EXECUTIVE SUMMARY ENROLLMENT GROWS YET MARGINS DROP FOR OHIO S HEALTH INSURING CORPORATIONS. 970,000 Ohioans remained uninsured in 2014.

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1 OHA exists to collaborate with member hospitals and health systems to ensure a healthy Ohio. February 2016 EXECUTIVE SUMMARY ENROLLMENT GROWS YET MARGINS DROP FOR OHIO S HEALTH INSURING CORPORATIONS In 2014, the number of Ohioans insured through Health Insuring Corporations grew by 10.4 percent to 6,708,381 people, fueled mostly by increased Medicaid managed care enrollment. Premium revenue also grew 10.7 percent over the previous year, although profitability declined 59 percent. Ohio expanded Medicaid to individuals earning up to 138 percent of the poverty level, which resulted in new Medicaid enrollees fueling most, if not all, of the growth in the HIC industry. This report focuses on the 25 HICs licensed in Ohio to provide coverage for basic health care services: physician services, inpatient hospital services, outpatient medical services, emergency health services, urgent care services, diagnostic laboratory services, diagnostic and therapeutic radiologic services, diagnostic and treatment services for biologically based mental illnesses, and preventive health care services. The data used to produce this analysis are collected from the Ohio Department of Insurance and the Centers for Medicare & Medicaid Services. HICs, also referred to as Health Maintenance Organizations, provided health insurance coverage for 58 percent of Ohio s 11.6 million residents in More than 970,000 Ohioans remained uninsured in Health insurance coverage and the distribution of coverage types reflect economic and societal trends: shifts in the demographic composition of the population and policy changes that impact access to care. As economic conditions improve, commercial and employer sponsored plans generally show increases in enrollment. However, several policy changes adopted with the Patient Protection and Affordable Care Act went into effect in 2014 and impacted those assumptions. The ACA created growth in the areas of Medicaid expansion and the health insurance marketplace. In Ohio, 12 insurance providers offered Qualified Health Plans in In 2014, Medicaid HICs experienced a 54 percent growth in premiums and a 42 percent growth in enrollment. Despite revenue growth, median total margin for HICs declined from 3.3 percent in 2013 to 1.4 percent in the health insurance marketplace. The open enrollment period in 2014 resulted in 188,867 covered lives in the new marketplace. Many individuals buying coverage on their own had higher health care costs than others with existing coverage. Individuals with pre-existing conditions who did not have employer-sponsored coverage were able to purchase coverage for the first time. Ohio Health Insuring Corporations Report 1

2 THE NUMBERS FOR 2014: MEDICAID'S IMPACT Each year the Ohio Hospital Association reviews financial statements filed with the Ohio Department of Insurance by Health Insuring Corporations to assess trends and to monitor financial performance in the industry. This year s report yields the following findings: 6.7 million Ohioans are enrolled in a HIC, 58% of all Ohioans There are 25 licensed plans, although three (AmeriGroup, Gateway and WellCare) seem to be winding down business due to discontinued Medicaid contracts. Medicaid business represented 36% of all enrollment, up from 28% in 2013, a 29% increase. $26.5 billion in premiums were paid to HICs in Medicaid plans were more profitable than commercial plans in 2014 (2.1% versus 1.4% median total margin). Aggregate net income for Ohio HICs in 2014 was $681,266,114. Medicaid plans accounted for 36% of those profits, $248,940,149 Premiums for HICs increased 17.2% in Aggregate underwriting margin was 3.2%, down from 4.2 in In addition to the 25 licensed HICs, a number of health plans operating in Ohio are licensed as property and casualty companies: Community Insurance Co., Medical Mutual of Ohio, Anthem Insurance Companies, Inc., and Medical Health Insuring Corporation of Ohio are among the larger insurers (note that some also hold HIC licenses) offering Preferred Provider Organizations and other types of indemnity insurance in their portfolios. Combined, these four plans enroll another 3 million plus Ohioans. COMPANY 2014 PREMIUMS $ Community Insurance Co. 5,221,589,105 Medical Mutual of Ohio 2,219,340,418 Anthem Insurance Companies, Inc. (multi-state totals) Medical Health Insuring Corporation of Ohio Source: Ohio Department of Insurance 4,735,298, ,400,746 HEALTH INSURING CORPORATIONS DEFINED The terms managed care, HMO and Health Insuring Corporation are not synonymous in Ohio. Although related, these terms define different aspects of the continuum of product types and purchasers of those products. Chapter of the Ohio Revised Code defines a HIC as: a corporation, as defined in division (H) of this section, that, pursuant to a policy, contract, certificate, or agreement, pays for, reimburses, or provides, delivers, arranges for, or otherwise makes available, basic health care services, supplemental health care services, or specialty health care services, or a combination of basic health care services and either supplemental health care services or specialty health care services, through either an open panel plan or a closed panel plan. COMPANY 2014 PREMIUMS $ CareSource 5,597,141,999 Community Insurance Company 5,279,770,418 Aetna Health, Inc. 2,854,134,538 Medical Mutual of Ohio 2,238,112,320 Molina Healthcare of Ohio, Inc. 1,782,074,313 UnitedHealthcare Community Plan of Ohio, Inc. 1,413,163,495 Buckeye Community Health Plan, Inc. 1,325,855,870 HealthAmerica Pennsylvania, Inc. 1,001,985,952 UnitedHealthcare of Ohio, Inc. 877,626,098 Paramount Advantage 725,282,736 Humana Health Plan of Ohio, Inc. 496,910,972 Mount Carmel Health Plan, Inc. 466,995,878 Aultcare Insurance Company 465,655,101 HealthSpan Integrated Care 419,159,699 The Health Plan of the Upper Ohio Valley, Inc. 381,496,117 Aetna Better Health, Inc. 335,337,638 SummaCare, Inc. 315,607,309 Medical Health Insuring Corporation of Ohio 159,756,026 Paramount Insurance Company 151,623,858 Paramount Health Care 143,021,577 WellCare of Ohio, Inc. 45,085,434 HealthSpan, Inc. 19,208,632 Mount Carmel Health Insurance 12,803,420 Gateway Health Plan of Ohio, Inc. 7,523,245 AmeriGroup Ohio, Inc. 293,313 Ohio Hospital Association 2016 Ohio Health Insuring Corporations Report 2

3 THE NUMBERS FOR 2014: ENROLLMENT UP, MARGINS DOWN ENROLLMENT As in prior years with high rates of growth, most of the 2014 increase in enrollment can be attributed to increased numbers of Ohioans covered by Medicaid plans. The Health Care Expense Ratio is a key financial measure that shows the percentage of premium dollars a health insurer pays for medical care and quality improvement expenses, as opposed to the portion allocated to overhead in the form of profits, administrative costs, and sales expenses. HCER is calculated using the formula: Total Medical and Hospital Expenses Total Revenue The median Health Care Expense ratio in 2014 was 84 percent. INDUSTRY FINANCIALS This report includes two measures of HIC profitability, net underwriting gain (or loss), and total margin. Net underwriting gain is calculated using the formula: Incurred Losses + Loss Adjustment Expense Earned Premiums The underwriting gain for Ohio HICs in 2014 was $855.2 million on premiums of $26.5 billion, for an aggregate 3.2 percent margin, down one percentage point from The median was 0.5 percent, down from 2.9 percent in It is worth noting that plans reporting these extreme values were also undergoing significant transitions, either exiting major segments of the market or in the middle of merger or acquisition. The Administrative Expense Ratio (AER) is the percent of revenue spent on overhead, salaries, commissions, marketing and other non-health services. It is calculated using the formula: Total Administrative Expenses Total Revenue Total margin is calculated using the formula: Net Income Total Revenue Ohio HICs reported total gains of $681.3 million in 2014, representing an aggregate total margin of 2.5 percent. The median total margin was 1.4 percent with a number of plans expressing extreme values due to major business transitions. Please refer to the index for plan-specific data. The Administrative Expense Ratio is the percent of revenue spent on overhead, salaries, commissions, marketing and other non-health services. It is calculated using the formula: Total Administrative Expenses Total Revenue Ohio Health Insuring Corporations Report 3

4 THE NUMBERS FOR 2014: PLANS FOR SPECIAL POPULATIONS SPECIAL MARKET SEGMENTS Medicaid Managed Care Since the 1990s, Ohio Medicaid has contracted with selected HICs, referred to as Managed Care Plans, or MCPs, to arrange health care services for certain covered members. The plans provide all services offered through traditional Medicaid and may add additional services. Providers contract with and bill Medicaid MCPs directly. In 2014, Medicaid MCPs covered 2,444,816 lives. Most MCP members qualify for coverage in the Covered Families and Children eligibility category. However, recent state law requires that most non-institutionalized individuals in the Aged, Blind, and Disabled eligibility category enroll in Medicaid MCPs. Ohio selected five plans to manage the full spectrum of Medicaid and Medicare benefits for dually eligible Medicaid beneficiaries: Aetna Better Health, Inc. Buckeye Community Health Plan, Inc. CareSource Molina Healthcare of Ohio, Inc. UnitedHealthcare Community Plan of Ohio, Inc. Over the years, revenues have increased significantly for MCPs operating in Ohio, to $11.2 billion in Net income and operating margins have also increased. In 2014, MCPs earned $255.5 million on premiums of $11.2 billion. In addition, the Ohio Department of Medicaid initiated MyCare Ohio, a three-year demonstration project, that uses MCPs to coordinate benefits for residents covered by Medicare and Medicaid. All Ohioans eligible for Medicaid due to new categories created under the ACA are enrolled in MCPs. MCPs function differently from commercial managed care programs. Rates are often tied to already inadequate fee-for-service Medicaid payments, and hospitals are not permitted to recover costs from Medicaid MCP enrollees. The state generally has the upper hand in determinations of network adequacy. NET INCOME Aetna Better Health, Inc. -19,588,189 *AmeriGroup 9,237,266 6,806,787 13,483,951 8,368, ,667 Buckeye 21,028,613 15,560,516 12,998,217 13,140, ,839 CareSource 112,375, ,208, ,481, ,942, ,663,608 Molina 37,921,933 45,343,065 18,762,516 34,003,852 55,873,718 Paramount Advantage 9,148,733 6,400,691 9,635,305 5,459,399 10,480,743 Unison/UHC Community Care 32,753,268 23,266,753 36,241,293 22,182,950 47,832,332 *Wellcare (1,378,955) 8,000,903 6,792,038 7,530,885 1,003,074 *No longer contracting with Ohio Medicaid The following companies function as MCPs for the Medicaid program Covered Families and Children and Aged Blind and Disabled eligibility categories throughout Ohio: Buckeye Community Health Plan, Inc. CareSource Molina Healthcare of Ohio, Inc. Paramount Advantage UnitedHealthcare Community Plan of Ohio, Inc. Individuals who are dually eligible for Medicare and Medicaid and who live in certain regions of the state are also eligible for the MyCare Ohio demonstration program. MyCare Ohio is an integrated care delivery system of managed care plans selected to coordinate physical, behavioral, and long-term care services for individuals over the age of 18 who are eligible for both Medicaid and Medicare. This includes people with disabilities, older adults, and individuals who receive behavioral health services. Medicare Advantage Medicare Advantage Plans are a form of plan offered by private companies that contract with Medicare to provide Medicare Part A and Part B benefits. Services are covered through the plan and are not paid under original Medicare. Most MA plans offer prescription drug coverage. In 2014, 39 MA plans reported combined enrollment of 821,631; of that number, 48 percent, or 395,985, including Ohio Health Insuring Corporations Report 4

5 THE NUMBERS FOR 2014 (CONTINUED) those participating in the MyCare Ohio demonstration were in HICs. The number of Medicare beneficiaries in MA plans grew 6 percent between 2013 and 2014; enrollment in Medicare Advantage HICs grew by 20 percent. MA plans operate in a different environment from commercial HICs. CMS tightly controls the manner in which MA plans market and enroll eligible individuals. Only a handful of HICs operate exclusively as MA plans: Mount Carmel Health Plan, Inc. and Mount Carmel Health Insuring Company, Paramount Health Care, and SummaCare, Inc. The majority of MA enrollees are in HICs that offer MA as one of several lines of business. MARKET DRIVERS AND STAKEHOLDERS EMPLOYER SPONSORED PLANS REMAIN LARGEST CUSTOMER SEGMENT The health insurance industry is experiencing unprecedented regulatory, financial and competitive disruption. Traditional employer group business is changing, government sponsorship of health coverage is expanding, and new opportunities for growth in exchanges and marketplaces are emerging. Collaboration between health plans and providers to drive value-based care and better health outcomes is creating additional opportunities to increase market share and improve patient outcomes and experiences. Employer-sponsored plans continue to be the majority of health insuring corporations book of business, despite the alternatives offered by the ACA. Most employers who offered health insurance prior to the ACA continue to provide their employees with insurance, often pushing for higher-quality, lower-cost coverage. Medicare Advantage enrollment will continue to increase market penetration as a percent of total Medicare beneficiaries. This will occur as the Baby Boomer generation ages and providers and health plans continue to push for lower costs and higher quality. HEALTH INSURANCE EXCHANGES Starting in 2014, individuals with employers that do not offer insurance are able to purchase it directly in the Health Insurance Marketplace. The Marketplace offers a choice of health plans that meet certain benefit and cost standards. Also, effective January 1, 2014, tax credits became available for people with income between 100 percent and 400 percent of the federal poverty line who are not eligible for other affordable coverage. The tax credits are usable for reducing monthly premium credits for insurance coverage purchased on health care exchanges. PROVIDER RELATIONSHIPS One of the most basic needs in today s healthcare system is for payers and providers to work together in alignment. On average, 85 percent of health care premium dollars are spent on health services. It makes sense for payers to align themselves with those who control those costs. Providers generally accept responsibility for the health and well-being of the patients for whom they provide care. For the benefit of all parties, patients in particular, reducing bureaucracy and inefficiency makes sense. In December 2014, CMS awarded Ohio a State Innovation Model Test Award in the amount of $75 million over a 48-month project period, to support the design of innovative, multi-player health payment and service delivery models designed to improve health system performance, improve quality of care, and decrease costs. Ideally, this award should facilitate alignment among payers and providers to agree on goals in patient care, payment, and tools to help attain those goals. The Governor s Office for Health Transformation is leading this effort which so far has engaged Ohio s major employers, health plans, hospital systems and consumer advocates. Emerging new models for delivery of care and payment are potentially positive developments which can lead to improved outcomes and reducing long term costs. Change is slow and incremental. However, providers and payers seem to be resilient and up to the task of transforming the health care delivery and payment system in Ohio. CONTACT Berna Bell Director, Health Economics and Policy Ohio Hospital Association Berna.Bell@ohiohospitals.org REFERENCES Ohio Department of Insurance. Annual Statements for the Year Ending December 31, 2014 Center for Medicare & Medicaid Services. Total Effectuated Enrollment and Financial Assistance by State. Center for Medicare & Medicaid Services. MA-Enrollment-by-SCC OHIO HOSPITAL ASSOCIATION 155 E. Broad St., Suite 301 Columbus, OH t f ohiohospitals.org : /helpingohiohospitals

6 Aetna Health, Inc. Aetna Better Health, Inc. Cash (excl. cash equivalents) 954,343 2,318,809 10,074,570 Total Current Assets 183,383, ,246, ,866,793 Total Other Assets 630,249, ,478,914 43,267,772 Total Property and Equipment Total Assets 813,632, ,725, ,134,565 Total Current Liabilities 435,793, ,839, ,467,998 Total Other Liabilities 48,490,790 40,130,871 Total Liabilities 484,283, ,970, ,467,998 Total 329,348, ,755,219 44,666,567 Premium 3,040,475,972 2,854,134, ,337,638 Point of Service Medicare Medicaid Other Revenue 1,512,790 35,037,183 77,220 Total Revenue 3,041,988,762 2,889,171, ,414,858 Total Medical and Hospital 2,537,739,721 2,333,573, ,294,455 Total Administrative Expenses 391,927, ,144,116 55,526,366 Total Expenses 2,929,666,843 2,714,717, ,820, ,321, ,454,583 (28,405,963) PROVISION FOR FEDERAL INCOME TAXES 11,299,216 57,431,430 (8,817,774) Net Income (Loss) 101,022, ,023,153 (19,588,189) Net Underwriting Gain 90,252, ,639,835 (28,483,183) TOTAL ENROLLMENT 700, ,409 20,515 8,724,305 7,477, ,443 Current Ratio Average Payment Period Total Margin 3.3% 4.1% -5.8% Administrative Expense Ratio 12.9% 13.2% 16.6% Health Care Expense Ratio 83.4% 80.8% 91.9%

7 AmeriGroup Ohio, Inc. AultCare Insurance Co. Cash (excl. cash equivalents) 10,955,145 (15,255,159) 17,236,926 15,372,382 Total Current Assets 15,525,314 (10,247,030) 38,064,661 37,693,759 Total Other Assets 23,195,140 25,055,072 76,256,461 77,425,009 Total Property and Equipment 880, ,588 Total Assets 38,720,454 14,808, ,201, ,984,356 Total Current Liabilities 4,273,395 3,733,940 52,774,065 52,698,560 Total Other Liabilities 607, , , ,140 Total Liabilities 4,880,650 4,717,752 53,502,401 53,542,700 Total 33,839,804 10,090,290 61,698,900 62,441,656 Premium 79,831, , ,121, ,655,101 Other Revenue 586, ,465 2,234,582 3,338,214 Total Revenue 80,418, , ,355, ,993,315 Total Medical and Hospital 51,668, , ,614, ,076,890 Total Administrative Expenses 16,476, ,074 58,652,214 59,675,439 Total Expenses 68,144, , ,266, ,752,329 12,273, ,000 4,089,105 9,240,986 PROVISION FOR FEDERAL INCOME TAXES 3,904, ,333 (658,843) 3,854,570 Net Income (Loss) 8,368, ,667 4,747,948 5,386,416 Net Underwriting Gain 11,897,502 (114,465) 1,854,524 5,902,771 TOTAL ENROLLMENT 113, , ,416 1,389,948 1,378,455 Current Ratio 3.63 (2.74) Average Payment Period , Total Margin 10.4% 24.3% 1.0% 1.1% Administrative Expense Ratio 20.5% 21.0% 12.9% 12.7% Health Care Expense Ratio 64.3% 36.9% 86.3% 85.3%

8 Buckeye Community Health Plan, Inc. CareSource Cash (excl. cash equivalents) 48,115,140 77,408, ,591, ,619,314 Total Current Assets 73,222, ,013, ,560,886 1,020,358,214 Total Other Assets 126,056, ,198, ,568, ,572,425 Total Property and Equipment Total Assets 199,278, ,211,636 1,129,129,397 1,720,930,639 Total Current Liabilities 93,564, ,486, ,498, ,149,734 Total Other Liabilities 580, ,832 1,247,520 Total Liabilities 93,564, ,067, ,270, ,397,254 Total 105,714, ,144, ,859, ,533,385 Premium 795,033,635 1,325,855,870 4,154,066,540 5,597,141,999 Other Revenue 2,034,653 2,295,550 28,510,959 34,653,749 Total Revenue 797,068,288 1,328,151,420 4,182,577,499 5,631,795,748 Total Medical and Hospital 620,036,510 1,060,816,906 3,489,072,099 4,729,883,282 Total Administrative Expenses 156,177, ,997, ,562, ,248,858 Total Expenses 776,214,462 1,319,814,747 4,047,635,022 5,471,132,140 20,853,826 8,336, ,942, ,663,608 PROVISION FOR FEDERAL INCOME TAXES 7,713,521 9,283,512 Net Income (Loss) 13,140,305 (946,839) 134,942, ,663,608 Net Underwriting Gain 18,819,179 6,041, ,297, ,726,555 TOTAL ENROLLMENT 172, , ,010 1,275,520 1,964,376 2,828,216 11,200,810 13,475,134 Current Ratio Average Payment Period Total Margin 1.6% -0.1% 3.2% 2.9% Administrative Expense Ratio 19.6% 19.5% 13.4% 13.2% Health Care Expense Ratio 77.8% 79.9% 83.4% 84.0%

9 Community Insurance Co. Gateway Health Plan of Ohio, Inc. Cash (excl. cash equivalents) (328,422,768) (329,949,957) 2, ,718 Total Current Assets 304,517, ,200,072 7,838,944 7,813,515 Total Other Assets 1,554,249,231 1,515,283, ,034 1,217,243 Total Property and Equipment 28,672,155 12,783,910 Total Assets 1,887,439,221 2,014,267,869 8,290,978 9,030,758 Total Current Liabilities 724,583, ,110,347 39,456 4,767,931 Total Other Liabilities 384,473, ,005,046 5,724,041 37,723 Total Liabilities 1,109,056,437 1,202,115,393 5,763,497 4,805,654 Total 778,382, ,152,476 2,527,481 4,225,104 Premium 5,077,537,837 5,279,770, ,523,245 Other Revenue 126,538,728 95,417,968 14,099 Total Revenue 5,204,076,565 5,375,188, ,537,344 Total Medical and Hospital 4,256,225,696 4,366,679, ,613,519 Total Administrative Expenses 386,580, ,663,268 7,110,749 7,491,790 Total Expenses 4,642,806,287 4,916,342,943 7,110,917 14,105, ,270, ,845,443 (7,109,929) (6,567,965) PROVISION FOR FEDERAL INCOME TAXES 168,795, ,973,149 Net Income (Loss) 392,474, ,872,294 (7,109,929) (6,567,965) Net Underwriting Gain 459,352, ,877,479 (7,110,917) (6,582,063) TOTAL ENROLLMENT 1,899,391 1,974,741 1,068 22,723,313 24,051,555 7,660 Current Ratio Average Payment Period Total Margin 7.5% 5.2% -87.1% Administrative Expense Ratio 7.4% 10.2% 99.4% Health Care Expense Ratio 81.8% 81.2% 17.0% 87.7%

10 HealthAmerica Pennsylvania, Inc. The Health Plan of the Upper Ohio Valley, Inc. Cash (excl. cash equivalents) 6,195,363 (3,782,092) 15,586,021 16,877,089 Total Current Assets 75,454,615 55,482,807 23,613,752 33,882,834 Total Other Assets 152,255, ,780, ,684, ,937,393 Total Property and Equipment 5,470,430 5,271,625 Total Assets 227,710, ,262, ,768, ,091,852 Total Current Liabilities 140,919,278 84,968,010 49,749,637 58,228,522 Total Other Liabilities 3,824,851 9,603,795 3,010,448 6,878,530 Total Liabilities 144,744,129 94,571,805 52,760,085 65,107,052 Total 82,966, ,691, ,008, ,984,800 Premium 809,510,130 1,001,985, ,585, ,496,117 Other Revenue 4,116,164 4,812,459 7,630,512 10,533,203 Total Revenue 813,626,294 1,006,798, ,215, ,029,320 Total Medical and Hospital 697,137, ,209, ,624, ,889,245 Total Administrative Expenses 85,562, ,716,281 23,410,942 38,253,795 Total Expenses 782,700,185 1,019,925, ,034, ,143,040 30,926,109 (13,127,453) 16,180,813 10,886,280 PROVISION FOR FEDERAL INCOME TAXES 10,828,997 (3,824,231) Net Income (Loss) 20,097,112 (9,303,222) 16,180,813 10,886,280 Net Underwriting Gain 26,814,745 (16,710,251) 8,550, ,077 TOTAL ENROLLMENT 142,144 72,230 78,097 76,460 1,551,168 1,685, , ,919 Current Ratio Average Payment Period Total Margin 2.5% -0.9% 4.3% 2.8% Administrative Expense Ratio 10.5% 14.2% 6.3% 9.8% Health Care Expense Ratio 85.7% 87.1% 89.4% 87.5%

11 HealthSpan Inc. HealthSpan Integrated Care Cash (excl. cash equivalents) 9,294, ,180,997 18,289,677 Total Current Assets 13,338, ,319,974 48,778,953 Total Other Assets 4,891, ,417 27,714,020 Total Property and Equipment 82,387,697 71,341,666 Total Assets 18,230, ,108, ,834,639 Total Current Liabilities 7,608, ,998,800 63,830,221 Total Other Liabilities 2,193,987 31,798,181 28,565,720 Total Liabilities 9,802, ,796,981 92,395,941 Total 8,428, ,311,107 55,438,698 Premium 19,208, ,889, ,159,699 Point of Service Medicare Medicaid Other Revenue 12,836,963 (65,289,644) (487,317) Total Revenue 32,045, ,599, ,672,382 Total Medical and Hospital 16,572, ,441, ,124,368 Total Administrative Expenses 18,394,671 52,588,513 64,249,061 Total Expenses 34,967, ,029, ,373,429 (2,921,481) (89,430,313) (53,701,047) PROVISION FOR FEDERAL INCOME TAXES Net Income (Loss) (2,921,481) (89,430,313) (53,701,047) Net Underwriting Gain (2,950,550) (21,211,863) (51,789,952) TOTAL ENROLLMENT 15,083 81,606 74,819 48, , ,471 Current Ratio Average Payment Period Total Margin -9.1% -21.9% -12.8% Administrative Expense Ratio 57.4% 12.9% 15.3% Health Care Expense Ratio 51.7% 109.0% 97.5%

12 Humana Health Plan of Ohio, Inc. Medical Health Insuring Corporation of Ohio Cash (excl. cash equivalents) 1,755,316 24,428, ,439 1,792,240 Total Current Assets 12,050,361 51,250,813 14,558,904 50,155,532 Total Other Assets 78,677,750 89,679,236 77,807,443 68,490,927 Total Property and Equipment 6,402 2,768 Total Assets 90,734, ,932,817 92,366, ,646,459 Total Current Liabilities 41,675,477 73,050,598 3,721,193 49,190,436 Total Other Liabilities 459,187 4,353,002 Total Liabilities 42,134,664 77,403,600 3,721,193 49,190,436 Total 48,599,849 63,529,217 88,645,154 69,456,023 Premium 367,085, ,910,972 12,338, ,756,026 Other Revenue 2,689,872 2,645,409 2,479,312 1,150,786 Total Revenue 369,775, ,556,381 14,817, ,906,812 Total Medical and Hospital 302,993, ,354,045 11,250, ,278,687 Total Administrative Expenses 59,313,269 95,999,962 1,153,504 25,425,879 Total Expenses 362,306, ,354,007 12,403, ,704,566 7,469,370 (25,797,626) 2,413,880 (18,797,754) PROVISION FOR FEDERAL INCOME TAXES 1,893,561 (264,852) 461,528 1,503,310 Net Income (Loss) 5,575,809 (25,532,774) 1,952,352 (20,301,064) Net Underwriting Gain 4,668,243 (28,388,922) (141,432) (19,872,540) TOTAL ENROLLMENT 75,337 90,884 2,746 41, ,161 1,072,064 31, ,555 Current Ratio Average Payment Period Total Margin 1.5% -5.1% 13.2% -12.6% Administrative Expense Ratio 16.0% 19.2% 7.8% 15.8% Health Care Expense Ratio 81.9% 85.9% 75.9% 95.9%

13 Medical Mutual of Ohio Molina Healthcare of Ohio, Inc. Cash (excl. cash equivalents) 16,935,600 30,974,911 14,865,745 73,323,850 Total Current Assets 184,554, ,181, ,127, ,366,025 Total Other Assets 1,500,034,060 1,507,727,388 71,204, ,773,926 Total Property and Equipment Total Assets 1,684,588,248 1,766,909, ,332, ,139,951 Total Current Liabilities 374,527, ,342, ,013, ,040,788 Total Other Liabilities 88,256,133 89,664,595 7,421,012 48,446,517 Total Liabilities 462,783, ,007, ,434, ,487,305 Total 1,221,804,341 1,279,901, ,898, ,652,646 Premium 2,473,581,183 2,238,112,320 1,244,167,735 1,782,074,313 Other Revenue 29,746,383 27,409,479 4,363,999 (3,027,701) Total Revenue 2,503,327,566 2,265,521,799 1,248,531,734 1,779,046,612 Total Medical and Hospital 2,068,746,339 1,819,680, ,507,530 1,351,464,312 Total Administrative Expenses 315,780, ,087, ,414, ,337,547 Total Expenses 2,384,527,132 2,150,767,999 1,195,922,456 1,683,801, ,800, ,753,800 52,609,278 95,244,753 PROVISION FOR FEDERAL INCOME TAXES 21,060,267 17,454,481 18,605,426 39,371,035 Net Income (Loss) 97,740,167 97,299,319 34,003,852 55,873,718 Net Underwriting Gain 88,925,265 87,440,134 52,316,716 98,025,771 TOTAL ENROLLMENT 1,111,733 1,022, , ,662 13,425,595 12,549,670 3,006,782 3,649,981 Current Ratio Average Payment Period Total Margin 3.9% 4.3% 2.7% 3.1% Administrative Expense Ratio 12.6% 14.6% 19.1% 18.7% Health Care Expense Ratio 82.6% 80.3% 76.7% 76.0%

14 Mount Carmel Health Plan, Inc. Mount Carmel Health Insurance Cash (excl. cash equivalents) 5,883,240 (5,746,282) 4,595,674 3,643,997 Total Current Assets 128,865,536 84,709, , ,663 Total Other Assets 198,231, ,564,613 2,358,364 2,783,672 Total Property and Equipment 2,605 Total Assets 327,100, ,274,162 7,890,373 7,274,332 Total Current Liabilities 35,677,812 40,698,236 1,003,744 1,404,230 Total Other Liabilities Total Liabilities 35,677,812 40,698,236 6,886,629 5,869,602 Total 291,422, ,575,926 7,890,373 7,273,832 Premium 405,202, ,995,878 8,698,762 12,803,420 Other Revenue 19,636,564 (3,884,374) 588,563 (347,578) Total Revenue 424,839, ,111,504 9,287,325 12,455,842 Total Medical and Hospital 358,773, ,588,360 8,236,075 12,181,424 Total Administrative Expenses 43,345,247 41,793, ,159 1,305,105 Total Expenses 402,118, ,382,168 9,216,234 13,486,529 43,377,380 6,804, ,987 (968,555) PROVISION FOR FEDERAL INCOME TAXES Net Income (Loss) 43,377,380 6,804, ,987 (968,555) Net Underwriting Gain 22,720,868 (4,270,664) 71,091 (1,030,687) TOTAL ENROLLMENT 37,669 45, , , ,475 Current Ratio Average Payment Period % Total Margin 10.2% 1.5% 97.8% Administrative Expense Ratio 10.2% 9.0% Health Care Expense Ratio 84.4% 91.9% 0.0%

15 Paramount Advantage Paramount Health Care Cash (excl. cash equivalents) 50,326, ,178,695 12,936,832 9,170,522 Total Current Assets 65,992, ,382,168 16,008,535 13,022,530 Total Other Assets 64,184,079 69,626,012 82,073,900 85,488,007 Total Property and Equipment 743, ,440 Total Assets 130,176, ,008,180 98,826,205 98,970,977 Total Current Liabilities 55,735, ,429,171 27,022,650 27,518,160 Total Other Liabilities 10,719,000 31,674,871 7,422,945 15,699,517 Total Liabilities 66,454, ,104,042 34,445,595 43,217,677 Total 63,721, ,904,138 64,380,610 55,753,300 Premium 387,877, ,282, ,770, ,021,577 Other Revenue 2,344,734 2,231,923 4,399,098 3,198,305 Total Revenue 390,222, ,514, ,169, ,219,882 Total Medical and Hospital 315,501, ,330, ,192, ,130,291 Total Administrative Expenses 65,857, ,837,513 16,197,453 6,751,839 Total Expenses 381,359, ,168, ,389, ,882,130 8,863,145 17,346,340 6,779,657 (662,248) PROVISION FOR FEDERAL INCOME TAXES 3,403,746 6,865,597 (468,231) (1,547,361) Net Income (Loss) 5,459,399 10,480,743 7,247, ,113 Net Underwriting Gain 8,625,769 16,905,849 2,380,559 (3,860,553) TOTAL ENROLLMENT 141, ,598 12,279 12,298 1,408,889 2,187, , ,295 Current Ratio Average Payment Period Total Margin 1.4% 1.4% 3.3% 0.6% Administrative Expense Ratio 16.9% 14.5% 7.5% 4.6% Health Care Expense Ratio 80.9% 83.1% 89.4% 95.8%

16 Paramount Insurance Co. SummaCare, Inc. Cash (excl. cash equivalents) 27,572,595 31,867,376 25,680,910 5,157,571 Total Current Assets 29,038,416 38,552,070 32,536,741 12,998,052 Total Other Assets 5,993,530 6,096,830 72,791,927 72,304,108 Total Property and Equipment Total Assets 35,031,946 44,648, ,328,668 85,302,160 Total Current Liabilities 20,335,395 24,046,980 74,114,367 41,749,184 Total Other Liabilities 88,262 23, , ,639 Total Liabilities 20,423,657 24,070,906 74,746,355 42,012,823 Total 14,608,289 20,577,994 30,582,313 43,289,337 Premium 79,182, ,623, ,513, ,607,309 Other Revenue 35, ,787 1,420,911 1,982,766 Total Revenue 79,217, ,768, ,934, ,590,075 Total Medical and Hospital 65,151, ,116, ,239, ,319,595 Total Administrative Expenses 10,957,699 19,711,895 30,420,239 30,814,539 Total Expenses 76,108, ,828, ,660, ,134,134 3,109,037 9,940,069 12,274,074 3,455,941 PROVISION FOR FEDERAL INCOME TAXES 1,216,319 3,671,526 3,158,887 1,404,123 Net Income (Loss) 1,892,718 6,268,543 9,115,187 2,051,818 Net Underwriting Gain 3,073,330 9,795,282 10,916,274 1,552,713 TOTAL ENROLLMENT 39,670 39,111 28,447 32, , , , ,053 Current Ratio Average Payment Period Total Margin 2.4% 4.1% 3.3% 0.6% Administrative Expense Ratio 13.8% 13.0% 10.9% 9.7% Health Care Expense Ratio 82.2% 80.5% 84.7% 89.2%

17 UnitedHealthcare Community Plan of Ohio, Inc. UnitedHealthcare of Ohio, Inc. Cash (excl. cash equivalents) 348, ,517 (5,098,373) (2,608,666) Total Current Assets 123,776, ,652,078 63,840,805 63,051,759 Total Other Assets 119,933, ,345, ,499, ,858,646 Total Property and Equipment Total Assets 243,709, ,997, ,340, ,910,405 Total Current Liabilities 114,520, ,452, ,685, ,066,210 Total Other Liabilities 373,642 2,353,271 1,041,659 1,993,248 Total Liabilities 114,894, ,805, ,727, ,059,458 Total 128,815, ,192, ,612, ,850,947 Premium 666,284,400 1,413,163,495 1,037,016, ,626,098 Other Revenue 2,477,255 (48,434,298) 10,525,623 7,324,253 Total Revenue 668,761,655 1,364,729,197 1,047,542, ,950,351 Total Medical and Hospital 513,806,915 1,052,437, ,634, ,060,571 Total Administrative Expenses 120,131, ,810, ,427, ,212,116 Total Expenses 633,938,586 1,286,247,864 1,043,061, ,272,687 34,823,069 78,481,333 4,480,849 39,677,664 PROVISION FOR FEDERAL INCOME TAXES 12,640,119 30,649, ,304 18,101,064 Net Income (Loss) 22,182,950 47,832,332 3,935,545 21,576,600 Net Underwriting Gain 33,420,752 77,696,813 (1,936,735) 34,306,940 TOTAL ENROLLMENT 167, , ,436 80,542 1,679,642 2,729,938 1,296, ,030 Current Ratio Average Payment Period Total Margin 3.3% 3.5% 0.4% 2.4% Administrative Expense Ratio 18.0% 17.1% 10.4% 12.7% Health Care Expense Ratio 76.8% 77.1% 89.1% 82.8%

18 WellCare of Ohio, Inc. BALANCE SHEET Cash (excl. cash equivalents) 32,951,988 28,801,458 Total Current Assets 60,972,629 40,077,451 Total Other Assets 2,730,917 4,688,707 Total Property and Equipment Total Assets 63,703,546 44,766,158 Total Current Liabilities 21,409,650 11,474,682 Total Other Liabilities 27,603 80,552 Total Liabilities 21,437,253 11,555,234 Total 42,266,293 33,210,924 Premium 199,562,062 45,085,434 Point of Service Medicare Medicaid Other Revenue 216, ,410 Total Revenue 199,778,909 45,209,844 Total Medical and Hospital 160,235,844 33,179,460 Total Administrative Expenses 28,585,198 8,947,446 Total Expenses 188,821,042 42,126,906 10,957,867 3,082,938 PROVISION FOR FEDERAL INCOME TAXES 3,426,982 2,079,864 Net Income (Loss) 7,530,885 1,003,074 Net Underwriting Gain 10,741,020 2,958,528 TOTAL ENROLLMENT 4,717 3, ,302 49,771 Current Ratio Average Payment Period Total Margin 3.8% 2.2% Administrative Expense Ratio 14.3% 19.8% Health Care Expense Ratio 80.2% 73.4%