54518201620100100 2016 ANNUAL STATEMENT Document Code: 201 For the Year Ending DECEMBER 31, 2016 OF THE CONDITION AND AFFAIRS OF THE BlueCross BlueShield of Tennessee, Inc. NAIC Group Code 3498 , 3498 (Current Period) NAIC Company Code 54518 Employer's ID Number 62-0427913 (Prior Period) Organized under the Laws of Tennessee Country of Domicile , State of Domicile or Port of Entry TN United States Licensed as business type: Life, Accident & Health[ ] Dental Service Corporation[ ] Other[ ] Incorporated/Organized Property/Casualty[ ] Hospital, Medical & Dental Service or Indemnity[X] Vision Service Corporation[ ] Health Maintenance Organization[ ] Is HMO Federally Qualified? Yes[ ] No[ ] N/A[X] 09/10/1945 Statutory Home Office Commenced Business 1 Cameron Hill Circle , 10/01/1945 Chattanooga, TN, US 37402-0001 (Street and Number) (City or Town, State, Country and Zip Code) Main Administrative Office 1 Cameron Hill Circle (Street and Number) Chattanooga, TN, US 37402-0001 (423)535-5600 (City or Town, State, Country and Zip Code) Mail Address (Area Code) (Telephone Number) 1 Cameron Hill Circle , Chattanooga, TN, US 37402-0001 (Street and Number or P.O. Box) (City or Town, State, Country and Zip Code) Primary Location of Books and Records 1 Cameron Hill Circle (Street and Number) Chattanooga, TN, US 37402-0001 (423)535-5600 (City or Town, State, Country and Zip Code) (Area Code) (Telephone Number) Internet Website Address www.bcbst.com Statutory Statement Contact Joseph DeWayne Moser (423)535-6894 (Name) (Area Code)(Telephone Number)(Extension) Joseph_Moser@bcbst.com (423)535-8331 (E-Mail Address) (Fax Number) CORPORATE OFFICERS Name Jason David Hickey Toliver Ralph Woodard, Jr Shelia Dian Clemons James Kertz Rochat Jill Anne Oaks Calvin Louis Anderson, SVP, COS Jennifer Beth Butler, VP Maria Osores Darras, VP Ronald Harris, VP # David Ramsey Locke, VP Kelly Renee Paulk, VP # Carla Stallings Raynor, VP Gary Lamar Steele, VP # Joshua Trey White, VP, Controller, CAO Rodney Bernell Woods, VP, CCE ADMINISTRATIVE OFFICERS Lois Diane Ball, VP, CISO # Amber Jeanine Cambron, SVP Stacy Pickerill Eiselstein, VP Jason David Hickey, President & CEO John Logan Maki, VP John Barclay Phillips, VP George Henry Smith, SVP, CMO Natalie Ann Tate, PharmD, VP Andrea DeGeoris Willis, SVP, CMO Robin Reed Young, VP, CU Tennessee Hamilton Marc Tyler Barclay, VP Nicholas Loukas Coussoule, SVP, CIO John Francis Giblin, EVP, CFO Jeffrey Aaron Hocking, VP # David Keith Marckel, VP Scott Christian Pierce, EVP, COO Joseph Benjamin Sobel, Dr, VP, CMO Roy Dean Vaughn, SVP, CCO # Dakasha Kentrese Winton, SVP, CGRO # Sherri Lynn Zink, SVP, CDEO BOARD OF DIRECTORS Betty Walters DeVinney, Chair Bruce Arnold Bosse # Lamar Julian Partridge Paul Eugene Stanton, Jr. MD State of County of Title President & CEO Treasurer Secretary Assistant Treasurer Assistant Secretary Marty Glenn Dickens, Vice Chair Miles Anderson Burdine # James Matthew Phillips Martha Swain Wallen Jason David Hickey President & CEO Reginald William Coopwood, MD Emily Josephine Reynolds # New Director Julie Hamilton Boerger, VP, CCO Erbon Dennis Culver, VP, CAE Anne Winfield Hance, SVP, GC # Daniel Rembrandt Jacobson, VP Lawrence Andrew Nall, SVP Joseph Todd Ray, VP James Howard Srite, SVP, CA Karen Denise Cook Ward, SVP, CHRO Toliver Ralph Woodard, Jr, VP, CRO # New Administrative Officer James Buford Baker Herbert Henry Hilliard Lottie Fay Ryans # ss The officers of this reporting entity being duly sworn, each depose and say that they are the described officers of the 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) Jason David Hickey John Francis Giblin Shelia Dian Clemons (Printed Name) 1. (Printed Name) 2. (Printed Name) 3. President & Chief Executive Officer Executive VP & Chief Financial Officer Secretary (Title) (Title) (Title) Subscribed and sworn to before me this day of , 2017 (Notary Public Signature) a. Is this an original filing? b. If no, 1. State the amendment number 2. Date filed 3. Number of pages attached Yes[X] No[ ] 0 0 ANNUAL STATEMENT FOR THE YEAR 2016 OF THE BlueCross BlueShield of Tennessee, Inc. EXHIBIT 2 - ACCIDENT AND HEALTH PREMIUMS DUE AND UNPAID 1 Name of Debtor 0199999 TOTAL Individuals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Group Subscribers: Federal Employees Health Benefits Plan (FEP) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0299997 Subtotal - Group Subscribers: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0299998 Premiums due and unpaid not individually listed . . . . . . . . . . . . . . . . . . . . . . 0299999 TOTAL Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0399999 Premiums due and unpaid from Medicare entities . . . . . . . . . . . . . . . . . . . . . 0499999 Premiums due and unpaid from Medicaid entities . . . . . . . . . . . . . . . . . . . . . 0599999 Accident and health premiums due and unpaid (Page 2, Line 15) . . 2 3 4 5 6 1 - 30 Days 31 - 60 Days 61 - 90 Days Over 90 Days Nonadmitted . . . . . . . . 704,113 . . . . . . . . . . 14,118 . . . . . . . . . . 10,150 . . . . . . . . 110,384 . . . . . . . . 134,652 7 Admitted . . . . . . . . 704,113 1,430,979 1,430,979 . . . . 22,785,621 . . . . 24,216,600 . . . . . . . . 837,918 ................ 0 . . . . 25,758,631 0 0 . . . . . . . . 698,370 . . . . . . . . 698,370 ................ 0 ................ 0 . . . . . . . . 712,488 0 0 . . . . . . . . . . 37,815 . . . . . . . . . . 37,815 ................ 0 ................ 0 . . . . . . . . . . 47,965 0 0 . . . . . . . . . . 44,857 . . . . . . . . . . 44,857 ................ 0 ................ 0 . . . . . . . . 155,241 0 0 . . . . . . . . . . 44,857 . . . . . . . . . . 44,857 ................ 0 ................ 0 . . . . . . . . 179,509 1,430,979 1,430,979 . . . . 23,521,806 . . . . 24,952,785 . . . . . . . . 837,918 ................ 0 . . . . 26,494,816 ...... ................ ................ ................ ................ ...... ...... ................ ................ ................ ................ ...... 18 ANNUAL STATEMENT FOR THE YEAR 2016 OF THE BlueCross BlueShield of Tennessee, Inc. EXHIBIT 3 - HEALTH CARE RECEIVABLES 1 Name of Debtor 0199998 Pharmaceutical Rebate Receivables - Not Individually Listed . . . . . . . 0199999 Subtotal - Pharmaceutical Rebate Receivables . . . . . . . . . . . . . . . . . . . . . . . . 0299998 Claim Overpayment Receivables - Not Individually Listed . . . . . . . . . . . 0299999 Subtotal - Claim Overpayment Receivables . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0399998 Loans and Advances to Providers - Not Individually Listed . . . . . . . . . . 0399999 Subtotal - Loans and Advances to Providers . . . . . . . . . . . . . . . . . . . . . . . . . . . 0499998 Capitation Arrangement Receivables - Not Individually Listed . . . . . . 0499999 Subtotal - Capitation Arrangement Receivables . . . . . . . . . . . . . . . . . . . . . . . 0599998 Risk Sharing Receivables - Not Individually Listed . . . . . . . . . . . . . . . . . . . . 0599999 Subtotal - Risk Sharing Receivables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0699998 Other Receivables - Not Individually Listed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0699999 Subtotal - Other Receivables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0799999 Gross health care receivables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 3 4 5 6 1 - 30 Days 31 - 60 Days 61 - 90 Days Over 90 Days Nonadmitted . . . . 17,508,688 . . . . 15,485,722 . . . . 15,522,235 . . . . 56,628,666 . . . . 56,628,666 . . . . 17,508,688 . . . . 15,485,722 . . . . 15,522,235 . . . . 56,628,666 . . . . 56,628,666 . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . 0 . . . . . . 3,157,472 . . . . . . 3,157,472 . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . 0 . . . . . . 3,157,472 . . . . . . 3,157,472 ................ 0 ................ 0 ................ 0 ................ 0 ................ 0 ................ 0 ................ 0 ................ 0 ................ 0 ................ 0 ................ 0 ................ 0 ................ 0 ................ 0 ................ 0 ................ 0 ................ 0 ................ 0 ................ 0 ................ 0 ................ 0 ................ 0 ................ 0 ................ 0 ................ 0 ................ 0 ................ 0 ................ 0 ................ 0 ................ 0 ................ 0 ................ 0 ................ 0 ................ 0 ................ 0 ................ 0 ................ 0 ................ 0 ................ 0 ................ 0 . . . . 17,508,688 . . . . 15,485,722 . . . . 15,522,235 . . . . 59,786,138 . . . . 59,786,138 7 Admitted . . . . 48,516,645 . . . . 48,516,645 ................ 0 ................ 0 ................ 0 ................ 0 ................ 0 ................ 0 ................ 0 ................ 0 ................ 0 ................ 0 . . . . 48,516,645 19 ANNUAL STATEMENT FOR THE YEAR 2016 OF THE BlueCross BlueShield of Tennessee, Inc. EXHIBIT 3A - ANALYSIS OF HEALTH CARE RECEIVABLES COLLECTED AND ACCRUED Health Care Receivables Collected Health Care Receivables Accrued During the Year as of December 31 of Current Year 1 2 3 4 On Amounts On Amounts Accrued Prior On Amounts Accrued On Amounts to January 1 of Accrued During December 31 of Accrued During Type of Health Care Receivable Current Year the Year Prior Year the Year 1. Pharmaceutical rebate receivables . . . . . . . . . . . . . . . . . . . . . . . . . 96,240,164 . . . . . . . . . 91,414,117 . . . . . . . . . . 7,473,713 . . . . . . . . . 97,671,598 2. Claim overpayment receivables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,826,452 . . . . . . . . . . 1,052,628 . . . . . . . . . . . . . 412,598 . . . . . . . . . . 2,744,874 3. Loans and advances to providers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . . . 0 4. Capitation arrangement receivables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . . . 0 5. Risk sharing receivables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . . . 0 6. Other health care receivables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . . . 0 7. TOTALS (Lines 1 through 6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98,066,616 . . . . . . . . . 92,466,745 . . . . . . . . . . 7,886,311 . . . . . . . 100,416,472 Note that the accrued amounts in Columns 3, 4, and 6 are the total health care receivables, not just the admitted portion. 5 Health Care Receivables in Prior Years (Columns 1 + 3) . . . . . . . 103,713,877 . . . . . . . . . . 2,239,050 ..................... 0 ..................... 0 ..................... 0 ..................... 0 . . . . . . . 105,952,927 6 Estimated Health Care Receivables Accrued as of December 31 of Prior Year . . . . . . . . . 95,127,316 . . . . . . . . . . 1,943,544 ..................... 0 ..................... 0 ..................... 0 ..................... 0 . . . . . . . . . 97,070,860 20 ANNUAL STATEMENT FOR THE YEAR 2016 OF THE BlueCross BlueShield of Tennessee, Inc. EXHIBIT 4 - CLAIMS UNPAID AND INCENTIVE POOL, WITHHOLD AND BONUS (Reported and Unreported) Aging Analysis of Unpaid Claims 1 2 3 4 5 6 Account 1 - 30 Days 31 - 60 Days 61 - 90 Days 91 - 120 Days Over 120 Days 0299999 Aggregate Accounts Not Individually Listed - Uncovered . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . 0 0399999 Aggregate Accounts Not Individually Listed - Covered . . . . . . . . . . . . . . . . . . . 10,785,511 . . . . . . 4,817,873 . . . . . . 1,385,835 . . . . . . . . 902,947 . . . . . . . . 581,639 0499999 Subtotals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10,785,511 . . . . . . 4,817,873 . . . . . . 1,385,835 . . . . . . . . 902,947 . . . . . . . . 581,639 0599999 Unreported claims and other claim reserves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0699999 TOTAL Amounts Withheld . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0799999 TOTAL Claims Unpaid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0899999 Accrued Medical Incentive Pool and Bonus Amounts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Total 0 18,473,805 . . . . 18,473,805 . . . 336,843,747 . . . . . . . . . . 98,183 . . . 355,415,735 . . . . . . 2,777,443 ................ .... 21 ANNUAL STATEMENT FOR THE YEAR 2016 OF THE BlueCross BlueShield of Tennessee, Inc. EXHIBIT 5 - AMOUNTS DUE FROM PARENT, SUBSIDIARIES AND AFFILIATES 1 Name of Affiliate Individually listed receivables Volunteer State Health Plan, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . RiverTrust, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Shared Health, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Group Insurance Services, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0199999 Total - Individually listed receivables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0299999 Receivables not inidvidually listed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0399999 TOTAL Gross Amounts Receivable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1 - 30 Days 44,915,316 0 . . . . . . . . 696,355 . . . . . . . . 328,619 . . . . 45,940,290 . . . . . . . . . . . 2,033 . . . . 45,942,323 3 4 31 - 60 Days .... ................ ................ ................ ................ ................ ................ ................ ................ 0 0 0 0 0 0 0 5 61 - 90 Days ................ ................ ................ ................ ................ ................ ................ 0 0 0 0 0 0 0 Over 90 Days 0 2,964,290 ................ 0 ................ 0 . . . . . . 2,964,290 ................ 0 . . . . . . 2,964,290 6 Admitted 7 Current Nonadmitted 0 2,964,290 ................ 0 ................ 0 . . . . . . 2,964,290 ................ 0 . . . . . . 2,964,290 44,915,316 0 . . . . . . . . 696,355 . . . . . . . . 328,619 . . . . 45,940,290 . . . . . . . . . . . 2,033 . . . . 45,942,323 8 Non-Current ................ ................ .... ................ ...... ...... ................ ................ ................ ................ ................ ................ ................ 0 0 0 0 0 0 0 22 ANNUAL STATEMENT FOR THE YEAR 2016 OF THE BlueCross BlueShield of Tennessee, Inc. EXHIBIT 6 - AMOUNTS DUE TO PARENT, SUBSIDIARIES AND AFFILIATES 1 Affiliate Individually Listed Payables Onlife, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Golden Security Insurance Company . . . . . . . . . . . . . . . . . . . . . . . . . . . Southern Diversified Business Services, Inc. . . . . . . . . . . . . . . . . . . SecurityCare of Tennessee, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . BeneVive, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0199999 Total - Individually Listed Payables . . . . . . . . . . . . . . . . . . 0299999 Payables not Individually Listed . . . . . . . . . . . . . . . . . . . . . . 0399999 TOTAL Gross Payables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Description Administrative Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Administrative Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Administrative Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Administrative Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Administrative Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ................................... X X X ................................... ................................... X X X ................................... ................................... X X X ................................... 3 Amount 1,941,402 1,696,040 . . . . . . . . . . . 310,363 . . . . . . . . . . . 308,460 . . . . . . . . . . . . 56,895 . . . . . . . . 4,313,160 ................... 0 . . . . . . . . 4,313,160 4 Current 1,941,402 1,696,040 . . . . . . . . . . . 310,363 . . . . . . . . . . . 308,460 . . . . . . . . . . . . 56,895 . . . . . . . . 4,313,160 ................... 0 . . . . . . . . 4,313,160 5 Non-Current ........ ........ ................... ........ ........ ................... ................... ................... ................... ................... ................... ................... 0 0 0 0 0 0 0 0 23 ANNUAL STATEMENT FOR THE YEAR 2016 OF THE BlueCross BlueShield of Tennessee, Inc. EXHIBIT 7 - PART 1 - SUMMARY OF TRANSACTIONS WITH PROVIDERS 1 2 3 Direct Medical Column 1 Expense as a % Payment of Total Payments Payment Method 24 Capitation Payments: 1. Medical groups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,761,736 2. Intermediaries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14,204,183 3. All other providers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 4. TOTAL Capitation Payments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15,965,919 Other Payments: 5. Fee-for-service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 826,106,763 6. Contractual fee payments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,289,879,442 7. Bonus/withhold arrangements - fee-for-service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 8. Bonus/withhold arrangements - contractual fee payments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,281,109 9. Non-contingent salaries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 10. Aggregate cost arrangements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 11. All other payments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 12. TOTAL Other Payments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,118,267,314 13. TOTAL (Line 4 plus Line 12) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,134,233,233 ............... ............... ............... ............... 4 5 6 Column 1 Column 1 Column 3 Expenses Paid Expenses Paid as a % to Affiliated to Non-Affiliated of Total Members Providers Providers Total Members Covered 0.043 0.344 0.000 0.386 ................ ................ ................ ................ . . . . . . . . . . . . . . 19.982 . . . . . . . . . . . . . . . . . . . 79.577 . . . . . 0.000 0.055 . . . . . . . . . . . . . . . 0.000 . . . . . . . . . . . . . . . 0.000 . . . . . . . . . . . . . . . 0.000 . . . . . . . . . . . . . . 99.614 . . . . . . . . . . . . 100.000 ............... ..... ............... ..... ..... ..... ..... ..... ..... 0 0 0 0 X X X .... X X X .... X X X .... X X X .... X X X .... X X X .... X X X .... X X X .... X X X .... ............... ............... ............... ............... ....... ....... ....... ....... ....... ....... ....... ....... ....... 0.000 0.000 0.000 0.000 X X X ...... X X X ...... X X X ...... X X X ...... X X X ...... X X X ...... X X X ...... X X X ...... X X X ...... ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ 0 0 0 0 . . . . . . 1,761,736 .... .... 0 . . . 826,106,763 0 3,289,879,442 0 ................ 0 0 . . . . . . 2,281,109 0 ................ 0 0 ................ 0 0 ................ 0 0 4,118,267,314 0 4,134,233,233 EXHIBIT 7 - PART 2 - SUMMARY OF TRANSACTIONS WITH INTERMEDIARIES 1 2 3 4 NAIC Code Name of Intermediary Capitation Paid Average Monthly Capitation 00000 . . . . . . . . . . . . . . . . . First American Admin dba Eyemed Vision Care . . . . . . . 9999999 TOTALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... ......... 14,204,182 14,204,182 1,183,682 X X X ....... 5 Intermediary's Total Adjusted Capital 0 X X X ....... 6 Intermediary's Authorized Control Level RBC 0 X X X ....... .......... ..................... ..................... ....... ....... ....... 14,204,183 0 15,965,919 ................ ANNUAL STATEMENT FOR THE YEAR 2016 OF THE BlueCross BlueShield of Tennessee, Inc. EXHIBIT 8 - FURNITURE, EQUIPMENT AND SUPPLIES OWNED 1 1. 2. 3. 4. 5. 6. Description Administrative furniture and equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Medical furniture, equipment and fixtures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Pharmaceuticals and surgical supplies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Durable medical equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Other property and equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TOTAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 3 Accumulated Cost Improvements Depreciation . . . 157,040,714 . . . . . . 2,201,289 . . . 127,188,263 ................ 0 ................ 0 ................ 0 ................ 0 ................ 0 ................ 0 ................ 0 ................ 0 ................ 0 ................ 0 ................ 0 ................ 0 . . . 157,040,714 . . . . . . 2,201,289 . . . 127,188,263 4 Book Value Less Encumbrances . . . . 32,053,740 ................ 0 ................ 0 ................ 0 ................ 0 . . . . 32,053,740 5 Assets Not Admitted . . . . 32,503,740 ................ 0 ................ 0 ................ 0 ................ 0 . . . . 32,503,740 6 Net Admitted Assets ................ ................ ................ ................ ................ ................ 0 0 0 0 0 0 25 ANNUAL STATEMENT FOR THE YEAR 2016 OF THE BlueCross BlueShield of Tennessee, Inc. 54518201643043100 2016 Document Code: 430 EXHIBIT OF PREMIUMS, ENROLLMENT AND UTILIZATION (a) REPORT FOR: 1. CORPORATION: BlueCross BlueShield of Tennessee, Inc. 2. LOCATION: BUSINESS IN THE STATE OF TENNESSEE DURING THE YEAR NAIC Group Code 3498 1 Total TOTAL Members at end of: 1. 2. 3. 4. 5. 6. Prior Year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . First Quarter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Second Quarter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Third Quarter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Current Year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Current Year Member Months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TOTAL Member Ambulatory Encounters for Year: 30 Tennessee 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. Physician . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Non-Physician . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TOTAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Hospital Patient Days Incurred . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Number of Inpatient Admissions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Health Premiums Written (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Life Premiums Direct . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Property/Casualty Premiums Written . . . . . . . . . . . . . . . . . . . . . . . . . Health Premiums Earned . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Property/Casualty Premiums Earned . . . . . . . . . . . . . . . . . . . . . . . . . Amount Paid for Provision of Health Care Services . . . . . . . . . . Amount Incurred for Provision of Health Care Services . . . . . . Comprehensive (Hospital & Medical) 2 3 Individual 6 Medicare Supplement Vision Only Dental Only Title XVIII Medicare Title XIX Medicaid Other .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... ............ ............ ............ ............ ............ .................. .................. .................. .................. .................. ........ ........ .......... ........ ........ ........ ........ .................. 9,878,862 1,673,058 . . . . . . . 11,551,920 . . . . . . . . . . 584,761 . . . . . . . . . . . . 73,029 . . . 4,744,120,706 .................. 0 .................. 0 . . . 4,744,389,569 .................. 0 . . . 4,134,233,233 . . . 4,107,767,816 . . . . . . . . 1,628,928 . . . . . . . . 3,193,642 . . . . . . . . . . 894,950 . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . 0 . . . . . . . . 1,808,297 . . . . . . . . 2,353,045 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141,646 . . . . . . . . . . 277,708 . . . . . . . . . . . . 77,822 . . . . . . . . . . 138,893 . . . . . . . . . . 675,133 . . . . . . . . . . 157,243 . . . . . . . . . . 204,613 . . . . . . . . . . . . . . . . . . 3,471,350 101,920 . . . . . . . . . . . . 19,929 . . . 1,812,928,434 .................. 0 .................. 0 . . . 1,813,090,154 .................. 0 . . . 1,445,396,890 . . . 1,443,820,347 ........ 7,078 . . . 1,041,474,855 .................. 0 .................. 0 . . . 1,041,486,483 .................. 0 . . . 1,073,515,827 . . . 1,056,231,743 ............. 972,772 150,888 . . . . . . . . . . . . 11,729 . . . . . 152,304,734 .................. 0 .................. 0 . . . . . 152,395,398 .................. 0 . . . . . 111,833,341 . . . . . 112,447,685 138,893 0 .................. 0 . . . . . . . 21,798,994 .................. 0 .................. 0 . . . . . . . 21,800,959 .................. 0 . . . . . . . 14,204,182 . . . . . . . 14,204,182 675,133 0 .................. 0 . . . . . 136,129,817 .................. 0 .................. 0 . . . . . 136,132,703 .................. 0 . . . . . 105,662,574 . . . . . 105,730,180 101,700 101,767 101,375 101,372 101,272 1,218,279 10 .......... .......... .......... .......... .......... 1,770,574 471,152 468,933 465,784 463,434 467,119 5,603,419 9 ............ ............ ............ ............ ............ . . . . . . . . . . . . 43,701 . . . . . . . . . . 373,503 408,899 406,749 402,647 399,117 4,868,191 8 .......... .......... .......... .......... .......... ........ 64,403 64,340 64,531 65,070 64,966 776,375 NAIC Company Code 54518 7 Federal Employees Health Benefits Plan .......... .......... .......... .......... .......... ........ ........ 441,384 421,623 420,321 414,568 420,314 5,032,728 5 1,779,538 1,800,372 1,780,492 1,758,144 1,746,221 . . . . . . . 21,316,043 ........ ........ ........ ........ ........ 235,143 241,749 225,796 213,903 194,995 2,670,977 Group 4 1,965,540 74,899 . . . . . . . . . . . . 11,284 . . . . . 660,153,765 .................. 0 .................. 0 . . . . . 660,153,765 .................. 0 . . . . . 594,406,666 . . . . . 590,547,279 92,253 93,061 95,936 97,150 98,438 1,146,074 2,557,658 213,353 . . . . . . . . . . . . 23,009 . . . . . 919,310,746 .................. 0 .................. 0 . . . . . 919,310,746 .................. 0 . . . . . 789,290,920 . . . . . 784,836,260 .......... .......... .......... ........ ........ .................. .......... .................. .................. ............ .......... .................. (a) For health business: number of persons insured under PPO managed care products .......1,746,221 and number of persons insured under indemnity only products ...............0. (b) For health premiums written: amount of Medicare Title XVIII exempt from state taxes or fees $.....919,310,746 .................. .................. .................. .................. .................. .................. .................. .................. 0 0 0 0 0 0 .................. .................. .................. .................. .................. 0 0 0 0 0 0 0 0 0 0 0 0 .................. .................. .................. 0 0 0 0 0 0 0 0 .................. 0 .................. 0 .................. 0 . . . . . . . . . . . . 19,361 .................. 0 .................. 0 . . . . . . . . . . . . 19,361 .................. 0 . . . . . . . . . . (77,167) . . . . . . . . . . (49,860) ANNUAL STATEMENT FOR THE YEAR 2016 OF THE BlueCross BlueShield of Tennessee, Inc. 54518201643059100 2016 Document Code: 430 EXHIBIT OF PREMIUMS, ENROLLMENT AND UTILIZATION (a) REPORT FOR: 1. CORPORATION: 2. LOCATION: BUSINESS IN THE STATE OF GRAND TOTAL DURING THE YEAR NAIC Group Code 3498 1 Total TOTAL Members at end of: 1. 2. 3. 4. 5. 6. Prior Year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . First Quarter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Second Quarter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Third Quarter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Current Year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Current Year Member Months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TOTAL Member Ambulatory Encounters for Year: 30 Grand Total 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. Physician . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Non-Physician . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TOTAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Hospital Patient Days Incurred . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Number of Inpatient Admissions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Health Premiums Written (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Life Premiums Direct . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Property/Casualty Premiums Written . . . . . . . . . . . . . . . . . . . . . . . . . Health Premiums Earned . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Property/Casualty Premiums Earned . . . . . . . . . . . . . . . . . . . . . . . . . Amount Paid for Provision of Health Care Services . . . . . . . . . . Amount Incurred for Provision of Health Care Services . . . . . . Comprehensive (Hospital & Medical) 2 3 Individual 6 Medicare Supplement Vision Only Dental Only Title XVIII Medicare Title XIX Medicaid Other .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... ............ ............ ............ ............ ............ .................. .................. .................. .................. .................. ........ ........ .......... ........ ........ ........ ........ .................. 9,878,862 1,673,058 . . . . . . . 11,551,920 . . . . . . . . . . 584,761 . . . . . . . . . . . . 73,029 . . . 4,744,120,706 .................. 0 .................. 0 . . . 4,744,389,569 .................. 0 . . . 4,134,233,233 . . . 4,107,767,816 . . . . . . . . 1,628,928 . . . . . . . . 3,193,642 . . . . . . . . . . 894,950 . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . 0 . . . . . . . . 1,808,297 . . . . . . . . 2,353,045 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141,646 . . . . . . . . . . 277,708 . . . . . . . . . . . . 77,822 . . . . . . . . . . 138,893 . . . . . . . . . . 675,133 . . . . . . . . . . 157,243 . . . . . . . . . . 204,613 . . . . . . . . . . . . . . . . . . 3,471,350 101,920 . . . . . . . . . . . . 19,929 . . . 1,812,928,434 .................. 0 .................. 0 . . . 1,813,090,154 .................. 0 . . . 1,445,396,890 . . . 1,443,820,347 ........ 7,078 . . . 1,041,474,855 .................. 0 .................. 0 . . . 1,041,486,483 .................. 0 . . . 1,073,515,827 . . . 1,056,231,743 ............. 972,772 150,888 . . . . . . . . . . . . 11,729 . . . . . 152,304,734 .................. 0 .................. 0 . . . . . 152,395,398 .................. 0 . . . . . 111,833,341 . . . . . 112,447,685 138,893 0 .................. 0 . . . . . . . 21,798,994 .................. 0 .................. 0 . . . . . . . 21,800,959 .................. 0 . . . . . . . 14,204,182 . . . . . . . 14,204,182 675,133 0 .................. 0 . . . . . 136,129,817 .................. 0 .................. 0 . . . . . 136,132,703 .................. 0 . . . . . 105,662,574 . . . . . 105,730,180 101,700 101,767 101,375 101,372 101,272 1,218,279 10 .......... .......... .......... .......... .......... 1,770,574 471,152 468,933 465,784 463,434 467,119 5,603,419 9 ............ ............ ............ ............ ............ . . . . . . . . . . . . 43,701 . . . . . . . . . . 373,503 408,899 406,749 402,647 399,117 4,868,191 8 .......... .......... .......... .......... .......... ........ 64,403 64,340 64,531 65,070 64,966 776,375 7 Federal Employees Health Benefits Plan .......... .......... .......... .......... .......... ........ ........ 441,384 421,623 420,321 414,568 420,314 5,032,728 5 1,779,538 1,800,372 1,780,492 1,758,144 1,746,221 . . . . . . . 21,316,043 ........ ........ ........ ........ ........ 235,143 241,749 225,796 213,903 194,995 2,670,977 Group NAIC Company Code 54518 4 1,965,540 74,899 . . . . . . . . . . . . 11,284 . . . . . 660,153,765 .................. 0 .................. 0 . . . . . 660,153,765 .................. 0 . . . . . 594,406,666 . . . . . 590,547,279 92,253 93,061 95,936 97,150 98,438 1,146,074 2,557,658 213,353 . . . . . . . . . . . . 23,009 . . . . . 919,310,746 .................. 0 .................. 0 . . . . . 919,310,746 .................. 0 . . . . . 789,290,920 . . . . . 784,836,260 .......... .......... .......... ........ ........ .................. .......... .................. .................. ............ .......... .................. (a) For health business: number of persons insured under PPO managed care products .......1,746,221 and number of persons insured under indemnity only products ...............0. (b) For health premiums written: amount of Medicare Title XVIII exempt from state taxes or fees $.....919,310,746 .................. .................. .................. .................. .................. .................. .................. .................. 0 0 0 0 0 0 .................. .................. .................. .................. .................. 0 0 0 0 0 0 0 0 0 0 0 0 .................. .................. .................. 0 0 0 0 0 0 0 0 .................. 0 .................. 0 .................. 0 . . . . . . . . . . . . 19,361 .................. 0 .................. 0 . . . . . . . . . . . . 19,361 .................. 0 . . . . . . . . . . (77,167) . . . . . . . . . . (49,860) ANNUAL STATEMENT FOR THE YEAR 2016 OF THE BlueCross BlueShield of Tennessee, Inc. SCHEDULE S - PART 1 - SECTION 2 Reinsurance Assumed Accident and Health Insurance Listed by Reinsured Company as of December 31, Current Year 1 NAIC Company Code 2 ID Number 3 Effective Date 4 Name of Reinsured 5 6 Domiciliary Jurisdiction Type of Reinsurance Assumed 7 8 9 Reserve Liability Other Than for Unearned Premiums Unearned Premiums Premiums 10 11 12 Reinsurance Payable on Paid and Unpaid Losses Modified Coinsurance Reserve Funds Withheld Under Coinsurance NONE 9999999 Total (Sum of 0799999 and 1099999) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .................. 0 .................. 0 .................. 0 .................. 0 .................. 0 .................. 0 31 ANNUAL STATEMENT FOR THE YEAR 2016 OF THE BlueCross BlueShield of Tennessee, Inc. SCHEDULE S - PART 2 Reinsurance Recoverable on Paid and Unpaid Losses Listed by Reinsuring Company as of December 31, Current Year 1 2 3 4 5 NAIC Company ID Effective Domiciliary Code Number Date Name of Company Jurisdiction 1199999 Total - Life and Annuity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Accident and Health - Non-Affiliates - U.S. Non-Affiliates 00000 . . . . AA-9990032 . . . 01/01/2014 US Dept of Hlth & Human Serv . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DC . . . . 1999999 Subtotal - Accident and Health - Non-Affiliates - U.S. Non-Affiliates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2199999 Total - Accident and Health - Non-Affiliates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2299999 Total - Accident and Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2399999 Total U.S. (Sum of 0399999, 0899999, 1499999 and 1999999) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2499999 Total Non-U.S. (Sum of 0699999, 0999999, 1799999 and 2099999) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9999999 Total (Sum of 1199999 and 2299999) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 6 7 Paid Losses .................. 0 65,020,616 65,020,616 . . . . . 65,020,616 . . . . . 65,020,616 . . . . . 65,020,616 .................. 0 . . . . . 65,020,616 Unpaid Losses 0 .................. 10,487,291 10,487,291 . . . . . 10,487,291 . . . . . 10,487,291 . . . . . 10,487,291 .................. 0 . . . . . 10,487,291 ..... ..... ..... ..... ANNUAL STATEMENT FOR THE YEAR 2016 OF THE BlueCross BlueShield of Tennessee, Inc. SCHEDULE S - PART 3 - SECTION 2 Reinsurance Ceded Accident and Health Insurance Listed by Reinsuring Company as of December 31, Current Year 1 2 3 NAIC Company ID Effective Code Number Date General Account - Authorized - Non-Affiliates - U.S. Non-Affiliates 4 Name of Company 5 6 Type of Domiciliary Reinsurance Jurisdiction Ceded 7 Type of Business Ceded 33 00000 . . . . AA-9990032 . . . 01/01/2014 US Dept of Hlth & Human Serv . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DC . . . . OTH/A/I . . . . . OH . . . . . . . . . . 0899999 Subtotal - General Account - Authorized - Non-Affiliates - U.S. Non-Affiliates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1099999 Total - General Account - Authorized - Non-Affiliates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1199999 Total - General Account Authorized . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1499999 Subtotal - General Account - Unauthorized - Affiliates - U.S. - Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2299999 Total - General Account - Unauthorized . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2599999 Subtotal - General Account - Certified - Affiliates - U.S. - Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3399999 Total - General Account - Certified . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3499999 Total - General Account - Authorized, Unauthorized and Certified . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3799999 Subtotal - Separate Accounts - Authorized - Affiliates - U.S. - Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4599999 Total - Separate Accounts - Authorized . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4899999 Subtotal - Separate Accounts - Unauthorized - Affiliates - U.S. - Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5699999 Total - Separate Accounts - Unauthorized . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5999999 Subtotal - Separate Accounts - Certified - Affiliates - U.S. - Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6699999 Total - Separate Accounts - Certified - Non-Affiliates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6799999 Total - Separate Accounts - Certified . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6899999 Total - Separate Accounts - Authorized, Unauthorized and Certified . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6999999 Total U.S. (Sum of 0399999, 0899999, 1499999, 1999999, 2599999, 3099999, 3799999, 4299999, 4899999, 5399999, 5999999 and 6499999) . . . . . . . . . . . . . . . . . . . . . . 7099999 Total Non-U.S. (Sum of 0699999, 0999999, 1799999, 2099999, 2899999, 3199999, 4099999, 4399999, 5199999, 5499999, 6299999 and 6599999) . . . . . . . . . . . . . . . . . 9999999 Total (Sum of 3499999 and 6899999) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 9 Premiums Unearned Premiums (Estimated) 4,498,126 4,498,126 . . . . . . 4,498,126 . . . . . . 4,498,126 ................ 0 ................ 0 ................ 0 ................ 0 . . . . . . 4,498,126 ................ 0 ................ 0 ................ 0 ................ 0 ................ 0 ................ 0 ................ 0 ................ 0 . . . . . . 4,498,126 ................ 0 . . . . . . 4,498,126 ...... ................ ...... ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ 10 Reserve Credit Taken Other than for Unearned Premiums 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Outstanding Surplus Relief 11 12 Current Year ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... Prior Year 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 13 14 Modified Coinsurance Reserve Funds Withheld Under Coinsurance ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ANNUAL STATEMENT FOR THE YEAR 2016 OF THE BlueCross BlueShield of Tennessee, Inc. SCHEDULE S - PART 4 Reinsurance Ceded To Unauthorized Companies 1 NAIC Company Code 2 ID Number 3 Effective Date 4 Name of Reinsurer 9999999 Total (Sum of 2399999 and 3499999) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a) Issuing or Confirming Bank Reference Number Letters of Credit Code American Bankers Association (ABA) Routing Number 5 6 Reserve Credit Taken Paid and Unpaid Losses Recoverable (Debit) .............. 0 7 .............. 0 8 Totals (Cols. 5 + 6 + 7) Other Debits .............. 0 .............. 0 9 10 11 Letters of Credit Issuing or Confirming Bank Reference Number (a) Trust Agreements .............. 0 .... XXX ... .............. 0 12 Funds Deposited by and Withheld from Reinsurers .............. NONE Issuing or Confirming Bank Name 13 14 15 Sum of Cols. 9+11+12 +13+14 Miscellaneous But Not in Balances Excess (Credit) of Col. 8 Other 0 .............. 0 .............. Letters of Credit Amount 34 ............... ............... ..................... ............................................................................................................................................ ..................... 0 0 .............. 0 ANNUAL STATEMENT FOR THE YEAR 2016 OF THE BlueCross BlueShield of Tennessee, Inc. SCHEDULE S - PART 5 Reinsurance Ceded to Certified Reinsurers as of December 31, Current Year (000 Omitted) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 NAIC Company Code ID Number Effective Date Name of Reinsurer Domiciliary Jurisdiction Percent Effective Collateral Certified Date of Required Reinsurer Certified for Full Rating (1 Reinsurer Credit through 6) Rating (0% - 100%) Reserve Credit Taken Paid and Unpaid Losses Recoverable (Debit) Other Debits Total Recoverable /Reserve Credit Taken (Col. 9 + 10 + 11) Net Obligation Miscellaneous Subject to Balances Collateral (Credit) (Col. 12 - 13) Dollar Amount of Collateral Required for Full Credit (Col. 14 x Col. 8) Multiple Beneficiary Trust 17 18 Letters of Credit Issuing or Confirming Bank Reference Number (a) 9999999 Total (Sum of 2399999 and 3499999) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . 0 . . . . . . . . . . 0 . . . . . . . . . . 0 . . . . . . . . . . 0 . . . . . . . . . . 0 . . . . . . . . . . 0 . . . . . . . . . . 0 . . . . . . . . . . 0 . . . X X X . . (a) Issuing or Confirming Bank Reference Number Letters of Credit Code American Bankers Association (ABA) Routing Number Collateral 19 20 Trust Agreements Funds Deposited by and Withheld from Reinsurers 21 22 Other Total Collateral Provided (Col. 16 + 17 + 19 + 20 + 21) .......... 0 .......... 0 .......... 0 .......... 0 ... XXX .. NONE Issuing or Confirming Bank Name Letters of Credit Amount 35 ............... ............... ..................... 23 Percent of Collateral Provided for Net Obligation Subject to Collateral (Col. 22 / Col. 14) ............................................................................................................................................ ..................... 0 24 25 26 Percent Credit Amount of Liability for Allowed on Credit Allowed Reinsurance Net Obligation for Net With Certified Subject to Obligation Reinsurers Collateral Subject to Due to (Col. 23 / Col. 8 Collateral Collateral not to Exceed (Col. 14 Deficiency 100%) x Col. 24) Cols. 14 - 25) ... XXX .. .......... 0 .......... 0 ANNUAL STATEMENT FOR THE YEAR 2016 OF THE BlueCross BlueShield of Tennessee, Inc. SCHEDULE S - PART 6 Five-Year Exhibit of Reinsurance Ceded Business (000 Omitted) 1 2016 A. OPERATIONS ITEMS 1. Premiums . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. Title XVIII-Medicare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. Title XIX - Medicaid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. Commissions and reinsurance expense allowance . . . . . . . . . . . . . . . . . 5. TOTAL Hospital and Medical Expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B. BALANCE SHEET ITEMS 6. Premiums receivable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7. Claims payable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. Reinsurance recoverable on paid losses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. Experience rating refunds due or unpaid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10. Commissions and reinsurance expense allowances due . . . . . . . . . . . 11. Unauthorized reinsurance offset . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. Offset for reinsurance with Certified Reinsurers . . . . . . . . . . . . . . . . . . . . . C. UNAUTHORIZED REINSURANCE (DEPOSITS BY AND FUNDS WITHHELD FROM) 13. Funds deposited by and withheld from (F) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14. Letters of credit (L) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15. Trust agreements (T) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16. Other (O) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D. REINSURANCE WITH CERTIFIED REINSURERS (DEPOSITS BY AND FUNDS WITHHELD FROM) 17. Multiple Beneficiary Trust . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18. Funds deposited by and withheld from (F) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. Letters of credit (L) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20. Trust agreements (T) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21. Other (O) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 2015 3 2014 4 2013 .............. 4,498 0 ................... 0 ................... 0 ................... 0 .............. 6,355 0 ................... 0 ................... 0 ................... 0 .............. ................... 5,810 0 ................... 0 ................... 0 ................... 0 ................... ................... ................... ................... ................... 0 10,487 . . . . . . . . . . . . 65,021 ................... 0 ................... 0 ................... 0 ................... 0 ................... 0 15,048 . . . . . . . . . . . 102,367 ................... 0 ................... 0 ................... 0 ................... 0 ................... ............ 0 12,574 . . . . . . . . . . . . 81,741 ................... 0 ................... 0 ................... 0 ................... 0 ................... ............ ............ ................... 0 0 0 0 ................... 0 0 0 0 ................... 0 0 0 0 ................... 0 0 0 0 0 ................... 0 0 0 0 0 ................... 0 0 0 0 0 ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... 36 ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... 5 2012 0 0 0 0 0 ................... 0 0 0 0 0 0 0 ................... 0 0 0 0 ................... 0 0 0 0 0 ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ANNUAL STATEMENT FOR THE YEAR 2016 OF THE BlueCross BlueShield of Tennessee, Inc. SCHEDULE S - PART 7 Restatement of Balance Sheet to Identify Net Credit For Ceded Reinsurance 1 As Reported (net of ceded) ASSETS (Page 2, Col. 3) 1. Cash and invested assets (Line 12) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. Accident and health premiums due and unpaid (Line 15) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. Amounts recoverable from reinsurers (Line 16.1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. Net credit for ceded reinsurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5. All other admitted assets (Balance) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. TOTAL Assets (Line 28) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . LIABILITIES, CAPITAL AND SURPLUS (Page 3) 7. Claims unpaid (Line 1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. Accrued medical incentive pool and bonus payments (Line 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. Premiums received in advance (Line 8) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10. Funds held under reinsurance treaties with authorized and unauthorized reinsurers (Line 19, first inset amount plus second inset amount) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. Reinsurance in unauthorized companies (Line 20 minus inset amount) . . . . . . . . . . . . . . . . . . . . 12. Reinsurance with Certified Reinsurers (Line 20 inset amount) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13. Funds held under reinsurance treaties with Certified Reinsurers (Line 19 third inset amount) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14. All other liabilities (Balance) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15. TOTAL Liabilities (Line 24) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16. TOTAL Capital and Surplus (Line 33) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17. TOTAL Liabilities, Capital and Surplus (Line 34) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NET CREDIT FOR CEDED REINSURANCE 18. Claims unpaid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. Accrued medical incentive pool . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20. Premiums received in advance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21. Reinsurance recoverable on paid losses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22. Other ceded reinsurance recoverables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23. TOTAL Ceded Reinsurance Recoverables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24. Premiums receivable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25. Funds held under reinsurance treaties with authorized and unauthorized reinsurers . . . . . 26. Unauthorized reinsurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27. Reinsurance with Certified Reinsurers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28. Funds held under reinsurance treaties with Certified Reinsurers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29. Other ceded reinsurance payables/offsets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30. TOTAL Ceded Reinsurance Payables/Offsets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31. TOTAL Net Credit for Ceded Reinsurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 2 Restatement Adjustments 3 Restated (gross of ceded) ... 1,960,947,481 190,801,970 . . . . . . . 65,020,616 ...... X X X ...... . . . . . 339,943,220 . . . 2,556,713,287 ................... 0 0 . . . . . (65,020,616) . . . . . . . 75,507,907 ................... 0 . . . . . . . 10,487,291 ... ..... ................... ..... ..... 344,928,444 2,777,443 . . . . . . . 44,245,017 ....... 10,487,291 0 ................... 0 ..... ........ ................... ........ 0 0 0 ................... ................... ..... 0 431,249,879 . . . . . 823,200,783 . . . 1,733,512,504 . . . 2,556,713,287 ................... ................... ................... 10,487,291 0 ................... 0 . . . . . . . 65,020,616 ................... 0 . . . . . . . 75,507,907 ................... 0 ................... 0 ................... 0 ................... 0 ................... 0 ................... 0 ................... 0 . . . . . . . 75,507,907 ....... ................... 1,960,947,481 190,801,970 ................... 0 . . . . . . . 75,507,907 . . . . . 339,943,220 . . . 2,567,200,578 355,415,735 2,777,443 . . . . . . . 44,245,017 0 0 0 ................... ................... 0 0 . . . . . . . 10,487,291 ...... X X X ...... . . . . . . . 10,487,291 ................... ................... ..... ................... ................... ................... ................... 0 0 0 0 431,249,879 . . . . . 833,688,074 . . . 1,733,512,504 . . . 2,567,200,578 ANNUAL STATEMENT FOR THE YEAR 2016 OF THE BlueCross BlueShield of Tennessee, Inc. SCHEDULE T - PART 2 INTERSTATE COMPACT - EXHIBIT OF PREMIUMS WRITTEN ALLOCATED BY STATES AND TERRITORIES Direct Business only 2 3 Disability Annuities Income (Group and (Group and Individual) Individual) 1 States, Etc. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48. 49. 50. 51. 52. 53. 54. 55. 56. 57. 58. 59. Alabama (AL) . . . . . . . . . . . . . . . . . . . . . Alaska (AK) . . . . . . . . . . . . . . . . . . . . . . . . Arizona (AZ) . . . . . . . . . . . . . . . . . . . . . . . Arkansas (AR) . . . . . . . . . . . . . . . . . . . . California (CA) . . . . . . . . . . . . . . . . . . . . Colorado (CO) . . . . . . . . . . . . . . . . . . . . Connecticut (CT) . . . . . . . . . . . . . . . . . Delaware (DE) . . . . . . . . . . . . . . . . . . . . District of Columbia (DC) . . . . . . . . Florida (FL) . . . . . . . . . . . . . . . . . . . . . . . . Georgia (GA) . . . . . . . . . . . . . . . . . . . . . . Hawaii (HI) . . . . . . . . . . . . . . . . . . . . . . . . . Idaho (ID) . . . . . . . . . . . . . . . . . . . . . . . . . . Illinois (IL) . . . . . . . . . . . . . . . . . . . . . . . . . . Indiana (IN) . . . . . . . . . . . . . . . . . . . . . . . . Iowa (IA) . . . . . . . . . . . . . . . . . . . . . . . . . . . Kansas (KS) . . . . . . . . . . . . . . . . . . . . . . . Kentucky (KY) . . . . . . . . . . . . . . . . . . . . . Louisiana (LA) . . . . . . . . . . . . . . . . . . . . Maine (ME) . . . . . . . . . . . . . . . . . . . . . . . . Maryland (MD) . . . . . . . . . . . . . . . . . . . . Massachusetts (MA) . . . . . . . . . . . . . Michigan (MI) . . . . . . . . . . . . . . . . . . . . . . Minnesota (MN) . . . . . . . . . . . . . . . . . . . Mississippi (MS) . . . . . . . . . . . . . . . . . . Missouri (MO) . . . . . . . . . . . . . . . . . . . . . Montana (MT) . . . . . . . . . . . . . . . . . . . . . Nebraska (NE) . . . . . . . . . . . . . . . . . . . . Nevada (NV) . . . . . . . . . . . . . . . . . . . . . . New Hampshire (NH) . . . . . . . . . . . . New Jersey (NJ) . . . . . . . . . . . . . . . . . . New Mexico (NM) . . . . . . . . . . . . . . . . New York (NY) . . . . . . . . . . . . . . . . . . . . North Carolina (NC) . . . . . . . . . . . . . . North Dakota (ND) . . . . . . . . . . . . . . . . Ohio (OH) . . . . . . . . . . . . . . . . . . . . . . . . . . Oklahoma (OK) . . . . . . . . . . . . . . . . . . . Oregon (OR) . . . . . . . . . . . . . . . . . . . . . . Pennsylvania (PA) . . . . . . . . . . . . . . . . Rhode Island (RI) . . . . . . . . . . . . . . . . . South Carolina (SC) . . . . . . . . . . . . . . South Dakota (SD) . . . . . . . . . . . . . . . Tennessee (TN) . . . . . . . . . . . . . . . . . . Texas (TX) . . . . . . . . . . . . . . . . . . . . . . . . . Utah (UT) . . . . . . . . . . . . . . . . . . . . . . . . . . Vermont (VT) . . . . . . . . . . . . . . . . . . . . . . Virginia (VA) . . . . . . . . . . . . . . . . . . . . . . . Washington (WA) . . . . . . . . . . . . . . . . . West Virginia (WV) . . . . . . . . . . . . . . . Wisconsin (WI) . . . . . . . . . . . . . . . . . . . . Wyoming (WY) . . . . . . . . . . . . . . . . . . . . American Samoa (AS) . . . . . . . . . . . Guam (GU) . . . . . . . . . . . . . . . . . . . . . . . . Puerto Rico (PR) . . . . . . . . . . . . . . . . . U.S. Virgin Islands (VI) . . . . . . . . . . Northern Mariana Islands (MP) . Canada (CAN) . . . . . . . . . . . . . . . . . . . . Aggregate other alien (OT) . . . . . TOTALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . Life (Group and Individual) ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... 4 Long-Term Care (Group and Individual) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 NONE ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... 39 ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... 5 6 Deposit-Type Contracts 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... Totals 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ANNUAL STATEMENT FOR THE YEAR 2016 OF THE BlueCross BlueShield of Tennessee, Inc. SCHEDULE Y PART 1A - DETAIL OF INSURANCE HOLDING COMPANY SYSTEM 1 Group Code 3498 .. 2 3 Group Name NAIC Company Code 4 5 ID Number 6 FEDERAL RSSD CIK 7 Name of Securities Exchange if Publicly Traded (U.S. or International) 8 9 10 Names of Parent, Subsidiaries or Affiliates Domiciliary Location Relationship to Reporting Entity BlueCross BlueShield of Tennessee . . . . . . . . . . . . . . . . . . . . . 54518 62-0427913 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00000 20-0298456 . . ........... ........... ............. ............. ...................................... ...................................... BlueCross BlueShield of Tennessee, Inc. . . . . . . . . . . . . . . . . . . . . . Tennessee Health Foundation, Inc. 41 .. .. TN TN . . . . . RE . . . . OTH . Southern Health Plan, Inc. ......... .. TN . .. OTH . ...................................... Healthbox Nashville I, Inc. .......... .. DE . ... NIA .. ...................................... Southern Diversified Business Services, Inc. . . . . . . . . . . . . . . . . . . . . . . . . .. TN . ... DS .. ...................................... ...................................... Volunteer State Health Plan, Inc. . . Group Insurance Services, Inc. . . . . .. .. TN TN . . ... ... DS DS .. .. .. TN . ... DS .. .. .. TN TN . . ... ... DS DS .. .. ........... .. TN . ... DS .. 0000 .. 0000 .. ................................. 00000 58-1406632 . ........... ............. ...................................... ........ ................................. 00000 46-3305552 . ........... ............. ................................. 00000 62-1156889 . ........... ............. 0000 .. 3498 .. 0000 .. 3498 .. 3498 .. 0000 .. 0000 .. ................................. 0000 .. 0000 0000 BlueCross BlueShield of Tennssee . . . . . . . . . . . . . . . . . . . . . . 14046 62-1656610 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00000 62-0721232 BlueCross BlueShield of Tennssee . . . . . . . . . . . . . . . . . . . . . . 65463 62-1156312 BlueCross BlueShield of Tennssee . . . . . . . . . . . . . . . . . . . . . . 15005 46-1548495 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00000 20-8042682 . . ........... ........... ............. ............. . ........... ............. ...................................... Golden Security Insurance Company . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ........... ........... ............. ............. ...................................... ...................................... SecurityCare of Tennessee, Inc. . . . BeneVive, Inc. . . . . . . . . . . . . . . . . . . . . . . 00000 20-0528228 . ........... ............. ...................................... RiverTrust Solutions, Inc. ................................. 00000 20-2469347 . ........... ............. ...................................... .. ................................. 00000 20-3484545 . ........... ............. ...................................... Riverbend Government Benefits Administrator, Inc. . . . . . . . . . . . . . . . . . . Shared Health, Inc. . . . . . . . . . . . . . . . . . .. ................................. 00000 62-1631426 . ........... ............. ...................................... Onlife Health, Inc. Asterisk 11 Directly Controlled by (Name of Entity / Person) .......................................... BlueCross BlueShield of Tennessee, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . BlueCross BlueShield of Tennessee, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . BlueCross BlueShield of Tennessee, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . BlueCross BlueShield of Tennessee, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Southern Diversified Business Services, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Southern Diversified Business Services, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Southern Diversified Business Services, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Southern Diversified Business Services, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . BlueCross BlueShield of Tennessee, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . BeneVive, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Type of Control (Ownership, Board, Management, Attorney-in-Fact, Influence, Other) 13 14 15 16 If Control is Ownership Provide Percentage Ultimate Controlling Entity(ies) / Person(s) Is an SCA Filing Required? (Y/N) * ................................ .... N .... ........ .... N .... 0000001 .... N .... 0000002 .... N .... ........ .... N .... ........ .... N .... ........ .... N .... ........ .... N .... ........ .... N .... ........ .... N .... ........ .... N .... ........ .... N .... ........ .... N .... ........ .... N .... ........ .............................. ........ 0.0 Board of Directors .......... ........ 0.0 Board of Directors .......... ........ 0.0 Ownership, Influence ....... ...... 76.4 Ownership .................. ..... 100.0 Ownership .................. ..... 100.0 Ownership .................. ..... 100.0 Ownership .................. ..... 100.0 Ownership .................. ..... 100.0 Ownership Ownership .................. ..... .................. ..... 100.0 100.0 .. .. TN TN . . ... ... DS DS .. .. BeneVive, Inc. BeneVive, Inc. .......................... .......................... Ownership Ownership .................. ..... .................. ..... 100.0 100.0 ................... .. TN . ... DS .. BeneVive, Inc. .......................... Ownership .................. ..... 100.0 BlueCross BlueShield of Tennessee, Inc. . . . . . . . . . . . . . . BlueCross BlueShield of Tennessee, Inc. . . . . . . . . . . . . . . BlueCross BlueShield of Tennessee, Inc. . . . . . . . . . . . . . . BlueCross BlueShield of Tennessee, Inc. . . . . . . . . . . . . . . BlueCross BlueShield of Tennessee, Inc. . . . . . . . . . . . . . . BlueCross BlueShield of Tennessee, Inc. . . . . . . . . . . . . . . BlueCross BlueShield of Tennessee, Inc. . . . . . . . . . . . . . . BlueCross BlueShield of Tennessee, Inc. . . . . . . . . . . . . . . BlueCross BlueShield of Tennessee, Inc. . . . . . . . . . . . . . . BlueCross BlueShield of Tennessee, Inc. . . . . . . . . . . . . . . BlueCross BlueShield of Tennessee, Inc. . . . . . . . . . . . . . . BlueCross BlueShield of Tennessee, Inc. . . . . . . . . . . . . . . BlueCross BlueShield of Tennessee, Inc. . . . . . . . . . . . . . . Explanation 0000001 BlueCross BlueShield of Tennnessee, Inc. appoints the Board of Tennessee Health Foundation, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0000002 BlueCross BlueShield of Tennessee, Inc. appoints the Board of Southern Health Plan, Inc. doing business as BlueCross Blue Shield of Tennessee Community Trust . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ANNUAL STATEMENT FOR THE YEAR 2016 OF THE BlueCross BlueShield of Tennessee, Inc. SCHEDULE Y PART 2 - SUMMARY OF INSURER'S TRANSACTIONS WITH ANY AFFILIATES 1 NAIC Company Code 2 ID Number 3 Names of Insurers and Parent, Subsidiaries or Affiliates 42 54518 . . . . 62-0427913 . . BlueCross BlueShield of Tennessee, Inc. (BCBST) . . . . . . . . . . . . . . . . . 00000 . . . . 20-0298456 . . Tennessee Health Foundation, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00000 . . . . 58-1406632 . . Southern Health Plan, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00000 . . . . 62-1156889 . . Southern Diversified Business Services, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . 14046 . . . . 62-1656610 . . Volunteer State Health Plan, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00000 . . . . 62-0721232 . . Group Insurance Services, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65463 . . . . 62-1156312 . . Golden Security Insurance Company . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15005 . . . . 46-1548495 . . SecurityCare of Tennessee, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00000 . . . . 20-8042682 . . BeneVive, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00000 . . . . 20-0528228 . . RiverTrust Solutions, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00000 . . . . 62-1631426 . . Onlife Health, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00000 . . . . 20-3484545 . . Shared Health, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9999999 Control Totals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Schedule Y Part 2 Explanation: 4 Shareholder Dividends 11,000,000 0 ................ 0 . . . . . . 1,453,152 . . (12,000,000) . . . . . . (453,152) ................ 0 ................ 0 ................ 0 ................ 0 ................ 0 ................ 0 ................ 0 5 Capital Contributions (4,500,000) 0 ................ 0 ................ 0 ................ 0 ................ 0 ................ 0 . . . . . . 4,000,000 . . . . . . . . 500,000 ................ 0 ................ 0 ................ 0 ................ 0 6 Purchases, Sales or Exchanges of Loans, Securities, Real Estate, Mortgage Loans or Other Investments .. .... .... ....................... .. ................ ................ ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... 7 Income/(Disbursements) Incurred in Connection with Guarantees or Undertakings for the Benefit of any Affiliate(s) 0 0 0 0 0 0 0 0 0 0 0 0 0 ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... 8 9 10 Management Agreements and Service Contracts Income/ (Disbursements) Incurred Under Reinsurance Agreements * 0 . . . 227,652,340 0 . . . . . . (937,825) 0 . . . . . . . . (22,782) 0 . . . . . . . . 381,312 0 . (208,849,515) 0 . . . . (3,942,648) 0 . . . . (5,024,812) 0 . . . . (1,958,867) 0 . . . . . . . . 287,990 0 . . . . . . . . . . . . . . . 24 0 . . . . (4,619,851) 0 . . . . (2,965,366) 0 ................ 0 ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... 0 ........ 0 ........ 0 ........ 0 ........ 0 ........ 0 ........ 0 ........ 0 ........ 0 ........ 0 ........ 0 ........ 0 ........ 0 XXX 11 Any Other Material Activity not in the Ordinary Course of the Insurer's Business 12 Totals 0 . . . 234,152,340 0 . . . . . . (937,825) . . . . . . . . . . . . . . . . . . 0 . . . . . . . . (22,782) . . . . . . . . . . . . . . . . . . 0 . . . . . . 1,834,464 . . . . . . . . . . . . . . . . . . 0 . (220,849,515) . . . . . . . . . . . . . . . . . . 0 . . . . (4,395,800) . . . . . . . . . . . . . . . . . . 0 . . . . (5,024,812) . . . . . . . . . . . . . . . . . . 0 . . . . . . 2,041,133 . . . . . . . . . . . . . . . . . . 0 . . . . . . . . 787,990 . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . 24 . . . . . . . . . . . . . . . . . . 0 . . . . (4,619,851) . . . . . . . . . . . . . . . . . . 0 . . . . (2,965,366) .................. 0 ................ 0 13 Reinsurance Recoverable/ (Payable) on Losses and/or Reserve Credit Taken/ (Liability) 0 0 .................. 0 .................. 0 .................. 0 .................. 0 .................. 0 .................. 0 .................. 0 .................. 0 .................. 0 .................. 0 .................. 0 .................. .................. .................. .................. ANNUAL STATEMENT FOR THE YEAR 2016 OF THE BlueCross BlueShield of Tennessee, Inc. SUPPLEMENTAL EXHIBITS AND SCHEDULES INTERROGATORIES Response The following supplemental reports are required to be filed as part of your statement filing unless specifically waived by the domiciliary state. However, in the event that your domiciliary state waives the filing requirement, your response of WAIVED to the specific interrogatory will be accepted in lieu of filing a "NONE" report and a bar code will be printed below. If the supplement is required of your company but is not being filed for whatever reason, enter SEE EXPLANATION and provide an explanation following the interrogatory questions. 1. 2. 3. 4. MARCH FILING Will the Supplemental Compensation Exhibit be filed with the state of domicile by March 1? Will an actuarial opinion be filed by March 1? Will the confidential Risk-based Capital Report be filed with the NAIC by March 1? Will the confidential Risk-based Capital Report be filed with the state of domicile, if required by March 1? Yes Yes Yes Yes APRIL FILING 5. Will Management's Discussion and Analysis be filed by April 1? 6. Will the Supplemental Investment Risks Interrogatories be filed by April 1? 7. Will the Accident and Health Policy Experience Exhibit be filed by April 1? Yes Yes Yes JUNE FILING 8. Will an audited financial report be filed by June 1? 9. Will Accountants Letter of Qualifications be filed with the state of domicile and electronically with the NAIC by June 1? Yes Yes AUGUST FILING 10. Will the regulator-only (non-public) Communication of Internal Control Related Matters Noted in Audit be filed with the state of domicile and electronically with the NAIC (as a regulator-only non-public document) by August 1? Yes The following supplemental reports are required to be filed as part of your statement filing. However, in the event that your company does not transact the type of business for which the special report must be filed, your response of NO to the specific interrogatory will be accepted in lieu of filing a "NONE" report and a bar code will be printed below. If the supplement is required of your company but it is not being filed for whatever reason enter SEE EXPLANATION and provide an explanation following the interrogatory questions. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. MARCH FILING Will the Medicare Supplement Insurance Experience Exhibit be filed with the state of domicile and the NAIC by March 1? Will the Supplemental Life data due March 1 be filed with the state of domicile and the NAIC? Will the Supplemental Property/Casualty data due March 1 be filed with the state of domicile and the NAIC? Will Schedule SIS (Stockholder Information Supplement) be filed with the state of domicile by March 1? Will the actuarial opinion on participating and non-participating policies as required in Interrogatories 1 and 2 on Exhibit 5 to Life Supplement be filed with the state of domicile and electronically with the NAIC by March 1? Will the actuarial opinion on non-guaranteed elements as required in Interrogatory 3 to Exhibit 5 to Life Supplement be filed with the state of domicile and electronically with the NAIC by March 1? Will the Medicare Part D Coverage Supplement be filed with the state of domicile and the NAIC by March 1? Will an approval from the reporting entity's state of domicile for relief related to the five-year rotation requirement for lead audit partner be file electronically with the NAIC by March 1? Will an approval from the reporting entity's state of domicile for relief related to the one-year cooling off period for independent CPA be filed electronically with the NAIC by March 1? Will an approval from the reporting entity's state of domicile for relief related to the Requirements for Audit Committees be filed electronically with the NAIC by March 1? Yes Yes No Yes No No Yes No No No APRIL FILING Will the Long-Term Care Experience Reporting Forms be filed with the state of domicile and the NAIC by April 1? Will the Supplemental Life data due April 1 be filed with the state of domicile and the NAIC? Will the Supplemental Property/Casualty Insurance Expense Exhibit due April 1 be filed with any state that requires it, and, if so, the NAIC? Will the Supplemental Health Care Exhibit (Parts 1, 2 and 3) be filed with the state of domicile and the NAIC by April 1? Will the regulator only (non-public) Supplemental Health Care Exhibit's Allocation Report be filed with the state of domicile and the NAIC by April 1? Yes Yes No Yes Yes AUGUST FILING 26. Will Management's Report of Internal Control Over Financial Reporting be filed with the state of domicile by August 1? Yes Explanation: Bar Code: Health Property / Casualty Supplement 54518201620700000 2016 Actuarial Opinion on Participating and Non-Participating Policies Document Code: 207 54518201637100000 Statement of Non-Guaranteed Elements for Exhibit 5 54518201637000000 2016 2016 Approval for Relief related to five-year rotation for lead Audit Partner Document Code: 370 54518201622400000 2016 Approval for Relief related to one-year cooling off period for inde. CPA Approval for Relief related to Require. for Audit Committees 54518201622500000 54518201622600000 2016 Document Code: 225 Health Property/Casualty Supplement - Insurance Expense Exhibit 54518201621300000 2016 Document Code: 371 Document Code: 213 43 2016 Document Code: 224 Document Code: 226 ANNUAL STATEMENT FOR THE YEAR 2016 OF THE BlueCross BlueShield of Tennessee, Inc. OVERFLOW PAGE FOR WRITE-INS 44 ANNUAL STATEMENT FOR THE YEAR 2016 OF THE BlueCross BlueShield of Tennessee, Inc. MEDICARE SUPPLEMENT INSURANCE EXPERIENCE EXHIBIT For The Year Ended DECEMBER 31, 2016 54518201636043100 2016 Document Code: 360 (To be filed by March 1) FOR THE STATE OF TENNESSEE 1 NAIC Group Code: 3498 NAIC Company Code: 54518 Address (City, State and Zip Code): Chattanooga, TN 37402-0001 Person Completing This Exhibit: Steven Bart Bowling Title: Manager Actuary Services Telephone Number: (423)535-7745 3 4 5 6 7 8 9 2 10 Policies Issued Through 2013 Incurred Claims 14 12 13 Percent of Number of Premiums Premiums Covered Earned Amount Earned Lives 11 Compliance with OBRA Policy Form Number Standardized Medicare Supplement Medicare Benefit Plan Select Plan Characteristics Date Approved Date Approval Withdrawn Date Last Amended Date Closed Policy Marketing Trade Name Policies Issued in 2014, 2015, 2016 Incurred Claims 18 16 17 Percent of Number of Premiums Premiums Covered Earned Amount Earned Lives 15 Total Experience on Individual Policies Supp12 Tennessee Yes . . . . 65 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P . . . . . . . . No . . . . . . . . 2,4,6 . . . . . . 07/01/1966 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12/31/1991 BC 65 Standard Contract . . . . . . . . . . Yes . . . . 79 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P . . . . . . . . No . . . . . . . . 2,4,6 . . . . . . 01/01/1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12/31/1991 BC 65 - 79 . . . . . . . . . . . . . . . . . . . . . . . . . . Yes . . . . 80 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P . . . . . . . . No . . . . . . . . 2,4,6 . . . . . . 01/01/1966 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12/31/1991 BC 65 Prudent Purchaser . . . . . . . . . . Yes . . . . 81 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P . . . . . . . . No . . . . . . . . 2,4,6 . . . . . . 01/01/1966 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12/31/1991 BC 65 Premium Contract . . . . . . . . . . . Yes . . . . GA4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P . . . . . . . . No . . . . . . . . 2,4,7 . . . . . . 01/01/1966 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12/31/1991 Memphis 65 Transfers . . . . . . . . . . . . . . Yes . . . . MS Std C - REMH . . . . . . . . . . . . . . . . C . . . . . . . . Yes . . . . . . 2,3,4,6 . . . . . 03/01/1998 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 05/31/2010 Medicare Select Standard C . . . . . . . Yes . . . . MS Std F - REMI . . . . . . . . . . . . . . . . . . F . . . . . . . . Yes . . . . . . 2,3,4,6 . . . . . 03/01/1998 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 05/31/2010 Medicare Select Standard F . . . . . . . Yes . . . . MS Std J - RSBK . . . . . . . . . . . . . . . . . . J . . . . . . . . Yes . . . . . . 2,3,4,6 . . . . . 01/01/2000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 05/31/2010 Medicare Select Standard J . . . . . . . . Yes . . . . Std A N01 - N28 . . . . . . . . . . . . . . . . . . A . . . . . . . . No . . . . . . . 2,3,4,6 . . . . . 07/01/1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 05/31/2010 Standardized A . . . . . . . . . . . . . . . . . . . . . Yes . . . . Std A N01 - N28 . . . . . . . . . . . . . . . . . . A . . . . . . . . No . . . . . . . 2,3,4,6 . . . . . 06/01/2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Blue Elite Plan A . . . . . . . . . . . . . . . . . . . . Yes . . . . Std B N29 - N56 . . . . . . . . . . . . . . . . . . B . . . . . . . . No . . . . . . . 2,3,4,6 . . . . . 07/01/1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 05/31/2010 Standardized B . . . . . . . . . . . . . . . . . . . . . Yes . . . . Std C N57 - N84 . . . . . . . . . . . . . . . . . . C . . . . . . . . No . . . . . . . 2,3,4,6 . . . . . 01/01/1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 05/31/2010 Standardized C . . . . . . . . . . . . . . . . . . . . . Yes . . . . Std D J01 - J28 . . . . . . . . . . . . . . . . . . . D . . . . . . . . No . . . . . . . 2,3,4,6 . . . . . 04/01/1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 05/31/2010 Standardized D . . . . . . . . . . . . . . . . . . . . . Yes . . . . Std D J01 - J28 . . . . . . . . . . . . . . . . . . . D . . . . . . . . No . . . . . . . 2,3,4,6 . . . . . 06/01/2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Blue Elite Plan D . . . . . . . . . . . . . . . . . . . . Yes . . . . Std E O01 - O28 . . . . . . . . . . . . . . . . . . E . . . . . . . . No . . . . . . . 2,3,4,6 . . . . . 07/01/1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 05/31/2010 Standardized E . . . . . . . . . . . . . . . . . . . . . Yes . . . . Std F O29 - O56 . . . . . . . . . . . . . . . . . . F . . . . . . . . No . . . . . . . 2,3,4,6 . . . . . 07/01/1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 05/31/2010 Standardized F . . . . . . . . . . . . . . . . . . . . . Yes . . . . Std F O29 - O56 . . . . . . . . . . . . . . . . . . F . . . . . . . . No . . . . . . . 2,3,4,6 . . . . . 06/01/2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Blue Elite Plan F . . . . . . . . . . . . . . . . . . . . Yes . . . . Std G O57 - O84 . . . . . . . . . . . . . . . . . . G . . . . . . . . No . . . . . . . 2,3,4,6 . . . . . 07/01/1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 05/31/2010 Standardized G . . . . . . . . . . . . . . . . . . . . . Yes . . . . Std H P01 - P28 . . . . . . . . . . . . . . . . . . . H . . . . . . . . No . . . . . . . 2,3,4,6 . . . . . 07/01/1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 05/31/2010 Standardized H . . . . . . . . . . . . . . . . . . . . . Yes . . . . Std I J29 - J56 . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . No . . . . . . . 2,3,4,6 . . . . . 04/01/1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 05/31/2010 Standardized I . . . . . . . . . . . . . . . . . . . . . . Yes . . . . Std J P29 - P56 . . . . . . . . . . . . . . . . . . . . J . . . . . . . . No . . . . . . . 2,3,4,6 . . . . . 07/01/1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 05/31/2010 Standardized J . . . . . . . . . . . . . . . . . . . . . . Yes . . . . Std K - 6KNR . . . . . . . . . . . . . . . . . . . . . . K . . . . . . . . No . . . . . . . 2,3,4,6 . . . . . 01/01/2007 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 05/31/2010 Standardized K . . . . . . . . . . . . . . . . . . . . . Yes . . . . Std L - 6LNR . . . . . . . . . . . . . . . . . . . . . . . L . . . . . . . . No . . . . . . . 2,3,4,6 . . . . . 01/01/2007 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 05/31/2010 Standardized L . . . . . . . . . . . . . . . . . . . . . . 0199999 Total Experience on Individual Policies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... . . . . . . . 7,967,851 . . . . . . . . . . 37,305 . . . . . . . . . 130,835 . . . . . . . 2,595,457 . . . . . . . . . 708,072 . . . . . . . . . 725,269 . . . . . . . . . 736,118 . . . . . . . . . 126,506 . . . . . . . . . 706,138 . . . . . . . . . 511,127 . . . . . . . 3,108,713 . . . . . 18,160,581 . . . . . . . 7,961,403 . . . . . . . 1,724,263 . . . . . . . 6,098,450 . . . . . 39,439,771 . . . . . 13,083,523 . . . . . . . 1,280,885 . . . . . . . . . 714,438 . . . . . . . . . 668,564 . . . . . . . 8,061,347 . . . . . . . . . . 68,124 . . . . . . . . . . 62,088 .... 114,676,828 . . . . . . . 6,053,393 . . . . . . . . . . 23,692 . . . . . . . . . 167,870 . . . . . . . 1,649,414 . . . . . . . . . 514,812 . . . . . . . . . 450,008 . . . . . . . . . 436,998 . . . . . . . . . . 63,537 . . . . . . . . . 573,294 . . . . . . . . . 943,057 . . . . . . . 2,257,282 . . . . . 12,094,229 . . . . . . . 6,105,227 . . . . . . . 1,308,685 . . . . . . . 4,962,897 . . . . . 25,770,040 . . . . . . . 9,613,193 . . . . . . . . . 901,385 . . . . . . . . . 470,405 . . . . . . . . . 411,888 . . . . . . . 4,750,898 . . . . . . . . . . 38,226 . . . . . . . . . . 25,905 . . . . . . 76.0 . . . . . . 63.5 . . . . . 128.3 . . . . . . 63.6 . . . . . . 72.7 . . . . . . 62.0 . . . . . . 59.4 . . . . . . 50.2 . . . . . . 81.2 . . . . . 184.5 . . . . . . 72.6 . . . . . . 66.6 . . . . . . 76.7 . . . . . . 75.9 . . . . . . 81.4 . . . . . . 65.3 . . . . . . 73.5 . . . . . . 70.4 . . . . . . 65.8 . . . . . . 61.6 . . . . . . 58.9 . . . . . . 56.1 . . . . . . 41.7 . . . . . . . 748 .......... 3 . . . . . . . . 34 . . . . . . . 280 . . . . . . . . 85 . . . . . . . 149 . . . . . . . 185 . . . . . . . . 17 . . . . . . . 198 . . . . . . . 206 . . . . . . . 889 . . . . . 4,403 . . . . . 2,409 . . . . . . . 836 . . . . . 1,870 . . . . 10,729 . . . . . 3,058 . . . . . . . 350 . . . . . . . 149 . . . . . . . 192 . . . . . 1,326 . . . . . . . . 35 . . . . . . . . 18 ................. 0 ................. 0 ................. 0 ................. 0 ................. 0 ................. 0 ................. 0 ................. 0 ................. 0 . . . . . . . . . 145,002 ................. 0 ................. 0 ................. 0 . . . . . . . . . 820,236 ................. 0 ................. 0 . . . . . 11,122,177 ................. 0 ................. 0 ................. 0 ................. 0 ................. 0 ................. 0 79,586,335 ...... 69.4 . . . . 28,169 . . . . . . . . . . . . . . 261,646 . . . . . . . . . 279,659 . . . . . . . . . . 55,835 . . . . . . . . . 195,215 . . . . . . . . . . 13,148 . . . . . 24,142,170 ...... ...... ...... ...... ...... ...... . . . . . . . . 92 . . . . . . . 136 . . . . . . . . 38 . . . . . . . 114 .......... 8 . . . . 15,347 24,947,673 ...... 79.2 61.2 73.4 75.8 28.3 98.7 97.3 ..... 12,087,415 ................. 0 ................. 0 ................. 0 ................. 0 ................. 0 ................. 0 ................. 0 ................. 0 ................. 0 . . . . . . . . . 102,611 ................. 0 ................. 0 ................. 0 . . . . . . . . . 444,955 ................. 0 ................. 0 . . . . . . . 7,366,111 ................. 0 ................. 0 ................. 0 ................. 0 ................. 0 ................. 0 ....... 7,913,677 . . . . . . . . 0.0 . . . . . . . . 0.0 . . . . . . . . 0.0 . . . . . . . . 0.0 . . . . . . . . 0.0 . . . . . . . . 0.0 . . . . . . . . 0.0 . . . . . . . . 0.0 . . . . . . . . 0.0 . . . . . . 70.8 . . . . . . . . 0.0 . . . . . . . . 0.0 . . . . . . . . 0.0 . . . . . . 54.2 . . . . . . . . 0.0 . . . . . . . . 0.0 . . . . . . 66.2 . . . . . . . . 0.0 . . . . . . . . 0.0 . . . . . . . . 0.0 . . . . . . . . 0.0 . . . . . . . . 0.0 . . . . . . . . 0.0 .......... 0 .......... 0 .......... 0 .......... 0 .......... 0 .......... 0 .......... 0 .......... 0 .......... 0 . . . . . . . 502 .......... 0 .......... 0 .......... 0 . . . . . 1,765 .......... 0 .......... 0 . . . . 18,795 .......... 0 .......... 0 .......... 0 .......... 0 .......... 0 .......... 0 65.5 . . . . 21,062 ...... Total Experience on Group Policies Yes . . . . 65 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P . . . . . . . . No . . . . . . . . 3,5,6 . . . . . . 07/01/1966 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12/31/1991 BC 65 Standard Contract . . . . . . . . . . Yes . . . . 81 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P . . . . . . . . No . . . . . . . . 2,4,6 . . . . . . 01/01/1966 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12/31/1991 BC 65 Premium Contract . . . . . . . . . . . Yes . . . . Std D J01 - J28 . . . . . . . . . . . . . . . . . . . D . . . . . . . . No . . . . . . . 2,3,4,6 . . . . . 04/01/1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Standardized D . . . . . . . . . . . . . . . . . . . . . Yes . . . . Std F O29 - O56 . . . . . . . . . . . . . . . . . . F . . . . . . . . No . . . . . . . 2,3,4,6 . . . . . 07/01/1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Standardized F . . . . . . . . . . . . . . . . . . . . . Yes . . . . Std J P29 - P56 . . . . . . . . . . . . . . . . . . . . J . . . . . . . . No . . . . . . . 2,3,4,6 . . . . . 07/01/1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Standardized J . . . . . . . . . . . . . . . . . . . . . . Yes . . . . TVA - RNKN . . . . . . . . . . . . . . . . . . . . . . P . . . . . . . . No . . . . . . . . 3,5,6 . . . . . . 07/01/1966 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TVA Over 65 Supplement . . . . . . . . . . 0299999 Total Experience on Group Policies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . GENERAL INTERROGATORIES 1. If response in Column 1 is no, give full and complete details: N/A 2. Claims address and contact person provided to the Secretary of Health and Human Services as required by 42 U.S.C. 1395ss(c)(3)(E) for this state. 2.1 Address: 1 Cameron Hill Circle, Chattanooga TN 37402-0001 2.2 Contact Person and Phone Number: Dana Banks Shull (423)535-67103. Billing address and contact person for user fees established under 41 U.S.C. 1395u(h)(3)(B) 3.1 Address: 1 Cameron Hill Circle, Chattanooga TN 37402-0001 ..... ..... ..... ..... ..... ..... . . . . . . . . . 330,520 . . . . . . . . . 456,620 . . . . . . . . . . 76,026 . . . . . . . . . 257,605 . . . . . . . . . . 46,430 . . . . . 24,463,954 ..... 25,631,155 ..... ................. 0 ................. 0 ................. 0 ................. 0 ................. 0 ................. 0 ................. 0 ................. 0 ................. 0 ................. 0 ................. 0 ................. 0 0.0 0.0 0.0 0.0 0.0 0.0 . . . . 15,735 . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . 0 . . . . . . . . 0.0 ........ ........ ........ ........ ........ ........ 0 0 0 0 0 0 .......... 0 .......... .......... .......... .......... .......... .......... ANNUAL STATEMENT FOR THE YEAR 2016 OF THE BlueCross BlueShield of Tennessee, Inc. Medicare Supplement Ins. Exp. Exh. (continued) 3.2 Contact Person and Phone Number: Steven Bart Bowling (423)535-7745 4. Explain any policies identified above as policy type "O": N/A Supp12.1 ANNUAL STATEMENT FOR THE YEAR 2016 OF THE BlueCross BlueShield of Tennessee, Inc. 54518201636500100 2016 Document Code: 365 Medicare Part D Coverage Supplement (Net of Reinsurance) NAIC Group Code: 3498 (To be Filed By March 1) Individual Coverage 1 2 Insured 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. Premiums Collected 1.1 Standard Coverage 1.11 With Reinsurance Coverage . . . . . . . . . . . . . . 1.12 Without Reinsurance Coverage . . . . . . . . . . 1.13 Risk-Corridor Payment Adjustments . . . . 1.2 Supplemental Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Premiums Due and Uncollected - change 2.1 Standard Coverage 2.11 With Reinsurance Coverage . . . . . . . . . . . . . . 2.12 Without Reinsurance Coverage . . . . . . . . . . 2.2 Supplemental Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Unearned Premium and Advance Premium change 3.1 Standard Coverage 3.11 With Reinsurance Coverage . . . . . . . . . . . . . . 3.12 Without Reinsurance Coverage . . . . . . . . . . 3.2 Supplemental Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Risk-Corridor Payment Adjustments - change 4.1 Receivable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.2 Payable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Earned Premiums 5.1 Standard Coverage 5.11 With Reinsurance Coverage . . . . . . . . . . . . . . 5.12 Without Reinsurance Coverage . . . . . . . . . . 5.13 Risk-Corridor Payment Adjustments . . . . 5.2 Supplemental Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TOTAL Premiums . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Claims Paid 7.1 Standard Coverage 7.11 With Reinsurance Coverage . . . . . . . . . . . . . . 7.12 Without Reinsurance Coverage . . . . . . . . . . 7.2 Supplemental Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Claim Reserves and Liabilities - change 8.1 Standard Coverage 8.11 With Reinsurance Coverage . . . . . . . . . . . . . . 8.12 Without Reinsurance Coverage . . . . . . . . . . 8.2 Supplemental Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Healthcare Receivables - change 9.1 Standard Coverage 9.11 With Reinsurance Coverage . . . . . . . . . . . . . . 9.12 Without Reinsurance Coverage . . . . . . . . . . 9.2 Supplemental Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Claims Incurred 10.1 Standard Coverage 10.11 With Reinsurance Coverage . . . . . . . . . . . . . . 10.12 Without Reinsurance Coverage . . . . . . . . . . 10.2 Supplemental Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TOTAL Claims . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Reinsurance Coverage and Low Income Cost Sharing 12.1 Claims Paid - Net of reimbursements applied . . 12.2 Reimbursements Received but Not Applied change . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.3 Reimbursements Receivable - change . . . . . . . . . . 12.4 Healthcare Receivables - change . . . . . . . . . . . . . . . . Aggregate Policy Reserves - change . . . . . . . . . . . . . . . . . . Expenses Paid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Expenses Incurred . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Underwriting Gain/Loss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Cash Flow Result . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Uninsured . . . . . . . . . . . . . . 20,581 . . . . . . . .....................0 ....... .....................0 ....... .....................0 ....... .....................0 ....... (1,220) .....................0 ............. ....... ....... .....................0 ....... .....................0 ....... .....................0 ....... .....................0 ....... .....................0 ....... . . . . . . . . . . . . . . 20,581 . . . . . . . (1,220) .....................0 .....................0 . . . . . . . . . . . . . . 19,361 ....... (77,167) ....... ............. ............ ....... ....... ....... .....................0 ....... .....................0 ....... . . . . . . . . . . . . . . 27,307 . . . . . . . .....................0 ....... .....................0 ....... .....................0 ....... .....................0 ....... .....................0 ....... ............ (49,860) ....... .....................0 ....... .....................0 ....... ............ ....... NAIC Company Code: 54518 Group Coverage 3 4 5 Total Insured Uninsured Cash (49,860) X X X ...... X X X ...... X X X ...... ....... X X X ...... .....................0 . . . . . . . . . . . . . . . 8,039 . . . . . . . . . . . . . . . 8,039 . . . . . . . . . . . . . . 61,182 ....... X X X ...... ....... X X X ...... X X X ...... X X X ...... X X X ...... .....................0 ....... X X X ...... X X X ...... X X X ...... .....................0 ....... X X X ...... X X X ...... X X X ...... .....................0 ....... X X X ...... X X X ...... .....................0 ....... X X X ...... X X X ...... X X X ...... X X X ...... X X X ...... .....................0 ....... X X X ...... X X X ...... X X X ...... .....................0 ....... X X X ...... X X X ...... X X X ...... .....................0 ....... X X X ...... X X X ...... X X X ...... .....................0 ....... X X X ...... X X X ...... X X X ...... X X X ...... .....................0 ....... .....................0 ....... .....................0 ....... .....................0 ....... .....................0 ....... .....................0 ....... .....................0 ....... .....................0 ....... .....................0 ....... .....................0 ....... .....................0 ....... .....................0 ....... .....................0 ....... .....................0 ....... .....................0 ....... .....................0 ....... .....................0 ....... .....................0 ....... .....................0 ....... .....................0 ....... .....................0 ....... .....................0 ....... .....................0 ....... X X X ...... X X X ...... X X X ...... .....................0 ....... X X X ...... .....................0 .....................0 ....... X X X ...... .....................0 ....... X X X ...... .....................0 ....... X X X ...... .....................0 ....... X X X ...... ....... X X X ...... X X X ...... X X X ...... X X X ...... X X X ...... . . . . . . . . . . . . . . 20,581 X X X ...... X X X ...... X X X ...... ....... X X X ...... X X X ...... X X X ...... ....... X X X ...... X X X ...... ....... X X X ...... X X X ...... X X X ...... X X X ...... X X X ...... ....... X X X ...... X X X ...... X X X ...... ............ X X X ...... X X X ...... X X X ...... ....... X X X ...... X X X ...... X X X ...... ....... X X X ...... X X X ...... X X X ...... X X X ...... ....... .....................0 .....................0 .....................0 ....... ....... ....... ....... ....... X X X ...... X X X ...... X X X ...... X X X ...... X X X ...... X X X ...... X X X ...... X X X ...... X X X ...... X X X ...... ....... X X X ...... ....... X X X ...... . . . . . . . . . . . . . . 20,581 ....... (77,167) .....................0 .....................0 ....... ....... ....... ....... X X X ...... X X X ...... X X X ...... X X X ...... X X X ...... X X X ...... X X X ...... X X X ...... ....... X X X ...... . . . . . . . . . . . . (77,167) ....... .....................0 .....................0 ....... .....................0 ....... .....................0 .....................0 ....... .....................0 ....... .....................0 ....... Supp17 X X X ...... X X X ...... .....................0 ....... X X X ...... . . . . . . . X X X . . . . . . . . . . . . . . . . . . . . . 8,039 ....... X X X ...... ....... X X X ...... ....... X X X ...... ....... X X X ...... . . . . . . . X X X . . . . . . . . . . . . . . . . . . . . 89,709 .....................0 ....... ANNUAL STATEMENT FOR THE YEAR 2016 OF THE BlueCross BlueShield of Tennessee, Inc. 54518201620500000 2016 Document Code: 205 LIFE SUPPLEMENTS For the Year Ended December 31, 2016 NONE To Be Filed By March 1 Of The BlueCross BlueShield of Tennessee, Inc. Address (City, State and Zip Code) NAIC Group Code Insurance Company Chattanooga, TN 37402-0001 3498 NAIC Company Code 54518 Supp25 Employer's ID Number 62-0427913 ANNUAL STATEMENT FOR THE YEAR 2016 OF THE BlueCross BlueShield of Tennessee, Inc. EXHIBIT 5 - AGGREGATE RESERVE FOR LIFE CONTRACTS 1 2 3 4 Valuation Standard Total Industrial Ordinary 5 Credit (Group and Individual) 6 Group NONE 9999999 Totals - (Net) -Page 3, Line 1 ................................................................ ................. 0 ................. 0 ................. 0 ................. 0 .................0 Supp26 ANNUAL STATEMENT FOR THE YEAR 2016 OF THE BlueCross BlueShield of Tennessee, Inc. EXHIBIT 5 - INTERROGATORIES 1.1 Has the reporting entity ever issued both participating and non-participating contracts? 1.2 If not, state which kind is issued: Yes[ ] No[X] 2.1 Does the reporting entity at present issue both participating and non-participating contracts? 2.2 If not, state which kind is issued. Yes[ ] No[X] 3. Does the reporting entity at present issue or have in force contracts that contain non-guaranteed elements? If so, attach a statement that contains the determination procedures, answers to the interrogatories and an actuarial opinion as described in the instructions. Yes[ ] No[X] 4. Has the reporting entity any assessment or stipulated premium contracts in force? If so, state: 4.1 Amount of insurance: 4.2 Amount of reserve: 4.3 Basis of reserve 4.4 Basis of regular assessments 4.5 Basis of special assessments 4.6 Assessments collected during the year Yes[ ] No[X] $. . . . . . . . . . . . . . . . . . . . . . . . . 0 $. . . . . . . . . . . . . . . . . . . . . . . . . 0 $. . . . . . . . . . . . . . . . . . . . . . . . . 0 5. If the contract loan interest rate guaranteed in any one or more of its currently issued contracts is less than 5%, not in advance, state the contract loan rate guarantees on any such contracts 6. Does the reporting entity hold reserves for any annuity contracts that are less than the reserves that would be held on a standard basis? 6.1 If so, state the amount of reserve on such contracts on the basis actually held: 6.2 That would have been held (on an exact or approximate basis) using the actual ages of the annuitants; the interest rate(s) used in 6.1, and the same mortality basis used by the reporting entity for the valuation of comparable annuity benefits issued to standard lives. If the reporting entity has no comparable annuity benefits for standard lives to be valued, the mortality basis shall be the table most recently approved by the state of domicile for valuing individual annuity benefits: Attach statement of methods employed in their valuation. Yes[ ] No[X] $. . . . . . . . . . . . . . . . . . . . . . . . . 0 7. Does the reporting entity have any Synthetic GIC contracts or agreements in effect as of December 31 of the current year? 7.1 If yes, state the total dollar amount of assets covered by these contracts or agreements: 7.2 Specify the basis (fair value, amortized cost, etc.) for determining the amount 7.3 State the amount of reserves established for this business: 7.4 Identify where the reserves are reported in the blank Yes[ ] No[X] $. . . . . . . . . . . . . . . . . . . . . . . . . 0 8. Does the reporting entity have any Contingent Deferred Annuity contracts or agreements in effect as of December 31 of the current year? 8.1 If yes, state the total dollar amount of account value covered by these contracts or agreements: 8.2 State the amount of reserves established for this business: 8.3 Identify where the reserves are reported in the blank: Yes[ ] No[X] $. . . . . . . . . . . . . . . . . . . . . . . . . 0 $. . . . . . . . . . . . . . . . . . . . . . . . . 0 9. Does the reporting entity have any Guaranteed Lifetime Income Benefit contracts, agreements or riders in effect as of December 31 of the current year? 9.1 If yes, state the total dollar amount of any account value associated with these contracts, agreements or riders: 9.2 State the amount of reserves established for this business: 9.3 Identify where the reserves are reported in the blank: Yes[ ] No[X] $. . . . . . . . . . . . . . . . . . . . . . . . . 0 $. . . . . . . . . . . . . . . . . . . . . . . . . 0 NONE Supp27 $. . . . . . . . . . . . . . . . . . . . . . . . . 0 $. . . . . . . . . . . . . . . . . . . . . . . . . 0 ANNUAL STATEMENT FOR THE YEAR 2016 OF THE BlueCross BlueShield of Tennessee, Inc. EXHIBIT 7 - DEPOSIT-TYPE CONTRACTS 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. Balance at the beginning of the year before reinsurance . . . . . . . . . . . . . . . . . . . . . . . . Deposits received during the year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Investment earnings credited to the account . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Other net change in reserves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Fees and other charges assessed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Surrender charges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Net surrender or withdrawal payments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Other net transfers to or (from) Separate Accounts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Balance at the end of current year before reinsurance (Lines 1 + 2 + 3 + 4 - 5 - 6 - 7 - 8) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Reinsurance balance at the beginning of the year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Net change in reinsurance assumed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Net change in reinsurance ceded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Reinsurance balance at the end of the year (Lines 10 + 11 - 12) . . . . . . . . . . . . . . . Net balance at the end of current year after reinsurance (Lines 9 + 13) . . . . . . . 1 2 3 Total Guaranteed Interest Contracts Annuities Certain 4 5 6 Dividend Premium and Supplemental Accumulations Other Deposit Contracts or Refunds Funds .............. 0 0 .............. 0 .............. 0 .............. 0 .............. 0 .............. 0 .............. 0 .............. 0 0 .............. 0 .............. 0 .............. 0 .............. 0 .............. 0 .............. 0 .............. .............. 0 0 .............. 0 .............. 0 .............. 0 .............. 0 .............. 0 .............. 0 .............. .............. 0 0 .............. 0 .............. 0 .............. 0 .............. 0 .............. 0 .............. 0 .............. .............. 0 0 .............. 0 .............. 0 .............. 0 .............. 0 .............. 0 .............. 0 .............. .............. .............. .............. .............. 0 0 .............. 0 .............. 0 .............. 0 .............. 0 .............. 0 0 .............. 0 .............. 0 .............. 0 .............. 0 .............. .............. 0 0 .............. 0 .............. 0 .............. 0 .............. 0 .............. .............. 0 0 .............. 0 .............. 0 .............. 0 .............. 0 .............. .............. 0 0 .............. 0 .............. 0 .............. 0 .............. 0 .............. .............. .............. .............. NONE 0 0 .............. 0 .............. 0 .............. 0 .............. 0 .............. 0 .............. 0 0 0 .............. 0 .............. 0 .............. 0 .............. 0 Supp28 ANNUAL STATEMENT FOR THE YEAR 2016 OF THE BlueCross BlueShield of Tennessee, Inc. SCHEDULE S - PART 1 - SECTION 1 Reinsurance Assumed Life Insurance, Annuities, Deposit Funds and Other Liabilities Without Life or Disability Contingencies, and Related Benefits Listed by Reinsured Company as of December 31, Current Year 1 2 3 NAIC Company Code ID Number Effective Date 4 5 6 7 Name of Reinsured Domiciliary Jurisdiction Type of Reinsurance Assumed Amount of In force at End of Year 8 9 Reserve 10 Reinsurance Payable on Paid and Unpaid Losses Premiums 11 12 Funds Withheld Under Coinsurance Modified Coinsurance Reserve NONE 9999999 Total (Sum of 1199999 and 2299999) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .................. 0 .................. 0 .................. 0 .................. 0 .................. 0 .................. 0 Supp29 ANNUAL STATEMENT FOR THE YEAR 2016 OF THE BlueCross BlueShield of Tennessee, Inc. SCHEDULE S - PART 3 - SECTION 1 Reinsurance Ceded Life Insurance, Annuities, Deposit Funds and Other Liabilities Without Life or Disability Contingencies, and Related Benefits Listed by Reinsuring Company as of December 31, Current Year 1 NAIC Company Code 2 3 4 5 ID Number Effective Date Name of Company Domiciliary Jurisdiction 6 Type of Reinsurance Ceded 7 Type of Business Ceded 8 Amount in Force at End of Year Reserve Credit Taken 9 10 Current Prior Year Year 11 Outstanding Surplus Relief 12 13 Current Prior Year Year Premiums 14 Modified Coinsurance Reserve 15 Funds Withheld Under Coinsurance NONE 9999999 Total (Sum of 3499999 and 6899999) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ................ 0 ............... 0 ............... 0 ................ 0 ............... 0 ............... 0 ................ 0 .................. 0 Supp30 ANNUAL STATEMENT FOR THE YEAR 2016 OF THE BlueCross BlueShield of Tennessee, Inc. 54518201620643100 DIRECT BUSINESS IN THE STATE OF TENNESSEE NAIC Group Code: 3498 LIFE INSURANCE 1 DIRECT PREMIUMS AND ANNUITY CONSIDERATIONS 1. 2. 3. 4. 5. 2 Credit Life (Group and Individual) Ordinary Life Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Annuity considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Deposit-type contract funds . . . . . . . . . . . . . . . . . . . . . . . . . . Other considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TOTALS (sum of Lines 1 to 4) . . . . . . . . . . . . . . . . . . . . . . . 2016 3 .......................... 0 0 .......................... 0 0 0 .......................... 0 0 0 0 0 .......................... 0 0 0 0 .......................... 0 0 0 .......................... .......................... .......................... 0 0 0 .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......... XXX 4 Group 0 0 0 0 0 .......................... 0 0 ......... .......................... .......................... .......................... 0 0 .......................... 0 0 0 .......................... 0 0 0 0 0 .......................... 0 0 0 0 .......................... 0 0 0 .......................... .......................... 0 0 .......................... 0 0 0 .......................... 0 0 0 0 0 .......................... 0 0 0 0 .......................... 0 0 0 .......................... .......................... .......................... 0 0 0 .......................... 0 0 0 0 .......................... 0 .......................... 0 .......................... 0 .......................... .......................... Total 0 0 0 0 0 .......................... .......................... 5 Industrial .......................... 0 0 .......................... Document Code: 206 DURING THE YEAR 2016 NAIC Company Code: 54518 .......................... .......... XXX 0 0 ......... .......................... .......................... .......................... 0 0 0 0 0 0 0 .......................... 0 0 .......................... 0 0 0 .......................... 0 0 0 0 0 .......................... 0 0 0 0 .......................... 0 0 0 .......................... .......................... .......................... 0 0 0 .......................... 0 0 0 0 .......................... 0 .......................... 0 0 .......................... 0 .......................... 0 .......................... .......................... .......................... DIRECT DIVIDENDS TO POLICYHOLDERS Life Insurance: 6.1 6.2 6.3 Paid in cash or left on deposit . . . . . . . . . . . . . . . . Applied to pay renewal premiums . . . . . . . . . . . . Applied to provide paid-up additions or shorten the endowment or premium paying period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TOTALS (sum of Lines 6.1 to 6.4) . . . . . . . . . . . .......................... 7.1 Paid in cash or left on deposit . . . . . . . . . . . . . . . . 7.2 Applied to provide paid-up annuities . . . . . . . . . 7.3 Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.4 TOTALS (sum of Lines 7.1 to 7.3) . . . . . . . . . . . GRAND TOTALS (Lines 6.5 plus 7.4) . . . . . . . . . . . . . . . .......................... 6.4 6.5 .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... 0 0 0 0 0 Annuities: 8. .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... 0 0 0 0 0 DIRECT CLAIMS AND BENEFITS PAID 9. 10. 11. 12. 13. 14. 15. Death benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Matured endowments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Annuity benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Surrender values and withdrawals for life contracts . Aggregate write-ins for miscellaneous direct claims and benefits paid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . All other benefits, except accident and health . . . . . . . TOTALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... 0 0 0 0 0 0 0 DETAILS OF WRITE-INS 1301. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1302. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1303. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1398. Summary of remaining write-ins for Line 13 from overflow page . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1399. TOTALS (Lines 1301 through 1303 plus 1398) (Line 13 above) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .......................... .......................... Credit Life (Group and Individual) 3 4 No. of Ind.Pols & Group Certifs. Amount Ordinary 1 DIRECT DEATH BENEFITS AND MATURED ENDOWMENTS INCURRED 16. 17. 2 Number Amount 0 ......... 0 ................ ......... ......... 0 0 ......... 0 ......... 0 ......... 0 ......... 0 0 ................ 0 ......... 0 ................... ................ ................ 0 0 ................ 0 ................ 0 ................ 0 ................ 0 ......... ......... 0 0 ......... 0 ......... 0 ......... 0 ......... 0 0 ......... 0 ................... Group 5 No. of Certificates 7 Amount 0 ................... 0 ......... ................... ................... 0 0 ................... 0 ................... 0 ................... 0 ................... 0 0 ......... .......................... Industrial 6 Number 0 ......... 0 ................ 0 ................ 0 ......... ......... ......... 0 0 ......... 0 ......... 0 ......... 0 ......... 0 ................ ................ 0 0 ................ 0 ................ 0 ................ 0 ................ 0 0 ................ 0 ......... Total 8 9 Amount ......... ......... 0 0 ......... 0 ......... 0 ......... 0 ......... 0 0 ................ 20. In force December 31, prior year . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . 0 . . . . . . . . . 0 (a). . . . . . . . . . . . . . . . 0 . . . . . . . . . 0 . . . . . . . . . . . . . . . . 0 . . . . . . . . . 0 21. Issued during year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . 0 . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . 0 . . . . . . . . . . . . . . . . 0 . . . . . . . . . 0 22. Other changes to in force (Net) . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . 0 . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . 0 . . . . . . . . . . . . . . . . 0 . . . . . . . . . 0 23. In force December 31 of current year . . . . . . . . . . 0 . . . . . . . . . . . . . . . . 0 . . . . . . . . . 0 (a). . . . . . . . . . . . . . . . 0 . . . . . . . . . 0 . . . . . . . . . . . . . . . . 0 . . . . . . . . . 0 (a) Includes Individual Credit Life Insurance prior year $...............0, current year $...............0. Includes Group Credit Life Insurance Loans less than or equal to 60 months at issue, prior year $...............0, current year $...............0. Loans greater than 60 months at issue BUT NOT GREATER THAN 120 MONTHS prior year $...............0, current year $...............0. ......... ......... .......................... ................ ......... 0 ................ 0 .......................... 0 ......... 0 18.1 18.2 18.3 18.4 18.5 18.6 19. Unpaid December 31, prior year . . . . . . Incurred during current year . . . . . . . . . . Settled during current year: By payment in full . . . . . . . . . . . . . . . . . . . . . . By payment on compromised claims . TOTALS Paid . . . . . . . . . . . . . . . . . . . . . . Reduction by compromise . . . . . . . . . . . . Amount rejected . . . . . . . . . . . . . . . . . . . . . . . TOTAL Settlements . . . . . . . . . . . . . . . . Unpaid Dec. 31, current year (Lines 16 + 17 - 18.6) . . . . . . . . . . . . . . . . . . . . . . . . . .......................... 10 Number Amount 0 ......... 0 .................0 ......... 0 0 ......... 0 ......... 0 ......... 0 ......... 0 .................0 ......... .................0 0 .................0 ......... 0 0 ......... 0 ......... 0 .................0 ......... .................0 0 ................ 0 ......... ................ ................ 0 0 ................ 0 ................ 0 ................ 0 ................ 0 0 ......... ................ ................ 0 0 ................ 0 ................ 0 .................0 .................0 .................0 .................0 .................0 No. of Policies POLICY EXHIBIT .................0 .................0 ACCIDENT AND HEALTH INSURANCE 1 2 Direct Premiums Direct Premiums Earned 24. 24.1 24.2 24.3 24.4 3 Dividends Paid Or Credited On Direct Business Group Policies (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,164,636,834 . . . . . . . 3,164,905,697 . . . . . . . . . . . . . . . . . . . . . Federal Employees Health Benefits Plan Premium (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 660,153,765 . . . . . . . . . 660,153,765 . . . . . . . . . . . . . . . . . . . . . Credit (Group and Individual) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . . . Collectively Renewable Policies (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . . . Medicare Title XVIII exempt from state taxes or fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 919,310,746 . . . . . . . . . 919,310,746 . . . . . . . . . . . . . . . . . . . . . Other Individual Policies 25.1 Non-cancelable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . . . 25.2 Guaranteed renewable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . . . 25.3 Non-renewable for stated reasons only (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . . . 25.4 Other accident only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . . . 25.5 All other (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19,361 . . . . . . . . . . . . . . . 19,361 . . . . . . . . . . . . . . . . . . . . . 25.6 TOTALS (sum of Lines 25.1 to 25.5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19,361 . . . . . . . . . . . . . . . 19,361 . . . . . . . . . . . . . . . . . . . . . 26. TOTALS (Lines 24 + 24.1 + 24.2 + 24.3 + 24.4 + 25.6) . . . . . . . . . . . . . . . . . . . . . . . . . . 4,744,120,706 . . . . . . . 4,744,389,569 . . . . . . . . . . . . . . . . . . . . . (b) For health business on indicated lines report: Number of persons insured under PPO managed care products .......1,746,221 and number of persons insured under indemnity only products ...............0. Supp31 Tennessee 4 5 Direct Losses Paid Direct Losses Incurred 0 0 0 0 0 . . . . . . . 2,750,612,814 . . . . . . . 2,732,434,137 0 0 0 0 0 0 0 . . . . . . . . . 594,406,666 . . . . . . . . . 590,547,279 ..................... 0 0 . . . . . . . . . 789,290,920 ..................... ..................... ..................... 0 0 . . . . . . . . . 784,836,260 ..................... 0 0 ..................... 0 ..................... 0 . . . . . . . . . . . . . (77,167) . . . . . . . . . . . . . (77,167) . . . . . . . 4,134,233,233 ..................... ..................... ..................... 0 0 ..................... 0 ..................... 0 . . . . . . . . . . . . . (49,860) . . . . . . . . . . . . . (49,860) . . . . . . . 4,107,767,816 ANNUAL STATEMENT FOR THE YEAR 2016 OF THE BlueCross BlueShield of Tennessee, Inc. 54518201620659100 2016 DIRECT BUSINESS IN THE STATE OF GRAND TOTAL NAIC Group Code: 3498 LIFE INSURANCE 1 DIRECT PREMIUMS AND ANNUITY CONSIDERATIONS 1. 2. 3. 4. 5. 2 Credit Life (Group and Individual) Ordinary Life Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Annuity considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Deposit-type contract funds . . . . . . . . . . . . . . . . . . . . . . . . . . Other considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TOTALS (sum of Lines 1 to 4) . . . . . . . . . . . . . . . . . . . . . . . 3 .......................... 0 0 .......................... 0 0 0 .......................... 0 0 0 0 0 .......................... 0 0 0 0 .......................... 0 0 0 .......................... .......................... .......................... 0 0 0 .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......... XXX 4 Group 0 0 0 0 0 .......................... 0 0 ......... .......................... .......................... .......................... 0 0 .......................... 0 0 0 .......................... 0 0 0 0 0 .......................... 0 0 0 0 .......................... 0 0 0 .......................... .......................... 0 0 .......................... 0 0 0 .......................... 0 0 0 0 0 .......................... 0 0 0 0 .......................... 0 0 0 .......................... .......................... .......................... 0 0 0 .......................... 0 0 0 0 .......................... 0 .......................... 0 .......................... 0 .......................... .......................... Total 0 0 0 0 0 .......................... .......................... 5 Industrial .......................... 0 0 .......................... Document Code: 206 DURING THE YEAR 2016 NAIC Company Code: 54518 .......................... .......... XXX 0 0 ......... .......................... .......................... .......................... 0 0 0 0 0 0 0 .......................... 0 0 .......................... 0 0 0 .......................... 0 0 0 0 0 .......................... 0 0 0 0 .......................... 0 0 0 .......................... .......................... .......................... 0 0 0 .......................... 0 0 0 0 .......................... 0 .......................... 0 0 .......................... 0 .......................... 0 .......................... .......................... .......................... DIRECT DIVIDENDS TO POLICYHOLDERS Life Insurance: 6.1 6.2 6.3 Paid in cash or left on deposit . . . . . . . . . . . . . . . . Applied to pay renewal premiums . . . . . . . . . . . . Applied to provide paid-up additions or shorten the endowment or premium paying period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TOTALS (sum of Lines 6.1 to 6.4) . . . . . . . . . . . .......................... 7.1 Paid in cash or left on deposit . . . . . . . . . . . . . . . . 7.2 Applied to provide paid-up annuities . . . . . . . . . 7.3 Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.4 TOTALS (sum of Lines 7.1 to 7.3) . . . . . . . . . . . GRAND TOTALS (Lines 6.5 plus 7.4) . . . . . . . . . . . . . . . .......................... 6.4 6.5 .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... 0 0 0 0 0 Annuities: 8. .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... 0 0 0 0 0 DIRECT CLAIMS AND BENEFITS PAID 9. 10. 11. 12. 13. 14. 15. Death benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Matured endowments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Annuity benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Surrender values and withdrawals for life contracts . Aggregate write-ins for miscellaneous direct claims and benefits paid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . All other benefits, except accident and health . . . . . . . TOTALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... 0 0 0 0 0 0 0 DETAILS OF WRITE-INS 1301. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1302. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1303. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1398. Summary of remaining write-ins for Line 13 from overflow page . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1399. TOTALS (Lines 1301 through 1303 plus 1398) (Line 13 above) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .......................... .......................... Credit Life (Group and Individual) 3 4 No. of Ind.Pols & Group Certifs. Amount Ordinary 1 DIRECT DEATH BENEFITS AND MATURED ENDOWMENTS INCURRED 16. 17. 2 Number Amount 0 ......... 0 ................ ......... ......... 0 0 ......... 0 ......... 0 ......... 0 ......... 0 0 ................ 0 ......... 0 ................... ................ ................ 0 0 ................ 0 ................ 0 ................ 0 ................ 0 ......... ......... 0 0 ......... 0 ......... 0 ......... 0 ......... 0 0 ......... 0 ................... Group 5 No. of Certificates 7 Amount 0 ................... 0 ......... ................... ................... 0 0 ................... 0 ................... 0 ................... 0 ................... 0 0 ......... .......................... Industrial 6 Number 0 ......... 0 ................ 0 ................ 0 ......... ......... ......... 0 0 ......... 0 ......... 0 ......... 0 ......... 0 ................ ................ 0 0 ................ 0 ................ 0 ................ 0 ................ 0 0 ................ 0 ......... Total 8 9 Amount ......... ......... 0 0 ......... 0 ......... 0 ......... 0 ......... 0 0 ................ 20. In force December 31, prior year . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . 0 . . . . . . . . . 0 (a). . . . . . . . . . . . . . . . 0 . . . . . . . . . 0 . . . . . . . . . . . . . . . . 0 . . . . . . . . . 0 21. Issued during year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . 0 . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . 0 . . . . . . . . . . . . . . . . 0 . . . . . . . . . 0 22. Other changes to in force (Net) . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . 0 . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . 0 . . . . . . . . . . . . . . . . 0 . . . . . . . . . 0 23. In force December 31 of current year . . . . . . . . . . 0 . . . . . . . . . . . . . . . . 0 . . . . . . . . . 0 (a). . . . . . . . . . . . . . . . 0 . . . . . . . . . 0 . . . . . . . . . . . . . . . . 0 . . . . . . . . . 0 (a) Includes Individual Credit Life Insurance prior year $...............0, current year $...............0. Includes Group Credit Life Insurance Loans less than or equal to 60 months at issue, prior year $...............0, current year $...............0. Loans greater than 60 months at issue BUT NOT GREATER THAN 120 MONTHS prior year $...............0, current year $...............0. ......... ......... .......................... ................ ......... 0 ................ 0 .......................... 0 ......... 0 18.1 18.2 18.3 18.4 18.5 18.6 19. Unpaid December 31, prior year . . . . . . Incurred during current year . . . . . . . . . . Settled during current year: By payment in full . . . . . . . . . . . . . . . . . . . . . . By payment on compromised claims . TOTALS Paid . . . . . . . . . . . . . . . . . . . . . . Reduction by compromise . . . . . . . . . . . . Amount rejected . . . . . . . . . . . . . . . . . . . . . . . TOTAL Settlements . . . . . . . . . . . . . . . . Unpaid Dec. 31, current year (Lines 16 + 17 - 18.6) . . . . . . . . . . . . . . . . . . . . . . . . . .......................... 10 Number Amount 0 ......... 0 .................0 ......... 0 0 ......... 0 ......... 0 ......... 0 ......... 0 .................0 ......... .................0 0 .................0 ......... 0 0 ......... 0 ......... 0 .................0 ......... .................0 0 ................ 0 ......... ................ ................ 0 0 ................ 0 ................ 0 ................ 0 ................ 0 0 ......... ................ ................ 0 0 ................ 0 ................ 0 .................0 .................0 .................0 .................0 .................0 No. of Policies POLICY EXHIBIT .................0 .................0 ACCIDENT AND HEALTH INSURANCE 1 2 Direct Premiums Direct Premiums Earned 24. 24.1 24.2 24.3 24.4 3 Dividends Paid Or Credited On Direct Business Group Policies (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,164,636,834 . . . . . . . 3,164,905,697 . . . . . . . . . . . . . . . . . . . . . Federal Employees Health Benefits Plan Premium (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 660,153,765 . . . . . . . . . 660,153,765 . . . . . . . . . . . . . . . . . . . . . Credit (Group and Individual) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . . . Collectively Renewable Policies (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . . . Medicare Title XVIII exempt from state taxes or fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 919,310,746 . . . . . . . . . 919,310,746 . . . . . . . . . . . . . . . . . . . . . Other Individual Policies 25.1 Non-cancelable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . . . 25.2 Guaranteed renewable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . . . 25.3 Non-renewable for stated reasons only (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . . . 25.4 Other accident only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . . . 25.5 All other (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19,361 . . . . . . . . . . . . . . . 19,361 . . . . . . . . . . . . . . . . . . . . . 25.6 TOTALS (sum of Lines 25.1 to 25.5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19,361 . . . . . . . . . . . . . . . 19,361 . . . . . . . . . . . . . . . . . . . . . 26. TOTALS (Lines 24 + 24.1 + 24.2 + 24.3 + 24.4 + 25.6) . . . . . . . . . . . . . . . . . . . . . . . . . . 4,744,120,706 . . . . . . . 4,744,389,569 . . . . . . . . . . . . . . . . . . . . . (b) For health business on indicated lines report: Number of persons insured under PPO managed care products .......1,746,221 and number of persons insured under indemnity only products ...............0. Supp31 Grand Total 4 5 Direct Losses Paid Direct Losses Incurred 0 0 0 0 0 . . . . . . . 2,750,612,814 . . . . . . . 2,732,434,137 0 0 0 0 0 0 0 . . . . . . . . . 594,406,666 . . . . . . . . . 590,547,279 ..................... 0 0 . . . . . . . . . 789,290,920 ..................... ..................... ..................... 0 0 . . . . . . . . . 784,836,260 ..................... 0 0 ..................... 0 ..................... 0 . . . . . . . . . . . . . (77,167) . . . . . . . . . . . . . (77,167) . . . . . . . 4,134,233,233 ..................... ..................... ..................... 0 0 ..................... 0 ..................... 0 . . . . . . . . . . . . . (49,860) . . . . . . . . . . . . . (49,860) . . . . . . . 4,107,767,816 ANNUAL STATEMENT FOR THE YEAR 2016 OF THE BlueCross BlueShield of Tennessee, Inc. INDEX TO HEALTH ANNUAL STATEMENT Analysis of Operations By Lines of Business . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . 7 Assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Cash Flow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Exhibit 1 - Enrollment By Product Type for Health Business Only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Exhibit 2 - Accident and Health Premiums Due and Unpaid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Exhibit 3 - Health Care Receivables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Exhibit 3A - Analysis of Health Care Receivables Collected and Accrued . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Exhibit 4 - Claims Unpaid and Incentive Pool, Withhold and Bonus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . 21 Exhibit 5 - Amounts Due From Parent, Subsidiaries and Affiliates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Exhibit 6 - Amounts Due To Parent, Subsidiaries and Affiliates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . 23 Exhibit 7 - Part 1 - Summary of Transactions With Providers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . 24 Exhibit 7 - Part 2 - Summary of Transactions With Intermediaries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . 24 Exhibit 8 - Furniture, Equipment and Supplies Owned . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . 25 Exhibit of Capital Gains (Losses) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . 15 Exhibit of Net Investment Income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Exhibit of Nonadmitted Assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Exhibit of Premiums, Enrollment and Utilization (State Page) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Five-Year Historical Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 General Interrogatories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . 27 Jurat Page . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . 1 Liabilities, Capital and Surplus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Notes To Financial Statements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Overflow Page For Write-ins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Schedule A - Part 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E01 Schedule A - Part 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E02 Schedule A - Part 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E03 Schedule A - Verification Between Years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . SI02 Schedule B - Part 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E04 Schedule B - Part 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E05 Schedule B - Part 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E06 Schedule B - Verification Between Years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . SI02 Schedule BA - Part 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E07 Schedule BA - Part 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E08 Schedule BA - Part 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E09 Schedule BA - Verification Between Years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . SI03 Schedule D - Part 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E10 Schedule D - Part 1A - Section 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . SI05 Schedule D - Part 1A - Section 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . SI08 Schedule D - Part 2 - Section 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E11 Schedule D - Part 2 - Section 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E12 Schedule D - Part 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E13 Schedule D - Part 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E14 Schedule D - Part 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E15 Schedule D - Part 6 - Section 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E16 Schedule D - Part 6 - Section 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E16 Schedule D - Summary By Country . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . SI04 Schedule D - Verification Between Years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . SI03 Schedule DA - Part 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E17 Schedule DA - Verification Between Years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . SI10 Schedule DB - Part A - Section 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . E18 Schedule DB - Part A - Section 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . E19 Schedule DB - Part A - Verification Between Years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . SI11 Schedule DB - Part B - Section 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . E20 Schedule DB - Part B - Section 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . E21 Schedule DB - Part B - Verification Between Years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . SI11 Schedule DB - Part C - Section 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . SI12 Schedule DB - Part C - Section 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . SI13 Schedule DB - Part D - Section 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . E22 Schedule DB - Part D - Section 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . E23 INDEX ANNUAL STATEMENT FOR THE YEAR 2016 OF THE BlueCross BlueShield of Tennessee, Inc. INDEX TO HEALTH ANNUAL STATEMENT Schedule DB - Verification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . SI14 Schedule DL - Part 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . E24 Schedule DL - Part 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . E25 Schedule E - Part 1 - Cash . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E26 Schedule E - Part 2 - Cash Equivalents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E27 Schedule E - Part 3 - Special Deposits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . E28 Schedule E - Verification Between Years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . SI15 Schedule S - Part 1 - Section 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Schedule S - Part 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Schedule S - Part 3 - Section 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Schedule S - Part 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Schedule S - Part 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Schedule S - Part 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Schedule S - Part 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Schedule T - Part 2 - Interstate Compact . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Schedule T - Premiums and Other Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . 38 Schedule Y - Part 1 - Information Concerning Activities of Insurer Members of a Holding Company Group . . . . . . . . . . . . . . . . . . . . . . 40 Schedule Y - Part 1A - Detail of Insurance Holding Company System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . 41 Schedule Y - Part 2 - Summary of Insurer's Transactions With Any Affiliates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Statement of Revenue and Expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Summary Investment Schedule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . SI01 Supplemental Exhibits and Schedules Interrogatories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . 43 Underwriting and Investment Exhibit - Part 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . 8 Underwriting and Investment Exhibit - Part 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . 9 Underwriting and Investment Exhibit - Part 2A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Underwriting and Investment Exhibit - Part 2B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Underwriting and Investment Exhibit - Part 2C . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . 12 Underwriting and Investment Exhibit - Part 2D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . 13 Underwriting and Investment Exhibit - Part 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . 14 INDEX.1