QUARTERLY STATEMENT AS OF MARCH 31, 2017 OF THE CONDITION AND AFFAIRS OF THE Neighborhood Health Plan of Rhode Island

Transcription

1 Document Code: 21 QUARTERLY STATEMENT AS OF MARCH 31, 217 CONDITION AND AFFAIRS NAIC Group Code, NAIC Company Code 9542 Employer s ID Number (Current Period) (Prior Period) Organized under the Laws of Rhode Island, State of Domicile or Port of Entry RI Country of Domicile United States of America Licensed as business type: Life, Accident & Health[ ] Property/Casualty[ ] Hospital, Medical & Dental Service or Indemnity[ ] Dental Service Corporation[ ] Vision Service Corporation[ ] Health Maintenance Organization[X] Other[ ] Is HMO Federally Qualified? Yes[ ] No[X] N/A[ ] Incorporated/Organized 12/9/1993 Commenced Business 12/1/1994 Statutory Home Office 91 Douglas Pike, Smithfield, RI, US 2917 (Street and Number) (City or Town, State, Country and Zip Code) Main Administrative Office 91 Douglas Pike (Street and Number) Smithfield, RI, US 2917 (41)459-6 (City or Town, State, Country and Zip Code) (Area Code) (Telephone Number) Mail Address 91 Douglas Pike, Smithfield, RI, US 2917 (Street and Number or P.O. Box) (City or Town, State, Country and Zip Code) Primary Location of Books and Records 91 Douglas Pike (Street and Number) Smithfield, RI, US 2917 (41)459-6 (City or Town, State, Country and Zip Code) (Area Code) (Telephone Number) Internet Web Site Address Statutory Statement Contact Joanne Roux (41) (Name) (Area Code)(Telephone Number)(Extension) jroux@nhpri.org (41) ( Address) (Fax Number) OFFICERS Peter Bancroft, Chairman Brenda Dowlatshahi, Secretary Name Peter Marino Frank Meaney Francisco Trilla MD Shantha Diaz Title Chief Executive Officer Chief Financial Officer Chief Medical Officer Chief Operating Officer OTHERS DIRECTORS OR TRUSTEES Jane Hayward, Vice Chairman Peter Walsh, Treasurer Merrill Thomas Brenda Dowlatshahi Raymond Joseph Lavoie Jr. Christopher Little Esq. Pablo Rodriguez MD Jane Hayward Peter Bancroft CPA Doris De Los Santos Peter Walsh Jeanne LaChance # William Hochstrasser-Walsh Dennis Roy Michael Lichtenstein Patricia Martinez Richard Besdine MD Peter Marino State of Rhode Island County of Providence ss The officers of this reporting entity being duly sworn, each depose and say that they are the described officers of said reporting entity, and that on the reporting period stated above, all of the herein described assets were the absolute property of the said reporting entity, free and clear from any liens or claims thereon, except as herein stated, and that this statement, together with related exhibits, schedules and explanations therein contained, annexed or referred to, is a full and true statement of all the assets and liabilities and of the condition and affairs of the said reporting entity as of the reporting period stated above, and of its income and deductions therefrom for the period ended, and have been completed in accordance with the NAIC Annual Statement Instructions and Accounting Practices and Procedures manual except to the extent that: (1) state law may differ; or, (2) that state rules or regulations require differences in reporting not related to accounting practices and procedures, according to the best of their information, knowledge and belief, respectively. Furthermore, the scope of this attestation by the described officers also includes the related corresponding electronic filing with the NAIC, when required, that is an exact copy (except for formatting differences due to electronic filing) of the enclosed statement. The electronic filing may be requested by various regulators in lieu of or in addition to the enclosed statement. (Signature) (Signature) (Signature) Peter Marino Frank Meaney Francisco Trilla, MD (Printed Name) (Printed Name) (Printed Name) Chief Executive Officer Chief Financial Officer Chief Medical Officer (Title) (Title) (Title) Subscribed and sworn to before me this a. Is this an original filing? Yes[X] No[ ] day of, 217 b. If no, 1. State the amendment number 2. Date filed 3. Number of pages attached (Notary Public Signature)

2 Q2 STATEMENT AS OF March 31, 217 ASSETS Current Statement Date Net Admitted December 31 Nonadmitted Assets Prior Year Net Assets Assets (Cols. 1-2) Admitted Assets 1. Bonds ,141, ,141, ,564,79 2. Stocks: 2.1 Preferred stocks Common stocks Mortgage loans on real estate: 3.1 First liens Other than first liens Real estate: 4.1 Properties occupied by the company (less $... encumbrances) Properties held for the production of income (less $... encumbrances) Properties held for sale (less $... encumbrances) Cash ($...114,39,42), cash equivalents ($...561,837) and short-term investments ($...147,118,445) ,719, ,719, ,139, Contract loans (including $... premium notes) Derivatives Other invested assets Receivables for securities , , ,117, Securities lending reinvested collateral assets Aggregate write-ins for invested assets Subtotals, cash and invested assets (Lines 1 to 11) ,879, ,879, ,821, Title plants less $... charged off (for Title insurers only) Investment income due and accrued , , , Premiums and considerations: 15.1 Uncollected premiums and agents balances in the course of collection ,455, ,455, ,75, Deferred premiums, agents balances and installments booked but deferred and not yet due (including $... earned but unbilled premiums) Accrued retrospective premiums ($...) and contracts subject to redetermination ($...) Reinsurance: 16.1 Amounts recoverable from reinsurers , , ,292, Funds held by or deposited with reinsured companies Other amounts receivable under reinsurance contracts Amounts receivable relating to uninsured plans Current federal and foreign income tax recoverable and interest thereon Net deferred tax asset Guaranty funds receivable or on deposit Electronic data processing equipment and software ,855, , ,685, ,517, Furniture and equipment, including health care delivery assets ($...) ,42, ,42, Net adjustments in assets and liabilities due to foreign exchange rates Receivables from parent, subsidiaries and affiliates Health care ($...9,9,19) and other amounts receivable ,72, , ,9, ,199, Aggregate write-ins for other-than-invested assets ,815, ,76, ,739, ,63, TOTAL assets excluding Separate Accounts, Segregated Accounts and Protected Cell Accounts (Lines 12 to 25) ,784, ,, ,783, ,826, From Separate Accounts, Segregated Accounts and Protected Cell Accounts TOTAL (Lines 26 and 27) ,784, ,, ,783, ,826,418 DETAILS OF WRITE-INS Summary of remaining write-ins for Line 11 from overflow page TOTALS (Lines 111 through 113 plus 1198) (Line 11 above) Prepaid Premium Tax ,142, ,142, ,533, Prepaid Expenses ,94, ,94, Receivable from State , , , Summary of remaining write-ins for Line 25 from overflow page , , TOTALS (Lines 251 through 253 plus 2598) (Line 25 above) ,815, ,76, ,739, ,63,587

3 Q3 STATEMENT AS OF March 31, 217 LIABILITIES, CAPITAL AND SURPLUS Current Period Prior Year Covered Uncovered Total Total 1. Claims unpaid (less $... reinsurance ceded) ,62, ,62, ,484, Accrued medical incentive pool and bonus amounts ,88, ,88, ,17,58 3. Unpaid claims adjustment expenses ,215, ,215, ,215, Aggregate health policy reserves, including the liability of $... for medical loss ratio rebate per the Public Health Service Act ,833, ,833, ,939, Aggregate life policy reserves Property/casualty unearned premium reserve Aggregate health claim reserves Premiums received in advance ,148, ,148, ,649, General expenses due or accrued ,68, ,68, ,5, Current federal and foreign income tax payable and interest thereon (including $... on realized gains (losses)) Net deferred tax liability Ceded reinsurance premiums payable Amounts withheld or retained for the account of others ,849, ,849, ,849, Remittances and items not allocated Borrowed money (including $... current) and interest thereon $... (including $... current) Amounts due to parent, subsidiaries and affiliates Derivatives Payable for securities , , , Payable for securities lending Funds held under reinsurance treaties with ($... authorized reinsurers, $... unauthorized reinsurers and $... certified reinsurers) Reinsurance in unauthorized and certified ($...) companies Net adjustments in assets and liabilities due to foreign exchange rates Liability for amounts held under uninsured plans ,619, ,619, ,953,4 23. Aggregate write-ins for other liabilities (including $... current) , , , Total liabilities (Lines 1 to 23) ,154, ,154, ,123, Aggregate write-ins for special surplus funds X X X X X X Common capital stock X X X X X X Preferred capital stock X X X X X X Gross paid in and contributed surplus X X X X X X Surplus notes X X X X X X Aggregate write-ins for other-than-special surplus funds X X X X X X Unassigned funds (surplus) X X X X X X ,629, ,72, Less treasury stock, at cost: shares common (value included in Line 26 $...) X X X X X X shares preferred (value included in Line 27 $...) X X X X X X Total capital and surplus (Lines 25 to 31 minus Line 32) X X X X X X ,629, ,72, Total Liabilities, capital and surplus (Lines 24 and 33) X X X X X X ,783, ,826,417 DETAILS OF WRITE-INS 231. Unclaimed Property Payable , , , Other Liabilities Summary of remaining write-ins for Line 23 from overflow page TOTALS (Lines 231 through 233 plus 2398) (Line 23 above) , , , X X X X X X X X X X X X X X X X X X Summary of remaining write-ins for Line 25 from overflow page X X X X X X TOTALS (Lines 251 through 253 plus 2598) (Line 25 above) X X X X X X X X X X X X X X X X X X X X X X X X Summary of remaining write-ins for Line 3 from overflow page X X X X X X TOTALS (Lines 31 through 33 plus 398) (Line 3 above) X X X X X X

4 Q4 STATEMENT AS OF March 31, 217 STATEMENT OF REVENUE AND EXPENSES Prior Year Prior Year Ended Current Year To Date To Date December Uncovered Total Total Total 1. Member Months X X X , , ,231, Net premium income (including $... non-health premium income) X X X ,159, ,898, ,119,659, Change in unearned premium reserves and reserves for rate credits X X X Fee-for-service (net of $... medical expenses) X X X Risk revenue X X X Aggregate write-ins for other health care related revenues X X X , ,231, Aggregate write-ins for other non-health revenues X X X Total revenues (Lines 2 to 7) X X X ,659, ,898, ,121,891,188 Hospital and Medical: 9. Hospital/medical benefits ,325, ,26, ,484, Other professional services ,773, ,39, ,374, Outside referrals ,441, ,4, ,43, Emergency room and out-of-area ,835, ,573, ,989, Prescription drugs ,39, ,71, ,911, Aggregate write-ins for other hospital and medical (5,792,189) ,2, (3,876,656) 15. Incentive pool, withhold adjustments and bonus amounts , ,798, ,629, Subtotal (Lines 9 to 15) ,888, ,911, ,557,346 Less: 17. Net reinsurance recoveries (215,82) , ,69, Total hospital and medical (Lines 16 minus 17) ,14, ,34, ,487, Non-health claims (net) Claims adjustment expenses, including $...4,546,192 cost containment expenses ,44, ,869, ,159, General administrative expenses ,897, ,934, ,717, Increase in reserves for life and accident and health contracts (including $... increase in reserves for life only) Total underwriting deductions (Lines 18 through 22) ,442, ,144, ,12,365, Net underwriting gain or (loss) (Lines 8 minus 23) X X X (783,64) (246,663) ,525, Net investment income earned , , ,249, Net realized capital gains (losses) less capital gains tax of $ (115,399) , , Net investment gains or (losses) (Lines 25 plus 26) , , ,565, Net gain or (loss) from agents or premium balances charged off [(amount recovered $...) (amount charged off $...)] (45,356) (1,358,596) 29. Aggregate write-ins for other income or expenses 3. Net income or (loss) after capital gains tax and before all other federal income taxes (Lines 24 plus 27 plus 28 plus 29) X X X (525,129) (118,136) ,732, Federal and foreign income taxes incurred X X X Net income (loss) (Lines 3 minus 31) X X X (525,129) (118,136) ,732,872 DETAILS OF WRITE-INS 61. EOHHS Incentive Income X X X , ,219, Grant Revenue X X X , X X X Summary of remaining write-ins for Line 6 from overflow page X X X TOTALS (Lines 61 through 63 plus 698) (Line 6 above) X X X , ,231, Miscellaneous Income X X X X X X X X X Summary of remaining write-ins for Line 7 from overflow page X X X TOTALS (Lines 71 through 73 plus 798) (Line 7 above) X X X Stop Loss Recoveries from EOHHS (4,84,585) (2,641,831) (15,953,37) 142. Gain Shares due to EOHHS ,732, CMS Cost Sharing Reduction Recoveries (1,77,64) (1,7,614) (14,923,349) Summary of remaining write-ins for Line 14 from overflow page TOTALS (Lines 141 through 143 plus 1498) (Line 14 above) (5,792,189) ,2, (3,876,656) Summary of remaining write-ins for Line 29 from overflow page TOTALS (Lines 291 through 293 plus 2998) (Line 29 above)

5 March 31, 217 STATEMENT OF REVENUE AND EXPENSES (Continued) CAPITAL & SURPLUS ACCOUNT Prior Year Current Year Prior Year Ended To Date To Date December Capital and surplus prior reporting year ,72, ,556, ,556, Net income or (loss) from Line (525,129) (118,136) ,732, Change in valuation basis of aggregate policy and claim reserves Change in net unrealized capital gains (losses) less capital gains tax of $ , (15,761) , Change in net unrealized foreign exchange capital gain or (loss) Change in net deferred income tax 39. Change in nonadmitted assets ,363, , (2,86,8) 4. Change in unauthorized and certified reinsurance Change in treasury stock Change in surplus notes Cumulative effect of changes in accounting principles Capital Changes: 44.1 Paid in Transferred from surplus (Stock Dividend) Transferred to surplus Surplus adjustments: 45.1 Paid in Transferred to capital (Stock Dividend) Transferred from capital Dividends to stockholders Aggregate write-ins for gains or (losses) in surplus Net change in capital and surplus (Lines 34 to 47) ,926, , ,146, Capital and surplus end of reporting period (Line 33 plus 48) ,629, ,579, ,72,672 DETAILS OF WRITE-INS Summary of remaining write-ins for Line 47 from overflow page TOTALS (Lines 471 through 473 plus 4798) (Line 47 above) Q5

6 Q6 STATEMENT AS OF March 31, 217 CASH FLOW Current Prior Prior Year Year Year Ended To Date To Date December 31 Cash from Operations 1. Premiums collected net of reinsurance ,347, ,935, ,25,119,68 2. Net investment income , , ,19, Miscellaneous income , ,231, TOTAL (Lines 1 to 3) ,436, ,445, ,29,37, Benefit and loss related payments ,714, ,979, ,818, Net transfers to Separate Accounts, Segregated Accounts and Protected Cell Accounts Commissions, expenses paid and aggregate write-ins for deductions ,68, ,478, ,2, Dividends paid to policyholders Federal and foreign income taxes paid (recovered) net of $... tax on capital gains (losses) TOTAL (Lines 5 through 9) ,323, ,457, ,64,821, Net cash from operations (Line 4 minus Line 1) ,113, ,987, (35,45,63) Cash from Investments 12. Proceeds from investments sold, matured or repaid: 12.1 Bonds ,85, ,318, ,436, Stocks Mortgage loans Real estate Other invested assets Net gains or (losses) on cash, cash equivalents and short-term investments Miscellaneous proceeds ,98, TOTAL investment proceeds (Lines 12.1 to 12.7) ,948, ,318, ,436, Cost of investments acquired (long-term only): 13.1 Bonds ,625, ,36, ,16, Stocks Mortgage loans Real estate Other invested assets Miscellaneous applications ,117, TOTAL investments acquired (Lines 13.1 to 13.6) ,625, ,36, ,134, Net increase (or decrease) in contract loans and premium notes Net cash from investments (Line 12.8 minus Line 13.7 and Line 14) ,323, (718,166) (5,697,759) Cash from Financing and Miscellaneous Sources 16. Cash provided (applied): 16.1 Surplus notes, capital notes Capital and paid in surplus, less treasury stock Borrowed funds Net deposits on deposit-type contracts and other insurance liabilities Dividends to stockholders Other cash provided (applied) (1,857,2) (3,217,963) (1,997,774) 17. Net cash from financing and miscellaneous sources (Line 16.1 through 16.4 minus Line 16.5 plus Line 16.6) (1,857,2) (3,217,963) (1,997,774) RECONCILIATION OF CASH, CASH EQUIVALENTS AND SHORT-TERM INVESTMENTS 18. Net change in cash, cash equivalents and short-term investments (Line 11, plus Lines 15 and 17) ,579, ,51, (43,146,136) 19. Cash, cash equivalents and short-term investments: 19.1 Beginning of year ,139, ,285, ,285, End of period (Line 18 plus Line 19.1) ,719, ,336, ,139,475 Note: Supplemental Disclosures of Cash Flow Information for Non-Cash Transactions:

7 March 31, 217 Total Members at end of: EXHIBIT OF PREMIUMS, ENROLLMENT AND UTILIZATION 1 Comprehensive (Hospital & Medical) Federal Medicare Vision Dental Employees Health Title XVIII Title XIX Total Individual Group Supplement Only Only Benefit Plan Medicare Medicaid Other 1. Prior Year , , , First Quarter , , , Second Quarter Third Quarter Current Year Current Year Member Months , , , , Total Member Ambulatory Encounters for Period: Q7 7. Physician ,648, , , ,577, Non-Physician , , , Total ,862, , , ,771, Hospital Patient Days Incurred , , , Number of Inpatient Admissions , , Health Premiums Written (a) ,739, ,115, , ,258, Life Premiums Direct Property/Casualty Premiums Written Health Premiums Earned ,739, ,115, , ,258, Property/Casualty Premiums Earned Amount Paid for Provision of Health Care Services ,39, ,118, , ,3, Amount Incurred for Provision of Health Care Services ,888, ,913, , ,75, (a) For health premiums written: amount of Medicare Title XVIII exempt from state taxes or fees $...

8 March 31, 217 CLAIMS UNPAID AND INCENTIVE POOL, WITHHOLD AND BONUS (Reported and Unreported) Aging Analysis of Unpaid Claims Account 1-3 Days 31-6 Days 61-9 Days days Over 12 Days Total Individually Listed Claims Unpaid Aggregate Accounts Not Individually Listed - Uncovered Aggregate Accounts Not Individually Listed - Covered ,984, ,8, , , , ,11, Subtotals ,984, ,8, , , , ,11, Unreported claims and other claim reserves ,5, Total Amounts Withheld Total Claims Unpaid ,62, Accrued Medical Incentive Pool And Bonus Amounts ,88,22 Q8

9 Q9 March 31, 217 UNDERWRITING AND INVESTMENT EXHIBIT ANALYSIS OF CLAIMS UNPAID-PRIOR YEAR-NET OF REINSURANCE 5 6 Liability Claims End of Paid Year to Date Current Quarter Estimated Claim Reserve and On On On On Claim Line Claims Incurred Claims Incurred Claims Unpaid Claims Incurred Claims Incurred Liability of Prior to January 1 During the Dec 31 of During the in Prior Years Dec 31 of Business of Current Year Year Prior Year Year (Columns 1+3) Prior Year 1. Comprehensive (hospital & medical) ,449, ,88, ,17, ,36, ,466, ,635, Medicare Supplement Dental only Vision only Federal Employees Health Benefits Plan Title XVIII - Medicare Title XIX - Medicaid ,552, ,391, ,979, ,245, ,531, ,849, Other health Health subtotal (Lines 1 to 8) ,1, ,48, ,996, ,65, ,997, ,484, Healthcare receivables (a) ,153, ,825, ,153, ,569, Other non-health Medical incentive pools and bonus amounts ,125, ,892, , ,17, ,17, Totals (Lines ) ,972, ,654, ,889, ,521, ,861, ,932,735 (a) Excludes $...74,868 loans or advances to providers not yet expensed.

10 STATEMENT AS OF March 31, 217 Notes to Financial Statement 1. Summary of Significant Accounting Policies A. Accounting Practices The accompanying financial statements of Neighborhood Health Plan of Rhode Island (the Company or Neighborhood ) have been prepared in conformity with accounting practices prescribed or permitted by the state of Rhode Island for determining and reporting the financial conditions and results of operations of an insurance company for determining its solvency under Rhode Island Insurance law. The National Association of Insurance Commissioners ( NAIC ) Accounting Practices and Procedures Manual, ( NAIC SAP ) has been adopted as a component of prescribed or permitted practices by the state of Rhode Island. A reconciliation of the Company s net income and capital and surplus between NAIC SAP and practices prescribed and permitted by the state of Rhode Island is shown below: SSAP # F/S Page F/S Line # NET INCOME (1) State basis (Page 4, Line 32, Columns 2 & 3) (2) State Prescribed Practices that increase/(decrease) NAIC SAP: (525,129) 19,732,872 (525,129) 19,732,872 14,629,385 12,72,671 14,629,385 12,72,671 (21 (299 Total (3) State Permitted Practices that increase/(decrease) NAIC SAP: (31 (399 Total (4) NAIC SAP (1-2-3=4) SURPLUS (5) State basis (Page 3, Line 33, Columns 3 & 4) (6) State Prescribed Practices that increase/(decrease) NAIC SAP: (61 (699 Total (7) State Permitted Practices that increase/(decrease) NAIC SAP: (71 (799 Total (8) NAIC SAP (5-6-7=8) Q1

11 STATEMENT AS OF March 31, 217 Notes to Financial Statement B. Use of Estimates in the Preparation of the Financial Statements. C. Accounting Policy (1) (5) (6) The Company had no loan-backed securities. (7) (13) - D. Going Concern None 2. Accounting Changes and Corrections of Errors 3. Business Combinations and Goodwill 4. Discontinued Operations 5. Investments A. Mortgage Loans B. Debt Restructuring C. Reverse Mortgages D. Loan-Backed Securities None E. Repurchase Agreements (1) Policy for requiring collateral or other security (2) Carrying amount and classification of both those assets and associated liabilities (3) Collateral accepted that it is permitted by contract or custom to sell or repledge: a. Aggregate amount of contractually obligated open collateral positions No Material Change b. Fair value of that collateral and of the portion of that collateral that it has sold or repledged None c. Information about the sources and uses of that collateral No Material Change (4) Aggregate value of the reinvested collateral which is one-line reported and the aggregate reinvested collateral which is reported in the investment schedules (5) Reinvestment of the cash collateral and any securities which it or its agent receives as collateral that can be sold or repledged Q1. 1

12 STATEMENT AS OF March 31, 217 Notes to Financial Statement (6) Collateral accepted that it is not permitted by contract or custom to sell or repledge (7) Collateral for transactions that extend beyond one year from the reporting date F. Real Estate G. Low-income housing tax credits (LIHTC) H. Restricted Assets I. Working Capital Finance Investments (2) Aggregate Book/Adjusted Carrying Value None (3) Events of Default None J. Offsetting and Netting of Assets and Liabilities None K. Structured Notes L. 5* Securities M. Short Sales N. Prepayment Penalty and Acceleration Fees 6. Joint Ventures, Partnerships and Limited Liability Companies 7. Investment Income 8. Derivative Instruments 9. Income Taxes 1. Information Concerning Parent, Subsidiaries and Affiliates A, B, & C - D. Amounts Due from or to Related Parties - E. Guarantees - F. Material management contracts G. Common Control - H. Deductions in Value - I. SCA that exceed 1% of Admitted Assets - J. Investments in SCAs - Q1.2

13 STATEMENT AS OF March 31, 217 Notes to Financial Statement K. Foreign Subsidiary - L. Downstream Noninsurance Holding Company - M. Investments in SCAs N. Investments in SCAs 11. Debt A. Debt - B. FHLB (Federal Home Loan Bank) Agreements - None 12. Retirement Plans, Deferred Compensation, Post-Employment Benefits, Compensated Absences and other Postretirement Benefit Plans. A. Defined Benefit Plan (1) Change in benefit obligation (2) Change in plan assets- (3) Funded status - (4) Components of net periodic benefit cost - None (5) The amount included in unassigned funds (surplus) for the period arising from a change in the additional minimum pension liability recognized - (6) Amounts in unassigned funds (surplus expected to be recognized in the next fiscal year as components of net periodic benefit cost - (7) Amounts in unassigned funds (surplus) that have not been recognized as components of net periodic benefit cost - (8) Weighted-average assumptions used to determine net period benefit cost - No Material Change (9) The amount of accumulated benefit obligation for defined benefit pension plans (1) (11) The defined benefit pension plan asset allocation as of the measurement date, and the target asset allocation, presented as a percentage of total plan assets - No Material Change (12) Estimated future payments, which reflect expected future service, as appropriate, are expected to be paid in the years (13) Regulatory contribution requirements (14) (21). B. Investment Policies and Strategies C. Plan Assets D. Long-term Rate-of-return-on-assets Assumption - E. Defined Contribution Plans F. Multi-Employer Plan Q1.3