%.%.%

31 Anesthesiology Exhibit B Page 8 Anne Arundel, Howard, Montgomery, Prince George's 4, 3, 2, 1, MMLIS MedPro TDC PRAIC PPIC NORCAL MagMut Proselect Aspen Capson MMICNC PPIE ,498 17,62 19,384 31,683 18,66 17,367 23,711 16,38 15, ,498 17,62 19,384 31,683 18,66 17,367 23,711 16,38 15, ,498 17,62 19,384 31,683 18,66 17,21 17,367 23,711 16,38 15,95 14,758 17, ,498 17,62 19,384 31,683 18,66 17,21 17,367 23,711 16,38 15,95 14,758 17,62 % chg 13 to 16.%.%.%.%.%.%.%.%.%

32 Anesthesiology Exhibit B Page 9 Rest of State 3, 2, 1, MMLIS MedPro TDC PRAIC PPIC NORCAL MagMut Proselect Aspen Capson MMICNC PPIE ,759 14,219 16,41 28,195 15,191 15,492 2,867 14,5 13, ,759 14,219 16,41 28,195 15,191 15,492 2,867 14,5 13, ,759 14,219 16,41 28,195 15,191 15,138 15,492 2,867 14,5 13,952 12,988 14, ,759 14,219 16,41 28,195 15,191 15,138 15,492 2,867 14,5 13,952 12,988 14,219 % chg 13 to 16.%.%.%.%.%.%.%.%.%

33 Dermatology No Surgery Exhibit B Page 1 Baltimore City and Baltimore County 2, 15, 1, 5, MMLIS MedPro TDC PRAIC PPIC NORCAL MagMut Proselect Aspen Capson MMICNC PPIE 214 1,47 11,375 15,98 11,536 1,416 11,459 14,75 9,72 12, ,47 11,375 15,98 11,536 1,416 11,459 14,75 9,72 12, ,47 11,375 15,98 11,536 1,416 11,38 11,459 14,75 9,72 12,111 1,227 11, ,47 11,375 15,98 11,536 1,416 11,38 11,459 14,75 9,72 12,111 1,227 11,375 % chg 13 to 16.%.%.%.%.%.%.%.%.%

34 Dermatology No Surgery Exhibit B Page 11 Anne Arundel, Howard, Montgomery, Prince George's 15, 1, 5, MMLIS MedPro TDC PRAIC PPIC NORCAL MagMut Proselect Aspen Capson MMICNC PPIE 214 9,133 1,111 13,724 1,692 9,468 1,57 13,367 8,91 11, ,133 1,111 13,724 1,692 9,468 1,57 13,367 8,91 11, ,133 1,111 13,724 1,692 9,468 1,34 1,57 13,367 8,91 11,45 9,298 1, ,133 1,111 13,724 1,692 9,468 1,34 1,57 13,367 8,91 11,45 9,298 1,111 % chg 13 to 16.%.%.%.%.%.%.%.%.%

35 Dermatology No Surgery Exhibit B Page 12 Rest of State 15, 1, 5, MMLIS MedPro TDC PRAIC PPIC NORCAL MagMut Proselect Aspen Capson MMICNC PPIE 214 8,38 8,426 11,172 9,71 7,78 9,365 11,764 8,1 9, ,38 8,426 11,172 9,71 7,78 9,365 11,764 8,1 9, ,38 8,426 11,172 9,71 7,78 8,831 9,365 11,764 8,1 9,689 8,182 8, ,38 8,426 11,172 9,71 7,78 8,831 9,365 11,764 8,1 9,689 8,182 8,426 % chg 13 to 16.%.%.%.%.%.%.%.%.%

36 Internal Medicine No Surgery Exhibit B Page 13 Baltimore City and Baltimore County 25, 2, 15, 1, 5, MMLIS MedPro TDC PRAIC PPIC NORCAL MagMut Proselect Aspen Capson MMICNC PPIE Campmed ,948 17,775 21,977 2,71 13,2 18,19 18,575 11,664 16, ,948 17,775 21,977 2,71 13,2 18,19 18,575 11,664 16, ,948 17,775 21,977 2,71 13,2 17,346 18,19 18,575 11,664 16,148 16,235 17, ,948 17,775 21,977 2,71 13,2 17,346 18,19 18,575 11,664 16,148 16,235 17,775 21,855 % chg 13 to 16.%.%.%.%.%.%.%.%.%

37 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 NORCAL MagMut Proselect Aspen Capson MMICNC PPIE Campmed ,498 15,798 2,513 19,22 11,835 16,624 16,885 1,692 14, ,498 15,798 2,513 19,22 11,835 16,624 16,885 1,692 14, ,498 15,798 2,513 19,22 11,835 15,768 16,624 16,885 1,692 14,727 14,758 15, ,498 15,798 2,513 19,22 11,835 15,768 16,624 16,885 1,692 14,727 14,758 15,798 19,53 % chg 13 to 16.%.%.%.%.%.%.%.%.%

38 Internal Medicine No Surgery Exhibit B Page 15 Rest of State 2, 15, 1, 5, MMLIS MedPro TDC PRAIC PPIC NORCAL MagMut Proselect Aspen Capson MMICNC PPIE Campmed ,759 13,165 16,66 17,4 9,635 14,75 14,86 9,72 12, ,759 13,165 16,66 17,4 9,635 14,75 14,86 9,72 12, ,759 13,165 16,66 17,4 9,635 13,877 14,75 14,86 9,72 12,918 12,988 13, ,759 13,165 16,66 17,4 9,635 13,877 14,75 14,86 9,72 12,918 12,988 13,165 15,5 % chg 13 to 16.%.%.%.%.%.%.%.%.%

39 Pediatrics No Surgery Exhibit B Page 16 Baltimore City and Baltimore County 3, 25, 2, 15, 1, 5, MMLIS MedPro TDC PRAIC PPIC NORCAL MagMut Proselect Aspen Capson MMICNC PPIE ,948 17,775 24,98 2,71 13,2 15,946 15,479 9,72 15, ,948 17,775 24,98 2,71 13,2 15,946 15,479 9,72 15, ,948 17,775 24,98 2,71 13,2 15,769 15,946 15,479 8,1 15,825 16,235 17, ,948 17,775 24,98 2,71 13,2 15,769 15,946 15,479 9,72 15,825 16,235 17,775 % chg 13 to 16.%.%.%.%.%.%.%.%.%

40 Pediatrics No Surgery Exhibit B Page 17 Anne Arundel, Howard, Montgomery, Prince George's 25, 2, 15, 1, 5, MMLIS MedPro TDC PRAIC PPIC NORCAL MagMut Proselect Aspen Capson MMICNC PPIE ,498 15,798 2,961 19,22 11,835 14,585 14,71 8,91 14, ,498 15,798 2,961 19,22 11,835 14,585 14,71 8,91 14, ,498 15,798 2,961 19,22 11,835 14,334 14,585 14,71 8,91 14,432 14,758 15, ,498 15,798 2,961 19,22 11,835 14,334 14,585 14,71 8,91 14,432 14,758 15,798 % chg 13 to 16.%.%.%.%.%.%.%.%.%

41 Pediatrics No Surgery Exhibit B Page 18 Rest of State 2, 15, 1, 5, MMLIS MedPro TDC PRAIC PPIC NORCAL MagMut Proselect Aspen Capson MMICNC PPIE ,759 13,165 17,718 17,4 9,635 12,955 12,383 8,1 12, ,759 13,165 17,718 17,4 9,635 12,955 12,383 8,1 12, ,759 13,165 17,718 17,4 9,635 12,615 12,955 12,383 9,72 12,66 12,988 13, ,759 13,165 17,718 17,4 9,635 12,615 12,955 12,383 8,1 12,66 12,988 13,165 % chg 13 to 16.%.%.%.%.%.%.%.%.%

42 Radiology (Diagnostic) No Surgery Exhibit B Page 19 Baltimore City and Baltimore County 4, 3, 2, 1, MMLIS MedPro TDC PRAIC PPIC NORCAL MagMut Proselect Aspen Capson MMICNC PPIE Campmed ,77 24,883 36,687 25,296 13,2 15,946 25,324 17,496 24, ,77 24,883 36,687 25,296 13,2 15,946 25,324 17,496 24, ,77 24,883 36,687 25,296 13,2 24,442 15,946 25,324 17,496 24,221 29,222 24, ,77 24,883 36,687 25,296 13,2 24,442 15,946 25,324 17,496 24,221 29,222 24,883 31,69 % chg 13 to 16.%.%.%.%.%.%.%.%.%

43 Radiology (Diagnostic) No Surgery Exhibit B Page 2 Anne Arundel, Howard, Montgomery, Prince George's 4, 3, 2, 1, MMLIS MedPro TDC PRAIC PPIC NORCAL MagMut Proselect Aspen Capson MMICNC PPIE Campmed ,95 22,116 32,73 23,186 11,835 14,585 23,2 16,38 22, ,95 22,116 32,73 23,186 11,835 14,585 23,2 16,38 22, ,95 22,116 32,73 23,186 11,835 22,218 14,585 23,2 16,38 22,9 26,564 22, ,95 22,116 32,73 23,186 11,835 22,218 14,585 23,2 16,38 22,9 26,564 22,116 28,319 % chg 13 to 16.%.%.%.%.%.%.%.%.%

44 Radiology (Diagnostic) No Surgery Exhibit B Page 21 Rest of State 3, 2, 1, MMLIS MedPro TDC PRAIC PPIC NORCAL MagMut Proselect Aspen Capson MMICNC PPIE Campmed ,965 18,431 27,667 2,71 9,635 12,955 2,259 14,5 19, ,965 18,431 27,667 2,71 9,635 12,955 2,259 14,5 19, ,965 18,431 27,667 2,71 9,635 19,553 12,955 2,259 14,5 19,377 23,379 18, ,965 18,431 27,667 2,71 9,635 19,553 12,955 2,259 14,5 19,377 23,379 18,431 22,475 % chg 13 to 16.%.%.%.%.%.%.%.%.%

45 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 NORCAL MagMut Proselect Aspen Capson MMICNC PPIE ,462 54,58 52,322 52,579 52,786 47,973 61,236 61, ,462 54,58 52,322 52,579 52,786 47,973 61,236 61, ,462 54,58 52,322 52,579 52,786 67,17 66,385 47,973 61,236 61,361 68,673 54, ,462 54,58 52,322 52,579 52,786 67,17 47,973 61,236 61,361 68,673 54,58 % chg 13 to 16.%.%.%.%.%.%

46 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 NORCAL MagMut Proselect Aspen Capson MMICNC PPIE ,323 48,447 46,677 47,959 47,982 43,61 56,133 55, ,323 48,447 46,677 47,959 47,982 43,61 56,133 55, ,323 48,447 46,677 47,959 47,982 6,921 6,61 43,61 56,133 55,961 62,425 48, ,323 48,447 46,677 47,959 47,982 6,921 43,61 56,133 55,961 62,425 48,447 % chg 13 to 16.%.%.%.%.%.%

47 Emergency Medicine - Inc. Major Surgery Exhibit C Page 3 Rest of State 6, 5, 4, 3, 2, 1, MMLIS MedPro TDC PRAIC PPIC NORCAL MagMut Proselect Aspen Capson MMICNC PPIE ,97 4,374 39,456 42,536 39,61 38,378 51,3 49, ,97 4,374 39,456 42,536 39,61 38,378 51,3 49, ,97 4,374 39,456 42,536 39,61 53,614 53,672 38,378 51,3 49,89 54,938 4, ,97 4,374 39,456 42,536 39,61 53,614 38,378 51,3 49,89 54,938 4,374 % chg 13 to 16.%.%.%.%.%.%

48 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 NORCAL MagMut Proselect Aspen Capson MMICNC PPIE ,872 48,452 52,322 2,71 28,643 35,631 36,68 31,59 3, ,872 48,452 52,322 2,71 28,643 35,631 36,68 31,59 3, ,872 48,452 52,322 2,71 28,643 4,21 35,631 36,68 31,59 3,68 4,587 48, ,872 48,452 52,322 2,71 28,643 4,21 35,631 36,68 31,59 3,68 4,587 48,452 % chg 13 to 16.%.%.%.%.%.%.%

49 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 NORCAL MagMut Proselect Aspen Capson MMICNC PPIE ,243 43,63 46,677 19,22 26,37 32,569 33,278 28,958 27, ,243 43,63 46,677 19,22 26,37 32,569 33,278 28,958 27, ,243 43,63 46,677 19,22 26,37 36,553 32,569 33,278 28,958 27,981 36,894 43, ,243 43,63 46,677 19,22 26,37 36,553 32,569 33,278 28,958 27,981 36,894 43,63 % chg 13 to 16.%.%.%.%.%.%.%

50 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 NORCAL MagMut Proselect Aspen Capson MMICNC PPIE ,897 35,887 39,456 17,4 21,196 28,91 29,286 26,325 24, ,897 35,887 39,456 17,4 21,196 28,91 29,286 26,325 24, ,897 35,887 39,456 17,4 21,196 32,168 28,91 29,286 26,325 24,544 32,47 35, ,897 35,887 39,456 17,4 21,196 32,168 28,91 29,286 26,325 24,544 32,47 35,887 % chg 13 to 16.%.%.%.%.%.%.%

51 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 NORCAL MagMut Proselect Aspen Capson MMICNC PPIE , , , ,317 19,97 115,14 137,97 139,725 14, , , , ,317 19,97 115,14 137,97 139,725 14, , , , ,317 19,97 113, ,14 137,97 139,725 14, , , , , , ,317 19,97 113, ,14 137,97 139,725 14, , ,641 % chg 13 to 16.%.%.%.%.%.%.%

52 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 NORCAL MagMut Proselect Aspen Capson MMICNC PPIE ,876 1,929 17, ,969 99,963 14, , ,81 95, ,876 1,929 17, ,969 99,963 14, , ,81 95, ,876 1,931 17, ,969 99,963 13,28 14, , ,81 95, ,12 19, ,876 1,931 17, ,969 99,963 13,28 14, , ,81 95, ,12 19,4 % chg 13 to 16.%.%.%.%.%.%.%

53 Obstetrics/Gynecology - Surgery Exhibit C Page 9 Rest of State 14, 12, 1, 8, 6, 4, 2, MMLIS MedPro TDC PRAIC PPIC NORCAL MagMut Proselect Aspen Capson MMICNC PPIE ,622 84,111 87, ,126 81,378 92,76 19, ,438 83, ,622 84,111 87, ,126 81,378 92,76 19, ,438 83, ,622 84,111 87, ,126 81,378 9,828 92,76 19, ,438 83,968 16,51 9, ,622 84,111 87, ,126 81,378 9,828 92,76 19, ,438 83,968 16,51 9,841 % chg 13 to 16.%.%.%.%.%.%.%

54 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 NORCAL MagMut Proselect Aspen Capson MMICNC PPIE , ,641 17,39 118,869 19,97 116,897 16,434 14, , ,641 17,39 118,869 19,97 116,897 16,434 14, , ,641 17,39 118,869 19,97 13,92 95, ,897 16,434 14,959 1, , , ,641 17,39 118,869 19,97 13,92 116,897 16,434 14,959 1, ,641 % chg 13 to 16.%.%.%.%.%.%

55 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 NORCAL MagMut Proselect Aspen Capson MMICNC PPIE 214 9,172 19,4 151,935 18,151 99,963 16,264 97,565 95, ,172 19,4 151,935 18,151 99,963 16,264 97,565 95, ,172 19,4 151,935 18,151 99, ,259 87,259 16,264 97,565 95,723 91,792 19, ,172 19,4 151,935 18,151 99, ,259 16,264 97,565 95,723 91,792 19,4 % chg 13 to 16.%.%.%.%.%.%

56 Neurology (including child) - Surgery Exhibit C Page 12 Rest of State 16, 14, 12, 1, 8, 6, 4, 2, MMLIS MedPro TDC PRAIC PPIC NORCAL MagMut Proselect Aspen Capson MMICNC PPIE 214 9,172 19,4 151,935 18,151 99,963 16,264 97,565 95, ,172 19,4 151,935 18,151 99,963 16,264 97,565 95, ,172 19,4 151,935 18,151 99, ,259 87,259 16,264 97,565 95,723 91,792 19, ,172 19,4 151,935 18,151 99, ,259 16,264 97,565 95,723 91,792 19,4 % chg 13 to 16.%.%.%.%.%.%

57 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 NORCAL MagMut Proselect Aspen Galen MMICNC PPIE ,77 39,367 32,39 29,883 19,53 2,928 35,849 18, ,77 39,367 32,39 29,883 19,53 2,928 35,849 18,954 29, ,77 39,367 32,39 29,883 19,53 26,87 2,928 35,849 18,954 29,66 29,222 39, ,77 39,367 32,39 29,883 19,53 26,87 2,928 35,849 18,954 29,66 29,222 39,367 % chg 13 to 16.%.%.%.%.%.%.%

58 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 NORCAL MagMut Proselect Aspen Galen MMICNC PPIE Series1 26,95 34,99 28,895 27,351 17,752 19,159 32,588 17,375 Series2 26,95 34,99 28,895 27,351 17,752 19,159 32,588 17,375 26,58 Series3 26,95 34,99 28,895 27,351 17,752 24,369 19,159 32,588 17,375 26,58 26,564 34,99 Series4 26,95 34,99 28,895 27,351 17,752 24,369 19,159 32,588 17,375 26,58 26,564 34,99 Series5.%.%.%.%.%.%.%

59 Neurology (including child) - Minor Surgery Exhibit C Page 15 Rest of State 35, 3, 25, 2, 15, 1, 5, MMLIS MedPro TDC PRAIC PPIC NORCAL MagMut Proselect Aspen Galen MMICNC PPIE ,965 29,159 24,426 24,379 14,452 17,39 28,679 15, ,965 29,159 24,426 24,379 14,452 17,39 28,679 15,795 23, ,965 29,159 24,426 24,379 14,452 21,446 17,39 28,679 15,795 23,253 23,379 29, ,965 29,159 24,426 24,379 14,452 21,446 17,39 28,679 15,795 23,253 23,379 29,159 % chg 13 to 16.%.%.%.%.%.%.%

60 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 NORCAL MagMut Proselect Aspen Capson MMICNC PPIE ,462 6,564 34,322 81,257 58,651 25,415 67,344 61,236 61, ,462 6,564 34,322 81,257 58,651 25,415 67,344 61,236 61, ,462 6,564 34,322 81,257 58,651 67,17 25,415 67,344 61,236 61,361 68,673 6, ,462 6,564 34,322 81,257 58,651 67,17 25,415 67,344 61,236 61,361 68,673 6,564 % chg 13 to 16.%.%.%.%.%.%.%