70670201820100100 2018 ANNUAL STATEMENT Document Code: 201 For the Year Ending DECEMBER 31, 2018 OF THE CONDITION AND AFFAIRS OF THE Health Care Service Corporation, a Mutual Legal Reserve Company NAIC Group Code 0917 , 0917 (Current Period) NAIC Company Code 70670 Employer's ID Number 36-1236610 (Prior Period) Organized under the Laws of Illinois Country of Domicile , State of Domicile or Port of Entry IL United States of America Licensed as business type: Life, Accident & Health[X] Dental Service Corporation[ ] Other[ ] Incorporated/Organized Property/Casualty[ ] Hospital, Medical & Dental Service or Indemnity[ ] Vision Service Corporation[ ] Health Maintenance Organization[ ] Is HMO Federally Qualified? Yes[ ] No[X] N/A[ ] 10/01/1936 Statutory Home Office Commenced Business 300 East Randolph Street 01/01/1937 , Chicago, IL, US 60601-5099 (Street and Number) (City or Town, State, Country and Zip Code) Main Administrative Office 300 East Randolph Street (Street and Number) Chicago, IL, US 60601-5099 (312)653-6000 (City or Town, State, Country and Zip Code) Mail Address (Area Code) (Telephone Number) 300 East Randolph Street , Chicago, IL, US 60601-5099 (Street and Number or P.O. Box) (City or Town, State, Country and Zip Code) Primary Location of Books and Records 300 East Randolph Street (Street and Number) Chicago, IL, US 60601-5099 (312)653-6000 (City or Town, State, Country and Zip Code) (Area Code) (Telephone Number) Internet Website Address www.hcsc.net Statutory Statement Contact James Edward Walsh (312)653-7443 (Name) (Area Code)(Telephone Number)(Extension) James_Walsh@bcbsil.com (312)653-1103 (E-Mail Address) (Fax Number) OFFICERS Name Paula Amy Steiner Eric Ansel Feldstein Blair Williams Todt Steven Betts, Senior Vice President Opella Finley Ernest, M.D., Senior Vice President Michael Eugene Frank, Senior Vice President Michael Ted Haynes, President- Oklahoma Division James Lawrence Kadela, Senior Vice President Douglas Lynch, Senior Vice President & Chief Actuary Carl Raymond McDonald, Treasurer Nazneen Razi, Senior Vice President Maurice Shena Smith, President-Illinois Division Illinois Cook OTHERS Kevin MacKenzie Cassidy, President- Employer Solutions Joel Mark Farran, Senior Vice President Stephen Farrell Hamman, Senior Vice President Robert Todd Hitchcock, President- Govt & Consumer Solutions Thomas Charles Lubben, Senior Vice President Danny Ken McCoy, M.D., President- Texas Division Andre Antonio Napoli, Senior Vice President Kurt Bryce Shipley, President- New Mexico Division Jeffrey Richard Tikkanen, SVP, President Plan Solutions & Market Development DIRECTORS OR TRUSTEES Timothy Lee Burke Dennis Joseph Gannon Marlin Ray Perryman, Ph.D. State of County of Title President & Chief Executive Officer SVP & Chief Financial Officer SVP Legal, Compliance, Bus Perf Officer & Secty Milton Carroll Dianne Brewer Gasbarra, M.D. Paula Amy Steiner Michelle Lynn Collins David John Lesar Gregory David Wasson Monte Eric Ford Elaine Marie Mendoza 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) Paula Amy Steiner Eric Ansel Feldstein Blair Williams Todt (Printed Name) 1. (Printed Name) 2. (Printed Name) 3. President & Chief Executive Officer SVP & Chief Financial Officer SVP Legal, Compliance, Bus Perf Officer & Secty (Title) (Title) (Title) Subscribed and sworn to before me this 26th day of February , 2019 (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[ ] ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company EXHIBIT 2 - ACCIDENT AND HEALTH PREMIUMS DUE AND UNPAID 1 Name of Debtor 0199999 TOTAL Individuals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Group Subscribers: STATE OF ILLINOIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FEDERAL EMPLOYEE HEALTH BENEFIT PLAN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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 1 - 30 Days 31 - 60 Days 61 - 90 Days Over 90 Days . . . . . . 2,914,236 . . . . . . . . 820,668 . . . . . . . . 198,641 . . . . . . . . . . . . . . . . . . .... 35,857,814 .... 35,612,913 .... 24,954,629 ...... 6,927,579 . . . 159,497,175 . . . . . . . . . . . . . . . . . . .................. .................. . . . 195,354,989 . . . . .... 24,954,629 . . . . . . . . 265,710 . . . . 25,220,338 ...... .................. .................. 98,671,819 . . . 124,090,798 .... 35,612,913 . . . 158,966,130 . . . . . . 1,269,564 . . . 354,321,120 . . . . 36,882,477 . . . . . . . . 282,881 . . . . . . . . . . . . . . . . . . . . . 307,501,683 . . . . 24,232,400 . . . 665,019,920 . . . . 61,935,545 .... 6,927,579 .................. ...... .... 6,927,579 68,874,194 75,801,773 6 Nonadmitted .................. 7 Admitted . . . . . . 3,933,545 .................. . . . 103,352,935 .................. . . . 159,497,175 .................. . . . 262,850,110 .................. . . . 160,501,404 .................. . . . 423,351,514 .................. ........ .................. . . . 499,280,096 .................. . . . 926,848,036 282,881 18 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 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 . . . . 75,200,182 . . . . 75,196,562 . . . . 75,205,429 . . . 228,179,199 . . . . 10,603,169 . . . . 75,200,182 . . . . 75,196,562 . . . . 75,205,429 . . . 228,179,199 . . . . 10,603,169 . . . 445,930,998 . . . 572,068,884 . . . . 29,180,857 . . . . 98,371,105 . . . 841,749,445 . . . 445,930,998 . . . 572,068,884 . . . . 29,180,857 . . . . 98,371,105 . . . 841,749,445 . . . 117,244,097 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117,244,097 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79,817 . . . . . . . . 239,101 . . . . . . . . . . . . . . . . . . . . . . . . . . 638,622 . . . . . . . . 957,540 . . . . . . . . . . 79,817 . . . . . . . . 239,101 . . . . . . . . . . . . . . . . . . . . . . . . . . 638,622 . . . . . . . . 957,540 7 Admitted . . . 443,178,203 . . . 443,178,203 . . . 303,802,399 . . . 303,802,399 . . . 117,244,097 . . . 117,244,097 .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. . . . 638,455,094 . . . 647,504,546 . . . 104,386,286 . . . 327,188,926 . . . 853,310,154 . . . 864,224,699 19 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company EXHIBIT 3A - ANALYSIS OF HEALTH CARE RECEIVABLES COLLECTED AND ACCRUED Health Care Receivables Collected During the Year 1 2 On Amounts Accrued Prior On Amounts to January 1 of Accrued During Current Year the Year . . . . . . . 375,086,728 . . . . . . . 410,059,608 . . . . . 1,097,027,170 . . . . . 6,196,185,103 . . . . . . . 131,592,152 . . . . . 9,580,297,570 . . . . . . . . . 44,913,591 . . . . . . . 126,211,816 Health Care Receivables Accrued as of December 31 of Current Year 3 4 On Amounts Accrued On Amounts December 31 of Accrued During Prior Year the Year . . . . . . . . . . . . . 112,219 . . . . . . . 453,669,152 . . . . . . . . . 38,847,633 . . . . . 1,106,704,211 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117,244,097 . . . . . . . . . . . . . 637,697 . . . . . . . . . . . . . 319,843 Type of Health Care Receivable 1. Pharmaceutical rebate receivables . . . . . . . . . . . . . . . . 2. Claim overpayment receivables . . . . . . . . . . . . . . . . . . . . 3. Loans and advances to providers . . . . . . . . . . . . . . . . . . 4. Capitation arrangement receivables . . . . . . . . . . . . . . . 5. Risk sharing receivables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. Other health care receivables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7. TOTALS (Lines 1 through 6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,648,619,641 . . . 16,312,754,097 . . . . . . . . . 39,597,550 . . . . . 1,677,937,303 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) . . . . . . . 375,198,947 . . . . . 1,135,874,803 . . . . . . . 131,592,152 . . . . . . . . . 45,551,288 6 Estimated Health Care Receivables Accrued as of December 31 of Prior Year . . . . . . . 360,109,777 . . . . . 1,115,421,151 . . . . . . . 167,582,123 . . . . . . . . . 45,551,294 ....................... ....................... ....................... ....................... ..... 1,688,217,191 ..... 1,688,664,346 20 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company EXHIBIT 4 - CLAIMS UNPAID AND INCENTIVE POOL, WITHHOLD AND BONUS (Reported and Unreported) Aging Analysis of Unpaid Claims 1 2 3 4 5 6 7 Account 1 - 30 Days 31 - 60 Days 61 - 90 Days 91 - 120 Days Over 120 Days Total 0299999 Aggregate Accounts Not Individually Listed - Uncovered . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0399999 Aggregate Accounts Not Individually Listed - Covered . . . . . . . . . . . . . . . . . . 514,293,522 . . . . 27,550,172 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 541,843,694 0499999 Subtotals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 514,293,522 . . . . 27,550,172 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 541,843,694 0599999 Unreported claims and other claim reserves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,457,278,193 0699999 TOTAL Amounts Withheld . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0799999 TOTAL Claims Unpaid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,999,121,887 0899999 Accrued Medical Incentive Pool and Bonus Amounts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 311,699,000 21 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company EXHIBIT 5 - AMOUNTS DUE FROM PARENT, SUBSIDIARIES AND AFFILIATES 1 Name of Affiliate Individually listed receivables HCSC INSURANCE SERVICES COMPANY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0199999 Total - Individually listed receivables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0299999 Receivables not inidvidually listed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0399999 TOTAL Gross Amounts Receivable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1 - 30 Days 3 4 5 6 Admitted 7 Current 8 Non-Current 31 - 60 Days 61 - 90 Days Over 90 Days Nonadmitted . . . 384,624,804 . . . . . . . . . . . . . . . . . . .................. .................. .................. . . . 384,624,804 . . . . . . . . . . . . . . . . . . . . . 384,624,804 . . . . . . . . . . . . . . . . . . .................. .................. .................. . . . 384,624,804 . . . . . . . . . . . . . . . . . . 35,778,447 . . . 420,403,251 .................. .................. .................. ...... .... .................. .................. .................. 9,726,939 . . . . . . 9,726,939 .... 26,051,508 .................. . . . 410,676,312 . . . . . . . . . . . . . . . . . . 22 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company EXHIBIT 6 - AMOUNTS DUE TO PARENT, SUBSIDIARIES AND AFFILIATES 1 Affiliate Individually Listed Payables 2 Description PRIME THERAPEUTICS LLC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CLAIM SETTLEMENTS WITH AFFILIATES . . . . . . . . . . . . . . . . . . . . . . . . . 0199999 Total - Individually Listed Payables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X X X . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0299999 Payables not Individually Listed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X X X . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0399999 TOTAL Gross Payables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X X X . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Amount 70,052,300 70,052,300 . . . . . . . . 2,048,489 . . . . . . . 72,100,789 4 Current 5 Non-Current 70,052,300 70,052,300 . . . . . . . . 2,048,489 . . . . . . . 72,100,789 ....... ....... ..................... ....... ....... ..................... ..................... ..................... 23 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,123,752,189 2. Intermediaries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. All other providers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58,317,416 4. TOTAL Capitation Payments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,182,069,605 Other Payments: 5. Fee-for-service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,238,234,590 6. Contractual fee payments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20,897,063,256 7. Bonus/withhold arrangements - fee-for-service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. Bonus/withhold arrangements - contractual fee payments . . . . . . . . . . . . . . . . . . . . . . . . . . 263,907,758 9. Non-contingent salaries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10. Aggregate cost arrangements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. All other payments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 655,488,857 12. TOTAL Other Payments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28,054,694,461 13. TOTAL (Line 4 plus Line 12) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29,236,764,066 ............... 3.844 ...................... ............... ............... 0.199 4.043 . . . . . . 2,800,657 . . . . . . . . . . . . . . 31.764 . . . . . . . . . . . . . . . . . . .................. ........ 0.903 ..... ..... ...................... ..... ...................... ..... 2.242 . . . . . . . . . . . . . . 95.957 . . . . . . . . . . . . 100.000 ..... ............... ...................... 120,901 ............... 1.371 ..... ..... 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 ...... 1,123,752,189 .................. .................. .................. .... . . . . . . 2,921,558 . . . . . . . . . . . . . . 33.135 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71.475 . . . . . ............... 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 . . . . . . . . . . . . . . 21.337 . . . . . ...................... 4 58,317,416 1,182,069,605 .................. 6,238,234,590 20,897,063,256 .................. .................. .................. ... .................. .................. .................. .................. .................. . . . 655,488,857 28,054,694,461 29,236,764,066 .................. .................. .................. 263,907,758 EXHIBIT 7 - PART 2 - SUMMARY OF TRANSACTIONS WITH INTERMEDIARIES 1 2 3 4 NAIC Code Name of Intermediary Capitation Paid Average Monthly Capitation 5 Intermediary's Total Adjusted Capital 6 Intermediary's Authorized Control Level RBC NONE 9999999 TOTALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ....................... ....... X X X ....... ....... X X X ....... ....... X X X ....... ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company EXHIBIT 8 - FURNITURE, EQUIPMENT AND SUPPLIES OWNED 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2 3 4 Book Value Accumulated Less Cost Improvements Depreciation Encumbrances . . . 357,932,632 . . . . . . . . . . . . . . . . . . . . . 245,521,314 . . . 112,411,318 5 Assets Not Admitted . . . 112,411,318 .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. . . . 357,932,632 . . . . . . . . . . . . . . . . . . 6 Net Admitted Assets . . . 245,521,314 . . . 112,411,318 . . . 112,411,318 . . . . . . . . . . . . . . . . . . 25 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201843002100 2018 Document Code: 430 EXHIBIT OF PREMIUMS, ENROLLMENT AND UTILIZATION (a) NAIC Group Code 0917 REPORT FOR: 1. CORPORATION: Health Care Service Corporation, a Mutual Legal Reserve Company BUSINESS IN THE STATE OF ALASKA DURING THE YEAR 1 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 Alaska 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 Total Individual . . . . . . . . . . . . . 1,115 . . . . . . . . . . . . . 1,069 . . . . . . . . . . . . . 1,019 . . . . . . . . . . . . . . . 992 . . . . . . . . . . . . . . . 936 ................... ................... .................. 1 ................... ................... . . . . . . . . . . . . 12,142 . . . . . . . . . . . . . . . . . . Group 1 3,795 3,721 . . . . . . . . . . . . . 7,516 . . . . . . . . . . . . . . . 209 . . . . . . . . . . . . . . . . . 67 . . . . . . . . 4,081,329 ................... ................... 834 791 781 760 734 9,244 2. LOCATION: NAIC Company Code 70670 4 5 6 Medicare Supplement Vision Only Dental Only 7 Federal Employees Health Benefits Plan 259 258 217 216 183 2,670 8 9 10 Title XVIII Medicare Title XIX Medicaid Other ............... ............... ............... ............... ............... . . . . . . . . . . . . . . . . . 22 . . . . . . . . . . . . . . . . . 20 . . . . . . . . . . . . . . . . . 20 . . . . . . . . . . . . . . . . . 16 . . . . . . . . . . . . . . . . . 19 ................... ................... ................... ................... ................... ............... ............... ............... ............... ............... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ............. ............... 227 ................... ............. ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ............... ............... 330 142 . . . . . . . . . . . . . . . 472 . . . . . . . . . . . . . . . . . 22 . . . . . . . . . . . . . . . . . 12 . . . . . . . . . . . . 20,775 ................... ................... ................... ................... . . . . . . . . . . . . . . . 349 . . . . . . . . . . . . . . . . . . . ................... ............... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... 3,465 3,230 . . . . . . . . . . . . . 6,695 . . . . . . . . . . . . . . . 187 . . . . . . . . . . . . . . . . . 55 . . . . . . . . 3,967,372 ................... ............ ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ........ ................... ............ ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ............ ............ ................... ................... ................... ................... ................... ................... ................... ................... ............. ............. ........ 4,081,329 ................... ........ ........ 5,146,002 5,015,664 ................... ................... ................... .......... .......... (18,006) (17,891) ............. ............. ........ ........ 3,967,372 5,019,034 4,888,534 ............ 20,775 ................... ............ ............ 53,149 54,836 (a) For health business: number of persons insured under PPO managed care products .............733 and number of persons insured under indemnity only products ..............20. (b) For health premiums written: amount of Medicare Title XVIII exempt from state taxes or fees $...............0 349 93,183 93,183 91,824 90,184 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201843003100 2018 Document Code: 430 EXHIBIT OF PREMIUMS, ENROLLMENT AND UTILIZATION (a) NAIC Group Code 0917 REPORT FOR: 1. CORPORATION: Health Care Service Corporation, a Mutual Legal Reserve Company BUSINESS IN THE STATE OF ARIZONA DURING THE YEAR 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 Arizona 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 . . . . . . 2,001 1,974 1,977 2,017 2,102 . . . . . . . . . . . . 24,051 Comprehensive (Hospital & Medical) 2 3 Individual NAIC Company Code 70670 4 5 6 Medicare Supplement Vision Only Dental Only 7 Federal Employees Health Benefits Plan 8 9 10 Title XVIII Medicare Title XIX Medicaid Other ................... ................... ................... ................... ................... . . . . . . . . . . . . . . . . . 30 . . . . . . . . . . . . . . . . . 24 . . . . . . . . . . . . . . . . . 28 . . . . . . . . . . . . . . . . . 27 . . . . . . . . . . . . . . . . . 33 ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... 1,856 1,844 1,841 1,888 1,964 . . . . . . . . . . . . 22,449 ................... ............... 324 ................... ................... ................... ................... . . . . . . . . . . . . 40,081 . . . . . . . . . . . . . . . . . . . . . . . . . . . 16,617 . . . . . . . . . . . . . . . ................... ................... ............ ............ ................... ................... . . . . . . . . . . . . . . . . . 51 . . . . . . . . . . . . . . . . . . . ................... ................... ................... ................... ................... ................... ................... ................... . . . . . . . . . . . . . . . . . 51 . . . . . . . . . . . . . . . . . . . ................... ................... ................... 3,695 . . . . . . . . . . . . . . . 729 . . . . . . . . 4,488,896 ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... 39,355 16,064 . . . . . . . . . . . . 55,419 . . . . . . . . . . . . . 3,674 . . . . . . . . . . . . . . . 726 . . . . . . . . 4,120,177 ................... ................... . . . . . . . . . . . . 56,698 726 502 . . . . . . . . . . . . . 1,228 . . . . . . . . . . . . . . . . . 21 .................. 3 . . . . . . . . . . 365,889 ................... ............. ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ........ ................... ............. ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ........ ........ ................... ................... ............. ............. ................... ................... ................... ................... ................... ................... ................... ................... ............. ............. ............. ............. ............. ............. ........ 4,488,896 ................... ........ ........ 5,291,540 5,351,379 115 106 108 102 105 1,278 Group 2. LOCATION: ............... ............... ............... ............... ............... ................... ................... ................... ................... ................... ............. .......... 365,889 ................... .......... .......... 541,673 517,878 ................... ................... ............. ............. ............. ............. ............. 4,120,177 4,744,424 4,828,003 (a) For health business: number of persons insured under PPO managed care products .............103 and number of persons insured under indemnity only products ...........1,966. (b) For health premiums written: amount of Medicare Title XVIII exempt from state taxes or fees $...............0 2,830 2,830 5,443 5,499 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201843004100 2018 Document Code: 430 EXHIBIT OF PREMIUMS, ENROLLMENT AND UTILIZATION (a) NAIC Group Code 0917 REPORT FOR: 1. CORPORATION: Health Care Service Corporation, a Mutual Legal Reserve Company BUSINESS IN THE STATE OF ARKANSAS DURING THE YEAR 1 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 Arkansas 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 Total Individual 6,471 7,029 7,271 7,853 8,294 . . . . . . . . . . . . 89,545 . . . . . . . . . . . . . . . . . 33 . . . . . . . . . . . . . . . . . 32 . . . . . . . . . . . . . . . . . 31 . . . . . . . . . . . . . . . . . 31 . . . . . . . . . . . . . . . . . 30 ............. ............. ............. ............. ............. ............... Group 4,998 5,489 5,727 6,114 6,400 366 . . . . . . . . . . . . 69,878 ............. ............. ............. ............. ............. . . . . . . . . . . . . 39,073 . . . . . . . . . . . . . . . 239 . . . . . . . . . . . . . . . . . . . . . . . . 18,879 . . . . . . . . . . . . . . . . . 97 . . . . . . . . . . . . 2. LOCATION: NAIC Company Code 70670 4 5 6 Medicare Supplement Vision Only Dental Only ............... ............... ............... ............... ............... ................... ................... ................... ................... ................... ............. 307 306 317 330 335 3,837 ................... 1,133 1,202 1,196 1,378 1,529 . . . . . . . . . . . . 15,464 ............. ............. ............. ............. ............. 7 Federal Employees Health Benefits Plan 8 9 10 Title XVIII Medicare Title XIX Medicaid Other ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... 2,907 . . . . . . . . . . . . . . . 611 . . . . . . . 30,366,194 .................. 336 3 .................. 3 . . . . . . . . . . . . 25,301 32,972 14,596 . . . . . . . . . . . . 47,568 . . . . . . . . . . . . . 2,054 . . . . . . . . . . . . . . . 452 . . . . . . . 29,338,130 ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... .......... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... .......... .......... ................... ................... ................... ................... ................... ................... ................... ................... . . . . . . . . . . . . 57,952 . . . . . . . . . . . . . . . ............. ....... 30,366,194 ................... ....... ....... 21,499,668 21,828,917 . . . . . . . . . . . . 25,301 . . . . . . . ................... .......... .......... 148,359 156,801 29,338,130 ................... ....... ....... 20,290,432 20,603,939 ............. ............. 5,862 2,480 . . . . . . . . . . . . . 8,342 . . . . . . . . . . . . . . . 850 . . . . . . . . . . . . . . . 156 . . . . . . . . . . 594,763 ................... ................... ................... ................... . . . . . . . . . . . . . 1,706 . . . . . . . . . . . . . . . . . . . ................... ............. ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... .......... ................... ................... ................... ................... .......... 594,763 ................... .......... .......... 770,394 778,030 (a) For health business: number of persons insured under PPO managed care products ...........6,416 and number of persons insured under indemnity only products .............349. (b) For health premiums written: amount of Medicare Title XVIII exempt from state taxes or fees $...............0 1,706 407,999 407,999 290,482 290,146 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201843006100 2018 Document Code: 430 EXHIBIT OF PREMIUMS, ENROLLMENT AND UTILIZATION (a) NAIC Group Code 0917 REPORT FOR: 1. CORPORATION: Health Care Service Corporation, a Mutual Legal Reserve Company BUSINESS IN THE STATE OF COLORADO DURING THE YEAR 1 Comprehensive (Hospital & Medical) 2 3 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 Colorado 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 . . . . . . Individual 799 772 790 820 845 9,637 Group 2. LOCATION: NAIC Company Code 70670 4 5 6 Medicare Supplement Vision Only Dental Only 8 9 10 Title XVIII Medicare Title XIX Medicaid Other ............... ............... ............... ............... ............... . . . . . . . . . . . . . . . 119 . . . . . . . . . . . . . . . 106 . . . . . . . . . . . . . . . 108 . . . . . . . . . . . . . . . . . 97 . . . . . . . . . . . . . . . 103 ................... ................... ................... ................... ................... ............... ............... ............... ............... ............... ................... ................... ................... ................... ................... . . . . . . . . . . . . . . . . . 29 . . . . . . . . . . . . . . . . . 22 . . . . . . . . . . . . . . . . . 29 . . . . . . . . . . . . . . . . . 32 . . . . . . . . . . . . . . . . . 34 ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ............. ............. 1,272 ................... ............. ................... ............... 359 ................... ................... ................... ................... . . . . . . . . . . . . 11,243 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,234 . . . . . . . . . . . . . . . ................... ................... . . . . . . . . . . . . 10,878 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,958 . . . . . . . . . . . . . . . . . . . ................... ................... . . . . . . . . . . . . . . . . . 48 . . . . . . . . . . . . . . . . . . . ................... ................... ................... ................... ................... ................... . . . . . . . . . . . . 17,477 ................... ............ . . . . . . . . . . . . . . . . . 48 . . . . . . . . . . . . . . . . . . . ................... ................... ................... ................... ............. ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... 16,836 1,317 . . . . . . . . . . . . . . . 263 . . . . . . . . 1,350,708 ................... 1,358 . . . . . . . . . . . . . . . 275 . . . . . . . . 1,631,339 365 228 . . . . . . . . . . . . . . . 593 . . . . . . . . . . . . . . . . . 41 . . . . . . . . . . . . . . . . . 12 . . . . . . . . . . 279,609 ................... ............. ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ........ ................... ............. ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ........ ........ ................... ................... ............. ............. ................... ................... ................... ................... ................... ................... ................... ................... ............. ........ 1,631,339 ................... ........ ........ 2,178,714 2,241,657 .......... 279,609 ................... .......... .......... 502,006 532,757 ................... 651 644 653 691 708 8,006 7 Federal Employees Health Benefits Plan 1,350,708 1,667,474 1,699,597 (a) For health business: number of persons insured under PPO managed care products .............102 and number of persons insured under indemnity only products .............709. (b) For health premiums written: amount of Medicare Title XVIII exempt from state taxes or fees $...............0 1,022 1,022 9,233 9,303 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201843007100 2018 Document Code: 430 EXHIBIT OF PREMIUMS, ENROLLMENT AND UTILIZATION (a) NAIC Group Code 0917 REPORT FOR: 1. CORPORATION: Health Care Service Corporation, a Mutual Legal Reserve Company BUSINESS IN THE STATE OF CONNECTICUT DURING THE YEAR 1 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 Connecticut 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 5 6 Medicare Supplement Vision Only Dental Only NAIC Company Code 70670 7 Federal Employees Health Benefits Plan Total Individual . . . . . . . . . . . . . . . . . 54 . . . . . . . . . . . . . . . . . 53 . . . . . . . . . . . . . . . . . 53 . . . . . . . . . . . . . . . . . 57 . . . . . . . . . . . . . . . . . 61 . . . . . . . . . . . . . . . . . 10 . . . . . . . . . . . . . . . . . 10 .................. 8 . . . . . . . . . . . . . . . . . 13 . . . . . . . . . . . . . . . . . 14 ................... ................... ................... ................... ................... . . . . . . . . . . . . . . . . . 43 . . . . . . . . . . . . . . . . . 42 . . . . . . . . . . . . . . . . . 44 . . . . . . . . . . . . . . . . . 43 . . . . . . . . . . . . . . . . . 45 ................... ................... ................... ................... ................... 137 ................... ............... 517 ................... 1 1 1 1 2 . . . . . . . . . . . . . . . . . 15 943 453 . . . . . . . . . . . . . 1,396 . . . . . . . . . . . . . . . . . 59 . . . . . . . . . . . . . . . . . 26 . . . . . . . . . . 139,783 . . . . . . . . . . . . . . . . . 27 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 . . . . . . . . . . . . . . . . . . . ............... ............... ................... 916 417 . . . . . . . . . . . . . 1,333 . . . . . . . . . . . . . . . . . 59 . . . . . . . . . . . . . . . . . 26 . . . . . . . . . . 133,771 ................... ................... ................... ................... ................... ............... 669 ............... ............... .......... 139,783 ................... .......... .......... 108,250 102,051 ............... Group 4 2. LOCATION: ................... Other ................... ................... ................... ................... ................... ................... ................... ................... .................. 2 ................... ................... ................... ................... ................... ................... ................... ................... .................. ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... .......... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ............... ............... ................... ................... ................... ................... ................... ................... ................... ................... ................... 6,012 Title XIX Medicaid ................... ................... ................... ................... ................... ................... ............. Title XVIII Medicare ................... ................... ................... ................... ................... ................... 6,012 10 ................... ................... ................... ................... ................... ................... ............. 9 ................... ................... ................... ................... ................... . . . . . . . . . . . . . . . . . 61 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,310 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 880 . . . . . . . . . . . . . . . . . . . .......... .......... 133,771 103,710 100,927 .................. .................. .................. .................. .................. 8 (a) For health business: number of persons insured under PPO managed care products ..............14 and number of persons insured under indemnity only products ..............45. (b) For health premiums written: amount of Medicare Title XVIII exempt from state taxes or fees $...............0 2 230 244 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201843008100 2018 Document Code: 430 EXHIBIT OF PREMIUMS, ENROLLMENT AND UTILIZATION (a) NAIC Group Code 0917 REPORT FOR: 1. CORPORATION: Health Care Service Corporation, a Mutual Legal Reserve Company BUSINESS IN THE STATE OF DELAWARE DURING THE YEAR 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 Delaware 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 Group 5 6 Medicare Supplement Vision Only Dental Only .................. .................. .................. .................. .................. 4,732 2,799 . . . . . . . . . . . . . 7,531 . . . . . . . . . . . . . . . 310 . . . . . . . . . . . . . . . . . 91 . . . . . . . . 4,168,915 .................. .................. 4,196 2,425 . . . . . . . . . . . . . 6,621 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 . . . . . . . . . . . . . 7,676 . . . . . . . . 4,069,895 ............... ............... ................... ................... ................... ................... ............. ............. ........ 4,168,915 ................... ........ ........ 3,225,922 3,272,203 7 Federal Employees Health Benefits Plan 9 10 Title XVIII Medicare Title XIX Medicaid Other ............... ............... ............... ............... ............... . . . . . . . . . . . . . . . . . 21 . . . . . . . . . . . . . . . . . 22 . . . . . . . . . . . . . . . . . 22 . . . . . . . . . . . . . . . . . 22 . . . . . . . . . . . . . . . . . 25 ................... ................... ................... ................... ................... ............... ............... ............... ............... ............... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ............. ............... 272 ................... ............. ................... ................... ................... ................... 4 9 . . . . . . . . . . . . . . . . . 13 ............. ............. 532 193 . . . . . . . . . . . . . . . 725 . . . . . . . . . . . . . . . . . 75 . . . . . . . . . . . . . . . . . 19 . . . . . . . . . . . . 36,616 ................... ................... ................... ................... . . . . . . . . . . . . . . . 172 . . . . . . . . . . . . . . . . . . . ................... ................... ................... ................... ................... ................... ................... ............... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ............ ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ............ ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ............ ............ ................... ................... ................... ................... ................... ................... ................... ................... 7,676 ................... ............. ............. 2,065 2,507 ........ 4,069,895 ................... ........ ........ 3,113,519 3,157,471 ............ 36,616 ................... ............ ............ 67,872 69,007 (a) For health business: number of persons insured under PPO managed care products .............773 and number of persons insured under indemnity only products ..............25. (b) For health premiums written: amount of Medicare Title XVIII exempt from state taxes or fees $...............0 123 163 154 161 175 1,955 8 1 1 1 1 1 . . . . . . . . . . . . . . . . . 12 ............. 747 730 743 764 772 8,981 NAIC Company Code 70670 4 892 916 920 948 973 . . . . . . . . . . . . 11,220 ............... ............... ............... ............... ............... 2. LOCATION: 172 54,728 54,728 42,465 43,219 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201843009100 2018 Document Code: 430 EXHIBIT OF PREMIUMS, ENROLLMENT AND UTILIZATION (a) NAIC Group Code 0917 REPORT FOR: 1. CORPORATION: Health Care Service Corporation, a Mutual Legal Reserve Company BUSINESS IN THE STATE OF DISTRICT OF COLUMBIA DURING THE YEAR 1 Comprehensive (Hospital & Medical) 2 3 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 District of Columbia 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 . . . . . . Individual . . . . . . . . . . . . . . . . . 20 . . . . . . . . . . . . . . . . . 17 . . . . . . . . . . . . . . . . . 18 . . . . . . . . . . . . . . . . . 19 . . . . . . . . . . . . . . . . . 15 ............... 7 7 7 7 6 211 . . . . . . . . . . . . . . . . . 83 .................. .................. .................. .................. .................. Group 4 5 6 Medicare Supplement Vision Only Dental Only ................... ................... ................... ................... ................... . . . . . . . . . . . . . . . . . 11 .................. 8 .................. 9 . . . . . . . . . . . . . . . . . 10 .................. 7 ................... ................... ................... ................... ................... ................... ............... 104 ................... 2. LOCATION: NAIC Company Code 70670 7 Federal Employees Health Benefits Plan 2 2 2 2 2 . . . . . . . . . . . . . . . . . 24 .................. .................. .................. .................. .................. 8 9 10 Title XVIII Medicare Title XIX Medicaid Other ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... .................. 2 ................... ................... ................... ................... ................... ................... ................... 264 112 . . . . . . . . . . . . . . . 376 . . . . . . . . . . . . . . . . . 36 .................. 6 . . . . . . . . . . . . 77,115 . . . . . . . . . . . . . . . . . 42 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 222 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 . . . . . . . . . . . . . . . . . . . ............... ................... ................... ................... ................... ................... ................... . . . . . . . . . . . . . . . . . 36 . . . . . . . . . . . . . . . . . . . ................... ................... ................... ................... ................... ................... ................... .................. ................... ................... ................... ................... ................... ................... . . . . . . . . . . . . 44,969 . . . . . . . . . . . . . . . . . . . 6 . . . . . . . . . . . . 32,146 ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ............... ............... ................... ................... ................... ................... ................... ................... ................... ................... ............... ............... 317 . . . . . . . . . . . . 77,115 . . . . . . . . . . . . 44,969 . . . . . . . . . . . . . . . . . . . ............ ................... ................... ................... ................... . . . . . . . . . . . . 50,923 . . . . . . . . . . . . 14,187 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49,252 . . . . . . . . . . . . 12,840 . . . . . . . . . . . . . . . . . . . ............ ............ 32,146 36,352 35,999 ................... .................. (a) For health business: number of persons insured under PPO managed care products ...............6 and number of persons insured under indemnity only products ...............7. (b) For health premiums written: amount of Medicare Title XVIII exempt from state taxes or fees $...............0 2 385 413 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201843010100 2018 Document Code: 430 EXHIBIT OF PREMIUMS, ENROLLMENT AND UTILIZATION (a) NAIC Group Code 0917 REPORT FOR: 1. CORPORATION: Health Care Service Corporation, a Mutual Legal Reserve Company BUSINESS IN THE STATE OF FLORIDA DURING THE YEAR 1 Comprehensive (Hospital & Medical) 2 3 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 Florida 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 . . . . . . . . . . . . . . . . . . 28,404 . . . . . . . . . . . . 29,110 . . . . . . . . . . . . 28,795 . . . . . . . . . . . . 29,491 . . . . . . . . . . . . 30,156 .......... 350,973 Individual 285 249 254 267 274 3,106 Group 19,551 19,959 19,406 19,845 20,265 237,494 ............... ............... ............... ............... ............... ............ ............ ............ ............ ............ ............. .......... 2. LOCATION: NAIC Company Code 70670 4 5 6 Medicare Supplement Vision Only Dental Only 4,531 4,526 4,605 4,678 4,859 . . . . . . . . . . . . 55,648 ............. ............. ............. ............. ............. ................... ................... ................... ................... ................... ................... 4,037 4,376 4,530 4,701 4,758 . . . . . . . . . . . . 54,725 ............. ............. ............. ............. ............. 7 Federal Employees Health Benefits Plan 8 9 10 Title XVIII Medicare Title XIX Medicaid Other ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... . . . . . . . . . . . . . 6,360 . . . . . . . . . . . . . . . . . . . ................... ................... ................... ................... ................... ................... 237,456 101,630 . . . . . . . . . . 339,086 . . . . . . . . . . . . 16,110 . . . . . . . . . . . . . 3,522 . . . . . 126,296,433 . . . . . . . . . . . . . 1,795 . . . . . . . . . . 123,521 . . . . . . . . . . 112,140 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 711 . . . . . . . . . . . . 58,685 . . . . . . . . . . . . 35,874 . . . . . . . . . . . . . . . . . . . 182,206 6,495 . . . . . . . . . . . . . . . . . 49 . . . . . . . . . . . . . 1,749 . . . . . . . . 1,075,417 . . . . . 111,585,338 .......... 148,014 9,539 . . . . . . . . . . . . . 1,724 . . . . . . . 11,807,232 ................... ............. ................... ................... ................... ................... ............. ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ........ ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ........ ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ........ ........ ................... ................... ................... ................... ................... ................... ................... ................... .......... .......... ..... 126,296,433 ................... ..... ..... 117,181,464 117,725,679 ............. 2,506 .......... . . . . . . . . . . . . . . . . . 76 . . . . . . . . . . . . . ........ 1,075,417 ................... ........ ........ 1,420,867 1,449,727 ..... 111,585,338 ................... ..... ..... 102,385,770 102,717,672 ....... 11,807,232 ................... ....... ....... 12,205,351 12,370,900 6,360 1,828,445 1,828,445 1,169,476 1,187,380 (a) For health business: number of persons insured under PPO managed care products ..........20,458 and number of persons insured under indemnity only products ...........4,940. (b) For health premiums written: amount of Medicare Title XVIII exempt from state taxes or fees $...............0 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201843011100 2018 Document Code: 430 EXHIBIT OF PREMIUMS, ENROLLMENT AND UTILIZATION (a) NAIC Group Code 0917 REPORT FOR: 1. CORPORATION: Health Care Service Corporation, a Mutual Legal Reserve Company BUSINESS IN THE STATE OF GEORGIA DURING THE YEAR 1 Comprehensive (Hospital & Medical) 2 3 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 Georgia 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 . . . . . . Individual 449 449 471 488 506 5,677 Group 2. LOCATION: NAIC Company Code 70670 4 5 6 Medicare Supplement Vision Only Dental Only 7 Federal Employees Health Benefits Plan 8 9 10 Title XVIII Medicare Title XIX Medicaid Other ............... ............... ............... ............... ............... . . . . . . . . . . . . . . . . . 28 . . . . . . . . . . . . . . . . . 24 . . . . . . . . . . . . . . . . . 28 . . . . . . . . . . . . . . . . . 26 . . . . . . . . . . . . . . . . . 25 ................... ................... ................... ................... ................... ............... ............... ............... ............... ............... ................... ................... ................... ................... ................... . . . . . . . . . . . . . . . . . 10 .................. 7 . . . . . . . . . . . . . . . . . 12 . . . . . . . . . . . . . . . . . 13 . . . . . . . . . . . . . . . . . 14 ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ............. ............... 313 ................... ............. 411 418 431 449 467 5,226 ................... ............... 138 ................... ................... ................... ................... 8,694 3,826 . . . . . . . . . . . . 12,520 . . . . . . . . . . . . . . . 973 . . . . . . . . . . . . . . . 186 . . . . . . . . . . 987,339 . . . . . . . . . . . . . . . 150 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 . . . . . . . . . . . . . . . . . . . ............. ............. ................... ................... ................... ................... . . . . . . . . . . . . . . . . . 24 . . . . . . . . . . . . . . . . . . . ................... ................... ................... ................... ................... ................... ................... . . . . . . . . . . . . . . . . . 24 . . . . . . . . . . . . . . . . . . . ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... . . . . . . . . . . . . . . . . . 37 . . . . . . . . . . . . . . . . . . . ................... ................... ................... ............... 198 1 .................. 1 . . . . . . . . . . . . 66,423 ................... .................. ................... ................... 8,544 3,754 . . . . . . . . . . . . 12,298 . . . . . . . . . . . . . . . 972 . . . . . . . . . . . . . . . 185 . . . . . . . . . . 920,880 ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... . . . . . . . . . . . . . . . . . 37 . . . . . . . . . . . . . . . . . . . ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ............. ............. ................... ................... ................... ................... ................... ................... ................... ................... ............. ............. .......... 987,339 ................... ........ ........ 1,247,171 1,238,561 ................... . . . . . . . . . . . . 66,423 . . . . . . . . . . . . . . . . . . . .......... ................... ................... ................... . . . . . . . . . . . . 95,603 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73,390 . . . . . . . . . . . . . . . . . . . ........ ........ 920,880 1,149,095 1,162,698 (a) For health business: number of persons insured under PPO managed care products ..............24 and number of persons insured under indemnity only products .............468. (b) For health premiums written: amount of Medicare Title XVIII exempt from state taxes or fees $...............0 2,474 2,474 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201843013100 2018 Document Code: 430 EXHIBIT OF PREMIUMS, ENROLLMENT AND UTILIZATION (a) NAIC Group Code 0917 REPORT FOR: 1. CORPORATION: Health Care Service Corporation, a Mutual Legal Reserve Company BUSINESS IN THE STATE OF IDAHO DURING THE YEAR 1 Comprehensive (Hospital & Medical) 2 3 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 Idaho 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 . . . . . . Individual 149 153 158 161 162 1,884 Group 4 5 6 Medicare Supplement Vision Only Dental Only ............... ............... ............... ............... ............... . . . . . . . . . . . . . . . . . 14 . . . . . . . . . . . . . . . . . 18 . . . . . . . . . . . . . . . . . 18 . . . . . . . . . . . . . . . . . 20 . . . . . . . . . . . . . . . . . 20 ................... ................... ................... ................... ................... ............... ............... ............... ............... ............... 133 133 137 139 140 1,641 ................... ................... ................... ................... ................... ............. ............... 217 ................... ............. ................... 2. LOCATION: NAIC Company Code 70670 7 Federal Employees Health Benefits Plan 2 2 3 2 2 . . . . . . . . . . . . . . . . . 26 .................. .................. .................. .................. .................. 9 10 Title XVIII Medicare Title XIX Medicaid Other ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... . . . . . . . . . . . . . 1,736 . . . . . . . . . . . . . . . 106 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 864 . . . . . . . . . . . . . . . . . 59 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,630 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 803 . . . . . . . . . . . . . . . . . . . ................... ................... .................. 2 ................... ............. 2,600 131 . . . . . . . . . . . . . . . . . 34 . . . . . . . . . . 236,025 ............... 165 2 .................. 2 . . . . . . . . . . . . 16,368 ................... ............. .................. ................... ................... ................... ................... .................. ................... ............... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... 2,433 129 . . . . . . . . . . . . . . . . . 32 . . . . . . . . . . 219,657 ................... ............... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ............... ............... ................... ................... ................... ................... ................... ................... ................... ................... .......... 236,025 ................... .......... .......... 271,625 260,245 ................... . . . . . . . . . . . . 16,368 . . . . . . . . . . . . . . . . . . . .......... ................... ................... ................... . . . . . . . . . . . . 66,630 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54,274 . . . . . . . . . . . . . . . . . . . .......... .......... 219,657 204,810 206,004 (a) For health business: number of persons insured under PPO managed care products ..............20 and number of persons insured under indemnity only products .............140. (b) For health premiums written: amount of Medicare Title XVIII exempt from state taxes or fees $...............0 2 8 186 (32) ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201843014100 2018 Document Code: 430 EXHIBIT OF PREMIUMS, ENROLLMENT AND UTILIZATION (a) NAIC Group Code 0917 REPORT FOR: 1. CORPORATION: Health Care Service Corporation, a Mutual Legal Reserve Company BUSINESS IN THE STATE OF ILLINOIS DURING THE YEAR 1 Comprehensive (Hospital & Medical) 2 3 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 Illinois 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 . . . . . . Individual 4,102,847 4,273,823 4,281,936 4,261,803 4,255,042 . . . . . . . 51,366,252 .......... .......... .......... .......... .......... 26,668,793 12,133,438 . . . . . . . 38,802,231 . . . . . . . . 3,338,679 . . . . . . . . . . 471,806 . . 16,458,261,664 ........ ........ ........ ........ ........ 1,419,418 1,420,762 1,416,467 1,428,858 1,450,906 . . . . . . . 17,131,791 5 6 Medicare Supplement Vision Only Dental Only ........ ................... ........ ........ .......... ........ . . . . . . . . 2,029,842 . . . . . . . 11,653,274 . . . . . . . . . . . . . . . . . . 940,693 . . . . . . . . 6,052,805 . . . . . . . . ................... ................... . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,662,238 . . . . . . . . 1,194,821 . . . . . . . . . . . . . . . . . . 395,438 . . . . . . . . . . 559,222 . . . . . . . . . . 577,661 . . . . . . . . ................... .......... ................... ................... .......... 17,706,079 439,329 . . . . . . . . . . 112,027 . . . 7,922,170,820 ................... ................... ................... ................... ................... ................... 13,975,358,318 13,932,683,263 Other .......... .......... .......... .......... .......... ....... .. .. Title XIX Medicaid ............ ............ ............ ............ ............ 2,970,535 176,454 . . . . . . . . . . . . 36,197 . . . 2,432,952,954 ................... Title XVIII Medicare .......... .......... .......... .......... .......... .......... 16,423,244,992 10 .......... .......... .......... .......... .......... ........ .. 9 ................... ................... ................... ................... ................... 6,444,395 1,744,468 . . . . . . . . 8,188,863 . . . . . . . . . . 688,549 . . . . . . . . . . 120,411 . . . . . 986,665,378 ....... ....... ... 2,437,578,402 ................... ... ... 1,751,525,553 1,732,413,026 ... 7,866,103,410 ................... ... ... 6,585,492,192 6,517,501,228 170,788 169,491 168,922 168,520 168,404 2,028,124 8 375,011 374,772 373,291 372,375 370,024 4,481,789 ........ ........ ........ ........ ........ 294,808 320,683 315,317 323,725 331,215 3,874,555 NAIC Company Code 70670 7 Federal Employees Health Benefits Plan .......... .......... .......... .......... .......... ........ 317,878 344,518 330,131 318,218 305,196 3,950,417 Group 4 2. LOCATION: 69,692 60,424 61,464 61,918 61,241 735,734 374,636 433,152 455,751 424,364 396,382 5,216,986 1,080,616 1,150,021 1,160,593 1,163,825 1,171,674 . . . . . . . 13,946,856 ........ ........ ........ ........ ........ ........ .......... ................... 2,221,460 86,520 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22,308 . . . . . 114,305,896 . . . 1,125,171,086 ........ ............ 1,772,482 627,170 . . . . . . . . . . . . 50,063 . . . . . 894,732,544 3,684,223 1,863,151 . . . . . . . . 5,547,374 . . . . . . . . 1,320,657 . . . . . . . . . . 130,800 . . . 2,553,767,310 ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ..... ................... ................... ................... ................... ....... ....... ..... 981,500,265 ................... ..... ..... 784,161,343 791,357,955 ................... 395,438 114,422,263 74,266,618 74,843,137 (a) For health business: number of persons insured under PPO managed care products .......1,252,979 and number of persons insured under indemnity only products .........372,563. (b) For health premiums written: amount of Medicare Title XVIII exempt from state taxes or fees $.....894,732,544 ... 1,149,709,043 ................... ... ... 1,045,852,496 1,066,370,922 ..... 894,861,290 ................... ..... ..... 874,303,261 905,598,183 ... 2,553,767,310 ................... ... ... 2,484,881,932 2,497,787,286 ................... ................... ................... ................... ................... ..... ..... 428,495,676 425,303,009 ................... ..... ..... 374,874,923 346,811,527 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201843015100 2018 Document Code: 430 EXHIBIT OF PREMIUMS, ENROLLMENT AND UTILIZATION (a) NAIC Group Code 0917 REPORT FOR: 1. CORPORATION: Health Care Service Corporation, a Mutual Legal Reserve Company BUSINESS IN THE STATE OF INDIANA DURING THE YEAR 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 Indiana 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 . . . . . . 4,186 5,100 5,134 5,018 5,076 . . . . . . . . . . . . 60,969 Comprehensive (Hospital & Medical) 2 3 Individual 5 6 Medicare Supplement Vision Only Dental Only ................... ................... ................... ................... ................... ............. ................... 1,184 1,194 1,208 1,243 1,272 . . . . . . . . . . . . 14,623 . . . . . . . . . . . . 23,520 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9,261 . . . . . . . . . . . . . . . ................... ................... . . . . . . . . . . . . 32,781 ................... ............ 4,666 . . . . . . . . . . . . . . . 739 . . . . . . . . 5,382,217 601 277 . . . . . . . . . . . . . . . 878 . . . . . . . . . . . . . . . . . 27 . . . . . . . . . . . . . . . . . 16 . . . . . . . . . . 480,165 ................... ............. ................... ................... ............. ........ 5,382,217 ................... ........ ........ 5,953,167 5,753,448 NAIC Company Code 70670 4 ............... ............... ............... ............... ............... ............. ............. ............. ............. ............. 7 Federal Employees Health Benefits Plan 8 9 10 Title XVIII Medicare Title XIX Medicaid Other ................... ................... ................... ................... ................... . . . . . . . . . . . . . . . . . 32 . . . . . . . . . . . . . . . . . 30 . . . . . . . . . . . . . . . . . 27 . . . . . . . . . . . . . . . . . 22 . . . . . . . . . . . . . . . . . 21 ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ............... 303 ................... ................... ................... 2,844 3,762 3,799 3,644 3,675 . . . . . . . . . . . . 44,750 . . . . . . . . . . . . 22,919 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8,902 . . . . . . . . . . . . . . . . . . . ................... ................... . . . . . . . . . . . . . . . . . 82 . . . . . . . . . . . . . . . . . . . ................... ................... ................... ................... ................... ................... ................... . . . . . . . . . . . . . . . . . 82 . . . . . . . . . . . . . . . . . . . ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... 31,821 4,639 . . . . . . . . . . . . . . . 723 . . . . . . . . 3,187,265 ................... ............. ................... ................... ................... ........ ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ........ ................... ............. ................... ................... ................... ........ ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ........ ........ ................... ................... ............ ............ ................... ................... ................... ................... ................... ................... . . . . . . . . 1,028,030 . . . . . . . . . . 850,354 .......... 126 114 100 109 108 1,293 Group 2. LOCATION: 480,165 ................... ........ ........ 1,386,535 1,315,313 ................... ............. ............. ............. ............. ............. 3,187,265 3,527,462 3,576,517 (a) For health business: number of persons insured under PPO managed care products .............108 and number of persons insured under indemnity only products ...........1,272. (b) For health premiums written: amount of Medicare Title XVIII exempt from state taxes or fees $...............0 4,825 4,825 11,140 11,263 ............. ............. ............. ............. ............. 1,709,962 1,709,962 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201843018100 2018 Document Code: 430 EXHIBIT OF PREMIUMS, ENROLLMENT AND UTILIZATION (a) NAIC Group Code 0917 REPORT FOR: 1. CORPORATION: Health Care Service Corporation, a Mutual Legal Reserve Company BUSINESS IN THE STATE OF KENTUCKY DURING THE YEAR 1 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 Kentucky 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 Total Individual 5,643 5,798 5,829 5,804 5,870 . . . . . . . . . . . . 69,839 . . . . . . . . . . . . . . . . . 20 . . . . . . . . . . . . . . . . . 14 . . . . . . . . . . . . . . . . . 14 . . . . . . . . . . . . . . . . . 14 . . . . . . . . . . . . . . . . . 15 ............. ............. ............. ............. ............. ............... Group 4,755 4,914 4,947 4,895 4,926 172 . . . . . . . . . . . . 59,029 ............. ............. ............. ............. ............. . . . . . . . . . . . . 30,357 . . . . . . . . . . . . . . . . . 62 . . . . . . . . . . . . . . . . . . . . . . . . 25,145 . . . . . . . . . . . . . . . . . 23 . . . . . . . . . . . . 2. LOCATION: NAIC Company Code 70670 4 5 6 Medicare Supplement Vision Only Dental Only 618 635 618 633 664 7,598 7 Federal Employees Health Benefits Plan 8 9 10 Title XVIII Medicare Title XIX Medicaid Other ............... ............... ............... ............... ............... ................... ................... ................... ................... ................... ............... ............... ............... ............... ............... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ............. 250 235 250 262 265 3,040 ................... ............. ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ............. ............. 4,118 2,188 . . . . . . . . . . . . . 6,306 . . . . . . . . . . . . . . . 956 . . . . . . . . . . . . . . . 135 . . . . . . . . . . 541,527 ................... ................... ................... ................... . . . . . . . . . . . . . 1,952 . . . . . . . . . . . . . . . . . . . ................... ............. ................... ................... ................... ................... 2,535 . . . . . . . . . . . . . . . 616 . . . . . . . 22,453,941 26,177 20,982 . . . . . . . . . . . . . . . . . 85 . . . . . . . . . . . . 47,159 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,579 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 481 . . . . . . . . . . . . 27,726 . . . . . . . 21,688,966 ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... .......... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... .......... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... .......... .......... ................... ................... ................... ................... ................... ................... ................... ................... . . . . . . . . . . . . 55,502 ............. ....... 22,453,941 ................... ....... ....... 19,844,927 19,821,465 . . . . . . . . . . . . 27,726 . . . . . . . ................... 21,688,966 ................... . . . . . . . . . . . . 11,968 . . . . . . . . . . . . . . . . . . . . 3,934 . . . . . . . 18,936,782 18,908,120 .......... 541,527 ................... .......... .......... 600,284 610,926 (a) For health business: number of persons insured under PPO managed care products ...........4,939 and number of persons insured under indemnity only products .............267. (b) For health premiums written: amount of Medicare Title XVIII exempt from state taxes or fees $...............0 1,952 195,722 195,722 295,893 298,486 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201843020100 2018 Document Code: 430 EXHIBIT OF PREMIUMS, ENROLLMENT AND UTILIZATION (a) NAIC Group Code 0917 REPORT FOR: 1. CORPORATION: Health Care Service Corporation, a Mutual Legal Reserve Company BUSINESS IN THE STATE OF MAINE DURING THE YEAR 1 Comprehensive (Hospital & Medical) 2 3 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 Maine 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 . . . . . . Individual . . . . . . . . . . . . . . . . . 34 . . . . . . . . . . . . . . . . . 33 . . . . . . . . . . . . . . . . . 35 . . . . . . . . . . . . . . . . . 35 . . . . . . . . . . . . . . . . . 35 ............... Group 5 5 5 5 5 421 . . . . . . . . . . . . . . . . . 60 .................. .................. .................. .................. .................. NAIC Company Code 70670 4 5 6 Medicare Supplement Vision Only Dental Only 7 Federal Employees Health Benefits Plan ................... ................... ................... ................... ................... . . . . . . . . . . . . . . . . . 27 . . . . . . . . . . . . . . . . . 26 . . . . . . . . . . . . . . . . . 28 . . . . . . . . . . . . . . . . . 28 . . . . . . . . . . . . . . . . . 28 ................... ................... ................... ................... ................... ................... ............... 337 ................... 2 2 2 2 2 . . . . . . . . . . . . . . . . . 24 ................... ................... ............... ............... .................. .................. .................. .................. .................. 8 9 10 Title XVIII Medicare Title XIX Medicaid Other ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... .................. 6 ................... ................... ................... ................... ................... ................... ................... ................... .................. ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... 429 238 . . . . . . . . . . . . . . . 667 . . . . . . . . . . . . . . . . . 67 . . . . . . . . . . . . . . . . . 14 . . . . . . . . . . . . 87,123 .................. .................. . . . . . . . . . . . . 21,770 . . . . . . . . . . . . . . . . . . . 428 231 . . . . . . . . . . . . . . . 659 . . . . . . . . . . . . . . . . . 67 . . . . . . . . . . . . . . . . . 14 . . . . . . . . . . . . 65,353 ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ............. ............. ................... ................... ................... ................... ................... ................... ................... ................... ............... ............... .................. 1 1 2 2. LOCATION: ................... ................... ................... ................... ................... . . . . . . . . . . . . 87,123 . . . . . . . . . . . . 21,770 . . . . . . . . . . . . . . . . . . . ............ ................... ................... ................... ................... ................... ............ ............ ................... . . . . . . . . . . . . 86,224 . . . . . . . . . . . . . . . . . . . . . . . . . 91,232 . . . . . . . . . . . . . 1,057 1,078 65,353 84,162 89,100 (a) For health business: number of persons insured under PPO managed care products ...............5 and number of persons insured under indemnity only products ..............28. (b) For health premiums written: amount of Medicare Title XVIII exempt from state taxes or fees $...............0 6 1,004 1,055 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201843021100 2018 Document Code: 430 EXHIBIT OF PREMIUMS, ENROLLMENT AND UTILIZATION (a) NAIC Group Code 0917 REPORT FOR: 1. CORPORATION: Health Care Service Corporation, a Mutual Legal Reserve Company BUSINESS IN THE STATE OF MARYLAND DURING THE YEAR 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 Maryland 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 . . . . . . 2,107 3,135 2,699 2,743 2,781 . . . . . . . . . . . . 33,845 Comprehensive (Hospital & Medical) 2 3 Individual 5 6 Medicare Supplement Vision Only Dental Only 8 9 10 Title XVIII Medicare Title XIX Medicaid Other . . . . . . . . . . . . . . . 585 . . . . . . . . . . . . . 1,057 . . . . . . . . . . . . . . . 827 . . . . . . . . . . . . . . . 808 . . . . . . . . . . . . . . . 784 ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ............. ................... ............ 10,449 ................... ................... ................... ................... . . . . . . . . . . . . 14,646 . . . . . . . . . . . . . . . . . 34 . . . . . . . . . . . . 11,772 . . . . . . . . . . . . . 2,840 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7,588 . . . . . . . . . . . . . . . . . . 6 . . . . . . . . . . . . . 5,583 . . . . . . . . . . . . . . . 952 . . . . . . . . . . . . . . . . . . . ................... ................... . . . . . . . . . . . . . 1,047 . . . . . . . . . . . . . . . . . . . ................... ................... ................... ................... ................... ................... . . . . . . . . . . . . 22,234 . . . . . . . . . . . . . . . . . 40 . . . . . . . . . . . . 17,355 338 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122 . . . . . . . . . . . . 31,969 . . . . . . . 10,785,354 ............. ............. ................... ................... ................... ................... ................... 3,792 358 . . . . . . . . . . . . . . . . . 68 . . . . . . . . . . 326,188 ................... 696 . . . . . . . . . . . . . . . 190 . . . . . . . 11,416,356 ............... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... .......... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... .......... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... .......... .......... ................... ................... ................... ................... ................... ................... ................... ................... ............... ....... 11,416,356 ................... ........ ........ 7,447,888 7,478,040 ............. ............. ............. ............. ............. ............... . . . . . . . . . . . . 31,969 . . . . . . . ................... 10,785,354 ................... . . . . . . . . . . . . . 4,436 . . . . . . . . . . . . . . . . . . . . . . . . . 11 . . . . . . . . 6,901,179 6,926,611 .......... 133 134 132 137 148 1,633 7 Federal Employees Health Benefits Plan ................... ................... ................... ................... ................... .................. .................. .................. .................. .................. 1,381 1,937 1,733 1,791 1,842 . . . . . . . . . . . . 21,679 NAIC Company Code 70670 4 ............... ............... ............... ............... ............... ............. ............. ............. ............. ............. 8 7 7 7 7 . . . . . . . . . . . . . . . . . 84 Group 2. LOCATION: 326,188 ................... .......... .......... 354,153 356,796 (a) For health business: number of persons insured under PPO managed care products ...........1,836 and number of persons insured under indemnity only products .............161. (b) For health premiums written: amount of Medicare Title XVIII exempt from state taxes or fees $...............0 1,047 272,845 272,845 188,120 194,622 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201843022100 2018 Document Code: 430 EXHIBIT OF PREMIUMS, ENROLLMENT AND UTILIZATION (a) NAIC Group Code 0917 REPORT FOR: 1. CORPORATION: Health Care Service Corporation, a Mutual Legal Reserve Company BUSINESS IN THE STATE OF MASSACHUSETTS DURING THE YEAR 1 Comprehensive (Hospital & Medical) 2 3 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 Massachusetts 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 . . . . . . Individual . . . . . . . . . . . . . . . . . 78 . . . . . . . . . . . . . . . . . 78 . . . . . . . . . . . . . . . . . 80 . . . . . . . . . . . . . . . . . 85 . . . . . . . . . . . . . . . . . 85 ............... 9 8 8 8 7 980 . . . . . . . . . . . . . . . . . 93 .................. .................. .................. .................. .................. Group 2. LOCATION: NAIC Company Code 70670 4 5 6 Medicare Supplement Vision Only Dental Only ................... ................... ................... ................... ................... . . . . . . . . . . . . . . . . . 67 . . . . . . . . . . . . . . . . . 69 . . . . . . . . . . . . . . . . . 71 . . . . . . . . . . . . . . . . . 76 . . . . . . . . . . . . . . . . . 77 ................... ................... ................... ................... ................... ................... ............... 875 ................... 7 Federal Employees Health Benefits Plan 2 1 1 1 1 . . . . . . . . . . . . . . . . . 12 .................. .................. .................. .................. .................. 9 10 Title XVIII Medicare Title XIX Medicaid Other ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... . . . . . . . . . . . . . 1,703 . . . . . . . . . . . . . . . . . 25 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 644 . . . . . . . . . . . . . . . . . 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,678 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 624 . . . . . . . . . . . . . . . . . . . ................... ................... .................. 9 ................... ............. 2,347 264 . . . . . . . . . . . . . . . . . 48 . . . . . . . . . . 297,973 . . . . . . . . . . . . . . . . . 36 . . . . . . . . . . . . . . . . . . . ............. .................. ................... ................... ................... ................... ................... ................... ............... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... . . . . . . . . . . . . 94,016 . . . . . . . . . . . . . . . . . . . 2,302 264 . . . . . . . . . . . . . . . . . 48 . . . . . . . . . . 203,539 ................... ............... ................... ............... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ............... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ............. ............. ................... ................... ................... ................... ................... ................... ................... ................... .......... 297,973 ................... .......... .......... 255,534 240,040 . . . . . . . . . . . . 94,016 . . . . . . . . . . . . . . . . . . . .......... ................... ................... ................... . . . . . . . . . . . . . 9,207 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (8,470) . . . . . . . . . . . . . . . . . . . .......... .......... 203,539 244,805 246,939 (a) For health business: number of persons insured under PPO managed care products ...............6 and number of persons insured under indemnity only products ..............78. (b) For health premiums written: amount of Medicare Title XVIII exempt from state taxes or fees $...............0 9 8 418 418 1,522 1,570 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201843023100 2018 Document Code: 430 EXHIBIT OF PREMIUMS, ENROLLMENT AND UTILIZATION (a) NAIC Group Code 0917 REPORT FOR: 1. CORPORATION: Health Care Service Corporation, a Mutual Legal Reserve Company BUSINESS IN THE STATE OF MICHIGAN DURING THE YEAR 1 Comprehensive (Hospital & Medical) 2 3 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 Michigan 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 . . . . . . Individual 607 596 596 612 629 7,251 Group 2. LOCATION: NAIC Company Code 70670 4 5 6 Medicare Supplement Vision Only Dental Only 7 Federal Employees Health Benefits Plan 8 9 10 Title XVIII Medicare Title XIX Medicaid Other ............... ............... ............... ............... ............... . . . . . . . . . . . . . . . . . 44 . . . . . . . . . . . . . . . . . 38 . . . . . . . . . . . . . . . . . 29 . . . . . . . . . . . . . . . . . 33 . . . . . . . . . . . . . . . . . 29 ................... ................... ................... ................... ................... ............... ............... ............... ............... ............... ................... ................... ................... ................... ................... . . . . . . . . . . . . . . . . . 11 . . . . . . . . . . . . . . . . . 11 .................. 3 .................. 3 .................. 2 ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ............. ............... 395 ................... ............. 552 547 564 576 598 6,790 ................... . . . . . . . . . . . . . . . . . 66 . . . . . . . . . . . . . . . . . . . ................... ................... ................... ............. ............. ................... ................... ................... ................... . . . . . . . . . . . . . . . . . 15 . . . . . . . . . . . . . . . . . . . ................... ................... ................... ................... ................... ................... ................... . . . . . . . . . . . . . . . . . 15 . . . . . . . . . . . . . . . . . . . ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ............... ................... ................... ................... ................... 9,373 4,873 . . . . . . . . . . . . 14,246 . . . . . . . . . . . . . . . 996 . . . . . . . . . . . . . . . 234 . . . . . . . . 1,401,111 ............... ............... 247 193 . . . . . . . . . . . . . . . 440 .................. 2 .................. 1 . . . . . . . . . . 120,670 ................... ................... ................... 9,126 4,665 . . . . . . . . . . . . 13,791 . . . . . . . . . . . . . . . 994 . . . . . . . . . . . . . . . 233 . . . . . . . . 1,279,788 ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ........ ................... ............... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ........ ........ ................... ................... ............. ............. ................... ................... ................... ................... ................... ................... ................... ................... ............. ............. ........ 1,401,111 ................... ........ ........ 1,471,390 1,508,066 .......... 120,670 ................... .......... .......... 196,175 204,549 ................... ................... ................... 1,279,788 1,273,458 1,302,002 (a) For health business: number of persons insured under PPO managed care products ..............29 and number of persons insured under indemnity only products .............598. (b) For health premiums written: amount of Medicare Title XVIII exempt from state taxes or fees $...............0 652 652 1,758 1,514 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201843024100 2018 Document Code: 430 EXHIBIT OF PREMIUMS, ENROLLMENT AND UTILIZATION (a) NAIC Group Code 0917 REPORT FOR: 1. CORPORATION: Health Care Service Corporation, a Mutual Legal Reserve Company BUSINESS IN THE STATE OF MINNESOTA DURING THE YEAR 1 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 Minnesota 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 Total Individual . . . . . . . . . . . . 10,989 . . . . . . . . . . . . 11,256 . . . . . . . . . . . . 10,987 . . . . . . . . . . . . 11,085 . . . . . . . . . . . . 11,250 . . . . . . . . . . . . . . . . . 13 . . . . . . . . . . . . . . . . . 10 . . . . . . . . . . . . . . . . . 10 . . . . . . . . . . . . . . . . . 10 . . . . . . . . . . . . . . . . . 10 .......... 133,452 ............... Group 119 9,675 9,548 9,281 9,334 9,478 112,779 2. LOCATION: NAIC Company Code 70670 4 5 6 Medicare Supplement Vision Only Dental Only ............. ............. ............. ............. ............. ............... ............... ............... ............... ............... ................... ................... ................... ................... ................... .......... ............. 220 218 215 228 242 2,676 ................... 1,081 1,480 1,481 1,513 1,520 . . . . . . . . . . . . 17,878 . . . . . . . . . . . . 54,132 . . . . . . . . . . . . . . . . . 58 . . . . . . . . . . . . . . . . . . . . . . . . 33,713 . . . . . . . . . . . . . . . . . 46 . . . . . . . . . . . . ............. ............. ............. ............. ............. 7 Federal Employees Health Benefits Plan 8 9 10 Title XVIII Medicare Title XIX Medicaid Other ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ............. ............. 3,480 1,625 . . . . . . . . . . . . . 5,105 . . . . . . . . . . . . . . . 654 . . . . . . . . . . . . . . . 126 . . . . . . . . . . 565,551 ................... ................... ................... ................... . . . . . . . . . . . . . 3,885 . . . . . . . . . . . . . . . . . . . ................... ............. ................... ................... ................... ................... 3,673 . . . . . . . . . . . . . . . 838 . . . . . . . 49,515,750 50,594 28,157 . . . . . . . . . . . . . . . 104 . . . . . . . . . . . . 78,751 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 712 . . . . . . . . . . . . 62,669 . . . . . . . 48,318,825 ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... .......... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... .......... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... .......... .......... ................... ................... ................... ................... ................... ................... ................... ................... . . . . . . . . . . . . 87,845 ............. ....... 49,515,750 ................... ....... ....... 46,853,076 47,164,341 . . . . . . . . . . . . 62,669 . . . . . . . ................... 48,318,825 ................... . . . . . . . . . . . . 23,076 . . . . . . . . . . . . . . . . . . . . 3,503 . . . . . . . 45,616,233 45,921,550 .......... 565,551 ................... .......... .......... 522,856 532,515 (a) For health business: number of persons insured under PPO managed care products ...........9,483 and number of persons insured under indemnity only products .............247. (b) For health premiums written: amount of Medicare Title XVIII exempt from state taxes or fees $...............0 3,885 568,705 568,705 690,912 706,774 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201843026100 2018 Document Code: 430 EXHIBIT OF PREMIUMS, ENROLLMENT AND UTILIZATION (a) NAIC Group Code 0917 REPORT FOR: 1. CORPORATION: Health Care Service Corporation, a Mutual Legal Reserve Company BUSINESS IN THE STATE OF MISSOURI DURING THE YEAR 1 Comprehensive (Hospital & Medical) 2 3 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 Missouri 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 . . . . . . Individual 785 775 771 776 782 9,315 Group 2. LOCATION: NAIC Company Code 70670 4 5 6 Medicare Supplement Vision Only Dental Only 8 9 10 Title XVIII Medicare Title XIX Medicaid Other ............... ............... ............... ............... ............... . . . . . . . . . . . . . . . . . 62 . . . . . . . . . . . . . . . . . 59 . . . . . . . . . . . . . . . . . 54 . . . . . . . . . . . . . . . . . 54 . . . . . . . . . . . . . . . . . 52 ................... ................... ................... ................... ................... ............... ............... ............... ............... ............... ................... ................... ................... ................... ................... . . . . . . . . . . . . . . . . . 18 . . . . . . . . . . . . . . . . . 16 . . . . . . . . . . . . . . . . . 15 . . . . . . . . . . . . . . . . . 15 . . . . . . . . . . . . . . . . . 14 ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ............. ............... 656 ................... ............. ................... ............... 184 ................... ................... ................... ................... . . . . . . . . . . . . 12,828 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,001 . . . . . . . . . . . . . . . ................... ................... . . . . . . . . . . . . 12,442 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,538 . . . . . . . . . . . . . . . . . . . ................... ................... . . . . . . . . . . . . . . . 298 . . . . . . . . . . . . . . . . . . . ................... ................... ................... ................... ................... ................... . . . . . . . . . . . . 18,829 ................... ............ ............... ................... ................... ................... ................... ................... ............. ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... 17,980 2,676 . . . . . . . . . . . . . . . 476 . . . . . . . . 1,758,118 ................... 2,756 . . . . . . . . . . . . . . . 516 . . . . . . . . 1,871,688 386 165 . . . . . . . . . . . . . . . 551 . . . . . . . . . . . . . . . . . 80 . . . . . . . . . . . . . . . . . 40 . . . . . . . . . . 113,153 ................... ............... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ........ ................... ............... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ........ ........ ................... ................... ............ ............ ................... ................... ................... ................... ................... ................... ................... ................... ............. ........ 1,871,688 ................... ........ ........ 2,751,968 2,813,883 .......... 113,153 ................... .......... .......... 559,430 631,116 ................... 705 700 702 707 716 8,475 7 Federal Employees Health Benefits Plan 1,758,118 2,156,731 2,147,278 (a) For health business: number of persons insured under PPO managed care products ..............52 and number of persons insured under indemnity only products .............716. (b) For health premiums written: amount of Medicare Title XVIII exempt from state taxes or fees $...............0 298 418 418 35,807 35,489 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201843027100 2018 Document Code: 430 EXHIBIT OF PREMIUMS, ENROLLMENT AND UTILIZATION (a) NAIC Group Code 0917 REPORT FOR: 1. CORPORATION: Health Care Service Corporation, a Mutual Legal Reserve Company BUSINESS IN THE STATE OF MONTANA DURING THE YEAR 1 Comprehensive (Hospital & Medical) 2 3 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 Montana 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 . . . . . . 200,865 174,846 172,015 173,196 172,090 2,075,239 Individual .......... .......... .......... .......... .......... . . . . . . . . . . . . 28,144 . . . . . . . . . . . . 19,490 . . . . . . . . . . . . 18,269 . . . . . . . . . . . . 17,508 . . . . . . . . . . . . 16,704 ........ .......... 220,363 Group 53,275 49,317 48,271 48,957 49,390 588,553 NAIC Company Code 70670 4 5 6 Medicare Supplement Vision Only Dental Only 19,059 19,852 19,733 19,708 19,542 237,070 13,717 13,268 12,590 13,253 12,960 157,237 7 Federal Employees Health Benefits Plan 32,728 32,589 32,473 32,459 32,378 389,789 8 9 10 Title XVIII Medicare Title XIX Medicaid Other ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ................... ................... ................... ................... ................... ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ................... ................... ................... ................... ................... ............ ............ ............ ............ ............ .......... .......... ................... .......... .......... .......... 35,334 19,185 19,245 19,195 19,051 230,047 ................... .......... 203,587 135,147 . . . . . . . . . . 338,734 . . . . . . . . . . . . 29,605 . . . . . . . . . . . . . 4,846 . . . . . 177,054,579 ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ....... . . . . . . . . 1,328,034 . . . . . . . . . . 171,335 . . . . . . . . . . 353,176 . . . . . . . . . . 252,716 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 371,152 . . . . . . . . . . . . 31,597 . . . . . . . . . . . . 75,980 . . . . . . . . . . . . 54,194 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 347,220 . . . . . . . . . . . . . . . . . . . . . . 21,234 . . . . . . . . . . . . 53,000 . . . . . . . . . . .......... 429,156 12,457 . . . . . . . . . . . . . 3,660 . . . . . 276,616,143 .......... 306,910 21,693 . . . . . . . . . . . . . 4,642 . . . . . . . 54,934,974 ................... ............ ............ ............ ................... ................... ................... 400,220 9,979 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,077 . . . . . . . . 5,140,297 . . . . . 198,065,227 ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ........ ................... ....... ................... ................... ................... ................... ................... ................... ........ ........ ................... ................... ....... ....... .......... . . . . . . . . . . . . 81,139 . . . . . . . . . . . . . ..... 884,081,643 ................... ..... ..... 759,184,895 757,774,215 ..... 155,274,744 ................... ..... ..... 118,544,118 113,131,175 ..... 274,606,721 ................... ..... ..... 232,810,022 230,416,914 ....... 53,802,641 ................... ....... ....... 38,383,060 38,500,472 ................... 21,234 18,608 21,145 21,434 22,116 22,065 252,180 202,932 7,405 . . . . . . . . . . . . 17,801 . . . . . . . . . . . . . 1,576 . . . . . 881,674,935 . . . . . 155,274,744 ........ 1,699,186 2. LOCATION: 5,152,820 3,308,130 3,198,326 (a) For health business: number of persons insured under PPO managed care products ..........95,125 and number of persons insured under indemnity only products ..........19,910. (b) For health premiums written: amount of Medicare Title XVIII exempt from state taxes or fees $.....177,054,579 .......... ............. ..... 204,692,599 ................... ..... ..... 185,124,745 187,219,917 ..... 176,348,247 ................... ..... ..... 170,171,946 169,918,300 14,588,971 14,203,871 10,842,874 15,389,112 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201843028100 2018 Document Code: 430 EXHIBIT OF PREMIUMS, ENROLLMENT AND UTILIZATION (a) NAIC Group Code 0917 REPORT FOR: 1. CORPORATION: Health Care Service Corporation, a Mutual Legal Reserve Company BUSINESS IN THE STATE OF NEBRASKA DURING THE YEAR 1 Comprehensive (Hospital & Medical) 2 3 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 Nebraska 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 . . . . . . Individual 607 636 637 685 675 7,736 Group ............... ............... ............... ............... ............... . . . . . . . . . . . . . . . . . 13 . . . . . . . . . . . . . . . . . 13 .................. 9 .................. 4 .................. 4 ............. . . . . . . . . . . . . . . . . . 99 . . . . . . . . . . . . . 526 551 557 574 559 6,610 ............... ............... ............... ............... ............... 2. LOCATION: NAIC Company Code 70670 4 5 6 Medicare Supplement Vision Only Dental Only 7 Federal Employees Health Benefits Plan 8 9 10 Title XVIII Medicare Title XIX Medicaid Other . . . . . . . . . . . . . . . . . 44 . . . . . . . . . . . . . . . . . 38 . . . . . . . . . . . . . . . . . 39 . . . . . . . . . . . . . . . . . 43 . . . . . . . . . . . . . . . . . 44 ................... ................... ................... ................... ................... . . . . . . . . . . . . . . . . . 24 . . . . . . . . . . . . . . . . . 34 . . . . . . . . . . . . . . . . . 32 . . . . . . . . . . . . . . . . . 64 . . . . . . . . . . . . . . . . . 68 ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... 494 ................... ............... 533 ................... ................... ................... ................... ............... 3,217 2,478 . . . . . . . . . . . . . 5,695 . . . . . . . . . . . . . . . 459 . . . . . . . . . . . . . . . . . 60 . . . . . . . . 2,852,329 . . . . . . . . . . . . . . . . . 50 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 . . . . . . . . . . . . . 2,451 2,061 . . . . . . . . . . . . . . . . . 78 . . . . . . . . . . . . . 4,512 . . . . . . . . . . . . . . . . . . 7 . . . . . . . . . . . . . . . 301 . . . . . . . . . . . . . . . . . . 2 . . . . . . . . . . . . . . . . . 33 . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,742,039 ............... ............... 716 297 . . . . . . . . . . . . . 1,013 . . . . . . . . . . . . . . . 151 . . . . . . . . . . . . . . . . . 25 . . . . . . . . . . . . 98,465 ................... ................... ................... ................... . . . . . . . . . . . . . . . . . 92 . . . . . . . . . . . . . . . . . . . ................... ................... ................... ................... ................... ................... ................... . . . . . . . . . . . . . . . . . 92 . . . . . . . . . . . . . . . . . . . ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ............ ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ........ ................... ............ ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ............ ............ ................... ................... ................... ................... ................... ................... ................... ................... ............. ............. ........ 2,852,329 ................... ........ ........ 2,940,985 2,951,317 . . . . . . . . . . . . 76,389 . . . . . . . . . . . . . . . . . . . . 76,339 . . . . . . . . 2,742,039 2,732,274 2,745,426 ............ 98,465 ................... .......... .......... 114,901 111,192 (a) For health business: number of persons insured under PPO managed care products .............561 and number of persons insured under indemnity only products ..............46. (b) For health premiums written: amount of Medicare Title XVIII exempt from state taxes or fees $...............0 11,825 11,825 17,421 18,359 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201843029100 2018 Document Code: 430 EXHIBIT OF PREMIUMS, ENROLLMENT AND UTILIZATION (a) NAIC Group Code 0917 REPORT FOR: 1. CORPORATION: Health Care Service Corporation, a Mutual Legal Reserve Company BUSINESS IN THE STATE OF NEVADA DURING THE YEAR 1 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 Nevada 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 Total Individual 5,444 5,725 5,824 5,838 6,005 . . . . . . . . . . . . 70,004 . . . . . . . . . . . . . . . . . 54 . . . . . . . . . . . . . . . . . 47 . . . . . . . . . . . . . . . . . 46 . . . . . . . . . . . . . . . . . 47 . . . . . . . . . . . . . . . . . 46 ............. ............. ............. ............. ............. ............... Group 4,190 4,477 4,520 4,490 4,651 560 . . . . . . . . . . . . 54,362 . . . . . . . . . . . . 30,039 . . . . . . . . . . . . . . . . . . . . . . . . . . . 16,846 . . . . . . . . . . . . . . . ............. ............. ............. ............. ............. 2. LOCATION: NAIC Company Code 70670 4 5 6 Medicare Supplement Vision Only Dental Only ............... ............... ............... ............... ............... ................... ................... ................... ................... ................... ............. 426 410 409 419 413 4,977 ................... 774 791 849 882 895 . . . . . . . . . . . . 10,105 ............... ............... ............... ............... ............... 7 Federal Employees Health Benefits Plan 8 9 10 Title XVIII Medicare Title XIX Medicaid Other ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ............ ............ 21,594 12,416 . . . . . . . . . . . . 34,010 . . . . . . . . . . . . . 1,643 . . . . . . . . . . . . . . . 361 . . . . . . . 25,492,999 ............. ............. 8,204 3,247 . . . . . . . . . . . . 11,451 . . . . . . . . . . . . . 1,043 . . . . . . . . . . . . . . . 163 . . . . . . . . . . 786,338 ................... ................... ................... ................... . . . . . . . . . . . . . 1,004 . . . . . . . . . . . . . . . . . . . ................... ............. ................... ................... ................... ................... 2,693 . . . . . . . . . . . . . . . 526 . . . . . . . 26,819,272 241 179 . . . . . . . . . . . . . . . 420 .................. 7 .................. 2 . . . . . . . . . . 248,951 ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... .......... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... .......... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... .......... .......... ................... ................... ................... ................... ................... ................... ................... ................... . . . . . . . . . . . . 46,885 ............. ....... 26,819,272 ................... ....... ....... 20,769,055 21,072,898 .......... 248,951 ................... .......... .......... 268,735 246,573 ....... 25,492,999 ................... ....... ....... 18,693,017 18,951,947 .......... 786,338 ................... ........ ........ 1,602,174 1,667,361 (a) For health business: number of persons insured under PPO managed care products ...........4,679 and number of persons insured under indemnity only products .............431. (b) For health premiums written: amount of Medicare Title XVIII exempt from state taxes or fees $...............0 1,004 290,984 290,984 205,129 207,018 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201843030100 2018 Document Code: 430 EXHIBIT OF PREMIUMS, ENROLLMENT AND UTILIZATION (a) NAIC Group Code 0917 REPORT FOR: 1. CORPORATION: Health Care Service Corporation, a Mutual Legal Reserve Company BUSINESS IN THE STATE OF NEW HAMPSHIRE DURING THE YEAR 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 New Hampshire 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 5 6 Medicare Supplement Vision Only Dental Only .................. .................. .................. .................. .................. 8,095 6,041 . . . . . . . . . . . . 14,136 . . . . . . . . . . . . . . . 454 . . . . . . . . . . . . . . . 128 . . . . . . . . 6,884,504 .................. 6 ............. . . . . . . . . . . . . . . . . . 18 . . . . . . . . . . . . . 7,623 5,161 . . . . . . . . . . . . . . . . . 24 . . . . . . . . . . . . 12,784 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 410 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,638,475 ............... ............... ................... ................... ................... ............. ............. ........ 6,884,504 ................... ........ ........ 8,940,522 8,819,058 7 Federal Employees Health Benefits Plan 9 10 Title XVIII Medicare Title XIX Medicaid Other ................... ................... ................... ................... ................... ............... ............... ............... ............... ............... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... 370 ................... ............. ................... ................... ................... ................... 466 286 . . . . . . . . . . . . . . . 752 . . . . . . . . . . . . . . . . . 44 . . . . . . . . . . . . . . . . . 12 . . . . . . . . . . . . 74,839 ................... ................... ................... ................... . . . . . . . . . . . . . . . 576 . . . . . . . . . . . . . . . . . . . ................... ................... ................... ................... ................... ................... ................... ............... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... .......... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ........ ................... .......... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... .......... .......... ................... ................... ................... ................... ................... ................... ................... ................... 6,473 7,363 ............. ............. ............. ............. ............. ........ ........ 6,638,475 8,746,594 8,621,763 ............... ............ 74,839 ................... ............ ............ 71,724 70,450 (a) For health business: number of persons insured under PPO managed care products ...........1,384 and number of persons insured under indemnity only products ..............34. (b) For health premiums written: amount of Medicare Title XVIII exempt from state taxes or fees $...............0 365 413 445 442 411 5,225 8 . . . . . . . . . . . . . . . . . 32 . . . . . . . . . . . . . . . . . 31 . . . . . . . . . . . . . . . . . 30 . . . . . . . . . . . . . . . . . 29 . . . . . . . . . . . . . . . . . 32 ............. ............. 1,357 1,370 1,365 1,389 1,385 . . . . . . . . . . . . 16,452 NAIC Company Code 70670 4 1,756 1,815 1,841 1,861 1,829 . . . . . . . . . . . . 22,059 ............. ............. ............. ............. ............. 2 1 1 1 1 . . . . . . . . . . . . . . . . . 12 Group 2. LOCATION: 576 171,191 171,191 115,731 119,482 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201843031100 2018 Document Code: 430 EXHIBIT OF PREMIUMS, ENROLLMENT AND UTILIZATION (a) NAIC Group Code 0917 REPORT FOR: 1. CORPORATION: Health Care Service Corporation, a Mutual Legal Reserve Company BUSINESS IN THE STATE OF NEW JERSEY DURING THE YEAR 1 Comprehensive (Hospital & Medical) 2 3 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 New Jersey 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 . . . . . . Individual . . . . . . . . . . . . . . . . . 85 . . . . . . . . . . . . . . . . . 83 . . . . . . . . . . . . . . . . . 80 . . . . . . . . . . . . . . . . . 83 . . . . . . . . . . . . . . . . . 89 ............. 9 7 6 6 6 1,007 . . . . . . . . . . . . . . . . . 79 .................. .................. .................. .................. .................. Group 4 5 6 Medicare Supplement Vision Only Dental Only ................... ................... ................... ................... ................... . . . . . . . . . . . . . . . . . 75 . . . . . . . . . . . . . . . . . 75 . . . . . . . . . . . . . . . . . 73 . . . . . . . . . . . . . . . . . 76 . . . . . . . . . . . . . . . . . 81 ................... ................... ................... ................... ................... ................... ............... 913 ................... 2. LOCATION: NAIC Company Code 70670 7 Federal Employees Health Benefits Plan 1 1 1 1 2 . . . . . . . . . . . . . . . . . 15 .................. .................. .................. .................. .................. 9 10 Title XVIII Medicare Title XIX Medicaid Other ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... . . . . . . . . . . . . . 2,109 . . . . . . . . . . . . . . . . . 34 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 979 . . . . . . . . . . . . . . . . . 25 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,075 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 952 . . . . . . . . . . . . . . . . . . . ................... ................... .................. 2 ................... ............. 3,088 292 . . . . . . . . . . . . . . . . . 46 . . . . . . . . . . 229,448 . . . . . . . . . . . . . . . . . 59 . . . . . . . . . . . . . . . . . . . ............. .................. ................... ................... ................... ................... ................... ................... ............... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... . . . . . . . . . . . . 19,825 . . . . . . . . . . . . . . . . . . . 3,027 292 . . . . . . . . . . . . . . . . . 46 . . . . . . . . . . 209,623 ................... ............... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ............... ............... ................... ................... ................... ................... ................... ................... ................... ................... .......... 229,448 ................... .......... .......... 306,997 299,334 . . . . . . . . . . . . 19,825 . . . . . . . . . . . . . . . . . . . .......... ................... ................... ................... . . . . . . . . . . . . 45,245 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35,680 . . . . . . . . . . . . . . . . . . . .......... .......... 209,623 261,243 263,147 (a) For health business: number of persons insured under PPO managed care products ...............6 and number of persons insured under indemnity only products ..............81. (b) For health premiums written: amount of Medicare Title XVIII exempt from state taxes or fees $...............0 2 8 509 507 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201843032100 2018 Document Code: 430 EXHIBIT OF PREMIUMS, ENROLLMENT AND UTILIZATION (a) NAIC Group Code 0917 REPORT FOR: 1. CORPORATION: Health Care Service Corporation, a Mutual Legal Reserve Company BUSINESS IN THE STATE OF NEW MEXICO DURING THE YEAR 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 New Mexico 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 . . . . . . 177,272 174,435 175,896 176,034 177,500 2,115,403 .......... .......... .......... .......... .......... ........ Comprehensive (Hospital & Medical) 2 3 Individual 2,213 3,685 3,524 3,521 3,413 . . . . . . . . . . . . 42,754 ............. ............. ............. ............. ............. Group 34,376 38,136 37,694 38,983 40,645 463,144 ............ ............ ............ ............ ............ .......... 875,186 686,380 . . . . . . . . 1,561,566 . . . . . . . . . . . . 78,623 . . . . . . . . . . . . 14,527 . . . . . 805,212,462 . . . . . . . . . . . . 14,718 . . . . . . . . . . . . . . . . . . . . . . 15,291 . . . . . . . . . . 4 5 6 Medicare Supplement Vision Only Dental Only ............ ............ ............ ............ ............ ................... .......... .......... .......... ................... .......... ................... .......... . . . . . . . . . . . . 20,653 . . . . . . . . . . ................... ................... ................... ................... ................... ..... ..... 730,627,953 708,583,593 ....... 24,572,339 ................... ....... ....... 20,209,431 20,770,313 ..... 240,838,913 ................... ..... ..... 198,569,518 199,425,462 Other ................... ................... ................... ................... ................... ................... 810,735,881 Title XIX Medicaid 31,306 25,294 25,146 25,121 25,089 302,414 ................... ..... Title XVIII Medicare ............ ............ ............ ............ ............ 1,204 . . . . . . . . . . . . . . . 241 . . . . . . . 24,572,339 ............. 10 ............ ............ ............ ............ ............ ................... ................... . . . . . . . . . . . . 30,009 9 ............ ............ ............ ............ ............ 87,042 45,546 . . . . . . . . . . 132,588 . . . . . . . . . . . . . 7,681 . . . . . . . . . . . . . 1,380 . . . . . . . 16,679,051 49,791 46,313 46,199 46,038 46,146 554,228 8 ................... ................... ................... ................... ................... ............ ............ 13,174 13,771 13,965 14,287 14,150 168,276 NAIC Company Code 70670 7 Federal Employees Health Benefits Plan 6,775 6,949 6,953 6,971 6,950 . . . . . . . . . . . . 83,584 ............. ............. ............. ............. ............. 173,931 144,396 . . . . . . . . . . 318,327 . . . . . . . . . . . . 12,929 . . . . . . . . . . . . . 2,648 . . . . . 241,007,740 .......... .......... 2. LOCATION: 39,637 40,287 42,415 41,113 41,107 501,003 .......... .......... 301,215 215,195 . . . . . . . . . . 516,410 . . . . . . . . . . . . 38,211 . . . . . . . . . . . . . 5,907 . . . . . 233,704,114 ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... 298,280 245,299 . . . . . . . . . . . . 20,653 . . . . . . . . . . 543,579 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18,598 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,351 . . . . . . . . 5,467,013 . . . . . 266,390,652 ................... ....... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ........ ................... ....... ................... ................... ................... ................... ................... ................... ........ ........ ................... ................... ....... ....... ....... 16,628,280 ................... ....... ....... 12,184,438 12,305,378 ................... ................... ................... 5,380,071 3,327,094 3,272,883 (a) For health business: number of persons insured under PPO managed care products ..........82,754 and number of persons insured under indemnity only products ...........8,274. (b) For health premiums written: amount of Medicare Title XVIII exempt from state taxes or fees $.....233,704,114 ..... 272,361,531 ................... ..... ..... 252,061,943 250,705,303 ..... 233,674,159 ................... ..... ..... 226,783,272 206,538,999 17,391,552 17,280,588 17,492,256 15,565,256 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201843036100 2018 Document Code: 430 EXHIBIT OF PREMIUMS, ENROLLMENT AND UTILIZATION (a) NAIC Group Code 0917 REPORT FOR: 1. CORPORATION: Health Care Service Corporation, a Mutual Legal Reserve Company BUSINESS IN THE STATE OF OHIO DURING THE YEAR 1 Comprehensive (Hospital & Medical) 2 3 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 Ohio 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 . . . . . . Individual 284 267 275 286 297 3,331 Group 2. LOCATION: NAIC Company Code 70670 4 5 6 Medicare Supplement Vision Only Dental Only ............... ............... ............... ............... ............... . . . . . . . . . . . . . . . . . 19 . . . . . . . . . . . . . . . . . 12 . . . . . . . . . . . . . . . . . 12 . . . . . . . . . . . . . . . . . 12 . . . . . . . . . . . . . . . . . 13 ................... ................... ................... ................... ................... ............... ............... ............... ............... ............... ................... ................... ................... ................... ................... ............. ............... 149 ................... ............. 262 251 259 269 278 3,128 ................... 3 4 4 5 6 . . . . . . . . . . . . . . . . . 54 4,997 1,846 . . . . . . . . . . . . . 6,843 . . . . . . . . . . . . . 1,114 . . . . . . . . . . . . . . . 176 . . . . . . . . . . 739,541 . . . . . . . . . . . . . . . . . 83 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 . . . . . . . . . . . . . . . . . . . ............. ............. .................. .................. .................. .................. .................. 7 Federal Employees Health Benefits Plan 8 9 10 Title XVIII Medicare Title XIX Medicaid Other ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... . . . . . . . . . . . . . . . . . 34 . . . . . . . . . . . . . . . . . . . ................... ................... ................... ................... ................... ................... ................... . . . . . . . . . . . . . . . . . 34 . . . . . . . . . . . . . . . . . . . ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ............... 149 1 .................. 1 . . . . . . . . . . . . 62,291 ................... .................. ................... ................... 4,914 1,746 . . . . . . . . . . . . . 6,660 . . . . . . . . . . . . . 1,113 . . . . . . . . . . . . . . . 175 . . . . . . . . . . 677,251 ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ............. ............. ................... ................... ................... ................... ................... ................... ................... ................... ............. ............. .......... 739,541 ................... .......... .......... 816,295 813,252 ................... . . . . . . . . . . . . 62,291 . . . . . . . . . . . . . . . . . . . .......... ................... ................... ................... . . . . . . . . . . . . 45,620 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29,296 . . . . . . . . . . . . . . . . . . . .......... .......... 677,251 768,094 781,306 (a) For health business: number of persons insured under PPO managed care products ..............13 and number of persons insured under indemnity only products .............278. (b) For health premiums written: amount of Medicare Title XVIII exempt from state taxes or fees $...............0 2,580 2,650 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201843037100 2018 Document Code: 430 EXHIBIT OF PREMIUMS, ENROLLMENT AND UTILIZATION (a) NAIC Group Code 0917 REPORT FOR: 1. CORPORATION: Health Care Service Corporation, a Mutual Legal Reserve Company BUSINESS IN THE STATE OF OKLAHOMA DURING THE YEAR 1 Comprehensive (Hospital & Medical) 2 3 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 Oklahoma 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 . . . . . . 745,996 781,019 782,164 782,138 791,391 9,421,550 Individual 134,526 149,470 145,406 144,325 142,445 1,757,360 Group 188,769 190,826 193,181 200,260 212,025 2,367,401 4 5 6 Medicare Supplement Vision Only Dental Only 2. LOCATION: 89,395 84,816 84,720 85,956 87,223 1,030,064 NAIC Company Code 70670 7 Federal Employees Health Benefits Plan 119,443 118,517 118,855 118,745 118,673 1,425,306 8 9 10 Title XVIII Medicare Title XIX Medicaid Other .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... ............ ............ ............ ............ ............ ................... ................... ................... ................... ................... ............ ............ ............ ............ ............ .......... .......... .......... .......... .......... . . . . . . . . . . . . . 3,192 . . . . . . . . . . . . . . . . . 78 . . . . . . . . . . . . . . . . . 77 . . . . . . . . . . . . . . . . . 78 . . . . . . . . . . . . . . . . . 80 ................... ................... ................... ................... ................... .......... .......... .......... .......... .......... ........ ........ ........ .......... 61,894 61,807 61,515 61,360 60,885 738,351 148,777 175,505 178,410 171,414 170,060 2,102,128 ................... ........ ........ ............... 940 ................... ........ ................... ................... . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,169,712 . . . . . . . . . . . . . . . . . . . . . . . 132,063 . . . . . . . . . . 387,236 . . . . . . . . . . . . . ................... ................... ................... ................... ................... .......... ................... ................... ................... ................... ................... ................... ................... 1,556,948 52,992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13,336 . . . . . . . 30,748,911 . . . . . 732,788,011 ................... ................... 4,100 2,252 . . . . . . . . . . . . . 6,352 . . . . . . . . . . . . . . . 912 . . . . . . . . . . . . . . . 155 . . . . . . . . . . 782,409 ................... ....... 4,464,942 1,551,506 . . . . . . . . 6,016,448 . . . . . . . . . . 273,466 . . . . . . . . . . . . 61,738 . . . 3,164,081,906 . . . . . . . . 1,080,736 . . . . . . . . 1,247,529 . . . . . . . . . . . . . . . . . . . . 353,603 . . . . . . . . . . 430,964 . . . . . . . . . . 1,678,493 52,880 . . . . . . . . . . . . 17,197 . . . . . . . . . . . . 13,251 . . . 1,153,065,993 . . . 1,057,350,953 962,865 245,388 . . . . . . . . 1,208,253 . . . . . . . . . . . . 97,729 . . . . . . . . . . . . 17,799 . . . . . 133,990,048 ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ....... ................... ....... ................... ................... ................... ................... ................... ................... ....... ....... ........ ........ ... 3,143,609,347 ................... ... ... 2,364,682,952 2,357,975,128 ........ 1,434,339 ........ . . . . . . . . . . . . 68,953 . . . . . . . . . . . . ... 1,153,197,351 ................... ..... ..... 762,908,879 768,015,280 ... 1,045,879,591 ................... ..... ..... 769,390,439 757,237,389 ..... 134,158,062 ................... ..... ..... 106,766,099 107,070,307 ................... 132,063 30,769,750 19,635,669 19,342,044 (a) For health business: number of persons insured under PPO managed care products .........472,868 and number of persons insured under indemnity only products ..........61,193. (b) For health premiums written: amount of Medicare Title XVIII exempt from state taxes or fees $.........782,409 ........ ............ ..... 724,354,315 ................... ..... ..... 660,549,376 666,101,801 .......... 791,560 ................... . . . . . . . . 3,173,460 . . . . . . . . . . . . . . . . . . . . . . . . . . (2,570,724) . . . . . . . . . . . . . . . . . . . ....... ....... 55,355,581 54,458,718 42,259,030 42,779,030 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201843038100 2018 Document Code: 430 EXHIBIT OF PREMIUMS, ENROLLMENT AND UTILIZATION (a) NAIC Group Code 0917 REPORT FOR: 1. CORPORATION: Health Care Service Corporation, a Mutual Legal Reserve Company BUSINESS IN THE STATE OF OREGON DURING THE YEAR 1 Comprehensive (Hospital & Medical) 2 3 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 Oregon 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 . . . . . . Individual 188 192 209 217 227 2,490 Group 2. LOCATION: NAIC Company Code 70670 4 5 6 Medicare Supplement Vision Only Dental Only ............... ............... ............... ............... ............... . . . . . . . . . . . . . . . . . 10 . . . . . . . . . . . . . . . . . 11 . . . . . . . . . . . . . . . . . 14 . . . . . . . . . . . . . . . . . 14 . . . . . . . . . . . . . . . . . 13 ................... ................... ................... ................... ................... ............... ............... ............... ............... ............... ................... ................... ................... ................... ................... ............. ............... 154 ................... ............. 174 177 191 199 210 2,288 ................... 4 4 4 4 4 . . . . . . . . . . . . . . . . . 48 2,748 1,440 . . . . . . . . . . . . . 4,188 . . . . . . . . . . . . . . . 321 . . . . . . . . . . . . . . . . . 63 . . . . . . . . . . 317,050 . . . . . . . . . . . . . . . 126 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 . . . . . . . . . . . . . . . . . . . ............. ............. . . . . . . . . . . . . 14,677 . . . . . . . . . . . . . . . . . . . 2,622 1,299 . . . . . . . . . . . . . 3,921 . . . . . . . . . . . . . . . 321 . . . . . . . . . . . . . . . . . 63 . . . . . . . . . . 302,374 ................... ................... ................... ................... ................... ................... ............. ............. .......... 317,050 ................... .......... .......... 428,398 429,745 ............... 203 ................... ................... ................... ................... ................... 10 Title XVIII Medicare Title XIX Medicaid Other ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... . . . . . . . . . . . . . . . . . 64 . . . . . . . . . . . . . . . . . . . ................... ................... ................... ................... ................... ................... ................... . . . . . . . . . . . . . . . . . 64 . . . . . . . . . . . . . . . . . . . ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ............. ............. ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... . . . . . . . . . . . . 32,415 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32,503 . . . . . . . . . . . . . . . . . . . 9 ................... ................... ................... ................... ................... .......... ................... 8 ................... ................... ................... ................... ................... . . . . . . . . . . . . 14,677 . . . . . . . . . . . . . . . . . . . .......... .......... 302,374 388,967 390,481 .................. .................. .................. .................. .................. 7 Federal Employees Health Benefits Plan (a) For health business: number of persons insured under PPO managed care products ..............13 and number of persons insured under indemnity only products .............210. (b) For health premiums written: amount of Medicare Title XVIII exempt from state taxes or fees $...............0 7,016 6,761 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201843039100 2018 Document Code: 430 EXHIBIT OF PREMIUMS, ENROLLMENT AND UTILIZATION (a) NAIC Group Code 0917 REPORT FOR: 1. CORPORATION: Health Care Service Corporation, a Mutual Legal Reserve Company BUSINESS IN THE STATE OF PENNSYLVANIA DURING THE YEAR 1 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 Pennsylvania 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 5 6 Medicare Supplement Vision Only Dental Only NAIC Company Code 70670 7 Federal Employees Health Benefits Plan Total Individual 1,991 1,946 1,971 2,009 2,050 . . . . . . . . . . . . 23,869 .................. 9 .................. 9 . . . . . . . . . . . . . . . . . 11 . . . . . . . . . . . . . . . . . 12 . . . . . . . . . . . . . . . . . 10 ................... ................... ................... ................... ................... ............... ............... ............... ............... ............... ................... ................... ................... ................... ................... 123 ................... ............. 183 173 172 164 169 2,033 ................... 4 5 6 7 6 . . . . . . . . . . . . . . . . . 68 3,674 1,417 . . . . . . . . . . . . . 5,091 . . . . . . . . . . . . . . . 728 . . . . . . . . . . . . . . . 141 . . . . . . . . 1,036,389 . . . . . . . . . . . . . . . . . 34 . . . . . . . . . . . . . . . . . . . .................. 6 ................... ............. ............. . . . . . . . . . . . . 41,699 . . . . . . . . . . . . . . . . . . . 3,640 1,406 . . . . . . . . . . . . . 5,046 . . . . . . . . . . . . . . . 728 . . . . . . . . . . . . . . . 141 . . . . . . . . . . 402,395 ................... ................... ................... ................... ................... ................... ............. ............. ............. ............. ............. ............. ............. ........ 1,036,389 ................... ............... Group 4 2. LOCATION: . . . . . . . . . . . . . . . . . 40 . . . . . . . . . . . . . . . . . . . ................... ................... ................... ................... 10 Title XVIII Medicare Title XIX Medicaid Other ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... 1,795 1,759 1,782 1,826 1,865 . . . . . . . . . . . . 21,645 ................... ................... ................... ................... .................. 5 ................... ................... ................... ................... ................... ................... ................... ................... .................. ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ............... ................... ................... ................... .......... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ............... ................... ................... ................... .......... ................... ................... ................... ................... ................... ................... ................... ................... ............... ............... ................... ................... ................... ................... ................... ................... .......... .......... .......... ................... ................... . . . . . . . . . . 884,420 . . . . . . . . . . . . 11,635 . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,454,532 . . . . . . . . . . . . . 6,481 . . . . . . . . . . . . . . . . . . . 9 ................... ................... ................... ................... ................... . . . . . . . . . . . . 41,699 . . . . . . . . . . . . . . . . . . . ................... 8 .......... .......... 402,395 520,570 523,373 .................. .................. .................. .................. .................. (a) For health business: number of persons insured under PPO managed care products ..............10 and number of persons insured under indemnity only products .............169. (b) For health premiums written: amount of Medicare Title XVIII exempt from state taxes or fees $...............0 5 834 834 517 449 ............. ............. ............. ............. ............. 591,461 591,461 351,699 924,230 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201843041100 2018 Document Code: 430 EXHIBIT OF PREMIUMS, ENROLLMENT AND UTILIZATION (a) NAIC Group Code 0917 REPORT FOR: 1. CORPORATION: Health Care Service Corporation, a Mutual Legal Reserve Company BUSINESS IN THE STATE OF SOUTH CAROLINA DURING THE YEAR 1 Comprehensive (Hospital & Medical) 2 3 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 South Carolina 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 . . . . . . Individual 317 303 311 311 315 3,725 Group 2. LOCATION: NAIC Company Code 70670 4 5 6 Medicare Supplement Vision Only Dental Only ............... ............... ............... ............... ............... . . . . . . . . . . . . . . . . . 49 . . . . . . . . . . . . . . . . . 40 . . . . . . . . . . . . . . . . . 36 . . . . . . . . . . . . . . . . . 33 . . . . . . . . . . . . . . . . . 36 ................... ................... ................... ................... ................... ............... ............... ............... ............... ............... ................... ................... ................... ................... ................... ............. ............... 444 ................... ............. 259 258 270 273 273 3,214 ................... 9 5 5 5 6 . . . . . . . . . . . . . . . . . 67 ............. ............. .................. .................. .................. .................. .................. 7 Federal Employees Health Benefits Plan 8 9 10 Title XVIII Medicare Title XIX Medicaid Other ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... . . . . . . . . . . . . . . . . . 14 . . . . . . . . . . . . . . . . . . . ................... ................... ................... ................... ................... ................... ................... . . . . . . . . . . . . . . . . . 14 . . . . . . . . . . . . . . . . . . . ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... 4,860 2,685 . . . . . . . . . . . . . 7,545 . . . . . . . . . . . . . . . 693 . . . . . . . . . . . . . . . 123 . . . . . . . . . . 682,634 ............... ............... 257 179 . . . . . . . . . . . . . . . 436 . . . . . . . . . . . . . . . . . 36 .................. 2 . . . . . . . . . . 188,645 ................... ................... ................... 4,603 2,492 . . . . . . . . . . . . . 7,095 . . . . . . . . . . . . . . . 657 . . . . . . . . . . . . . . . 121 . . . . . . . . . . 493,990 ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... .......... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... .......... .......... ................... ................... ............. ............. ................... ................... ................... ................... ................... ................... ................... ................... ............. ............. .......... 682,634 ................... .......... .......... 782,656 763,173 .......... 188,645 ................... .......... .......... 175,185 139,638 ................... ................... ................... 493,990 605,931 622,067 (a) For health business: number of persons insured under PPO managed care products ..............36 and number of persons insured under indemnity only products .............273. (b) For health premiums written: amount of Medicare Title XVIII exempt from state taxes or fees $...............0 1,541 1,468 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201843043100 2018 Document Code: 430 EXHIBIT OF PREMIUMS, ENROLLMENT AND UTILIZATION (a) NAIC Group Code 0917 REPORT FOR: 1. CORPORATION: Health Care Service Corporation, a Mutual Legal Reserve Company BUSINESS IN THE STATE OF TENNESSEE DURING THE YEAR 1 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 Total Individual . . . . . . . . . . . . 10,307 . . . . . . . . . . . . 11,277 . . . . . . . . . . . . 11,065 . . . . . . . . . . . . 11,351 . . . . . . . . . . . . 11,707 . . . . . . . . . . . . . . . . . 56 . . . . . . . . . . . . . . . . . 51 . . . . . . . . . . . . . . . . . 51 . . . . . . . . . . . . . . . . . 50 . . . . . . . . . . . . . . . . . 49 .......... 135,754 ............... Group 7,785 8,321 8,203 8,174 8,370 610 . . . . . . . . . . . . 99,386 . . . . . . . . . . . . 55,963 . . . . . . . . . . . . . . . . . . . . . . . . . . . 34,954 . . . . . . . . . . . . . . . ............. ............. ............. ............. ............. 2. LOCATION: NAIC Company Code 70670 4 5 6 Medicare Supplement Vision Only Dental Only ............... ............... ............... ............... ............... ................... ................... ................... ................... ................... ............. 490 477 487 523 559 6,068 ................... 1,976 2,428 2,324 2,604 2,729 . . . . . . . . . . . . 29,690 ............. ............. ............. ............. ............. 7 Federal Employees Health Benefits Plan 8 9 10 Title XVIII Medicare Title XIX Medicaid Other ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ............ ............ 47,421 28,127 . . . . . . . . . . . . 75,548 . . . . . . . . . . . . . 3,677 . . . . . . . . . . . . . . . 745 . . . . . . . 41,281,097 ............. ............. 8,283 4,086 . . . . . . . . . . . . 12,369 . . . . . . . . . . . . . 1,288 . . . . . . . . . . . . . . . 223 . . . . . . . . 1,034,894 ................... ................... ................... ................... . . . . . . . . . . . . . 2,635 . . . . . . . . . . . . . . . . . . . ................... ............. ................... ................... ................... ................... 5,030 . . . . . . . . . . . . . . . 971 . . . . . . . 43,378,731 259 106 . . . . . . . . . . . . . . . 365 . . . . . . . . . . . . . . . . . 65 .................. 3 . . . . . . . . . . 157,396 ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... .......... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... .......... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... .......... .......... ................... ................... ................... ................... ................... ................... ................... ................... . . . . . . . . . . . . 90,917 ............. ....... 43,378,731 ................... ....... ....... 34,799,015 34,967,572 .......... 157,396 ................... .......... .......... 100,443 100,117 ....... 41,281,097 ................... ....... ....... 33,110,992 33,248,536 ........ 1,034,894 ................... ........ ........ 1,093,394 1,111,070 (a) For health business: number of persons insured under PPO managed care products ...........8,404 and number of persons insured under indemnity only products .............574. (b) For health premiums written: amount of Medicare Title XVIII exempt from state taxes or fees $...............0 2,635 905,344 905,344 494,186 507,849 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201843044100 2018 Document Code: 430 EXHIBIT OF PREMIUMS, ENROLLMENT AND UTILIZATION (a) NAIC Group Code 0917 REPORT FOR: 1. CORPORATION: Health Care Service Corporation, a Mutual Legal Reserve Company BUSINESS IN THE STATE OF TEXAS DURING THE YEAR 1 Comprehensive (Hospital & Medical) 2 3 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 Texas 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 . . . . . . 3,117,770 3,262,045 3,270,356 3,262,844 3,319,933 . . . . . . . 39,303,579 ........ ........ ........ ........ ........ Individual 427,201 437,477 412,724 396,105 378,994 4,959,199 .......... .......... .......... .......... .......... ........ Group 1,160,880 1,174,528 1,183,371 1,192,016 1,243,167 . . . . . . . 14,314,786 ........ ........ ........ ........ ........ 4 5 6 Medicare Supplement Vision Only Dental Only 161,721 163,248 163,484 164,630 164,650 1,967,482 2. LOCATION: 343,272 370,553 376,654 382,915 399,024 4,580,552 NAIC Company Code 70670 7 Federal Employees Health Benefits Plan 8 9 10 Title XVIII Medicare Title XIX Medicaid Other .......... .......... .......... .......... .......... ................... ................... ................... ................... ................... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... ................... ................... ................... ................... ................... ............ ............ ............ ............ ............ .......... .......... .......... .......... .......... ........ ................... ........ ........ 422,400 423,011 421,794 421,337 421,733 5,067,167 ................... .......... ........ ................... ................... .......... .......... . . . . . . . 17,534,606 . . . . . . . . 2,688,077 . . . . . . . . . . . . . . . . 6,341,377 . . . . . . . . . . 992,191 . . . . . . . . . . . . . . . . 2,785,501 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 581,510 . . . . . . . . . . . . . . . . . . . ........ 3,367,011 198,159 . . . . . . . . . . . . 35,637 . . . . . 385,988,527 ................... .......... ................... ................... 4,246,122 1,360,241 . . . . . . . . . . 495,571 . . . . . . . . 5,606,363 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181,687 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47,852 . . . . . 133,072,759 . . . 2,849,476,235 41,526 41,374 46,950 46,290 45,862 536,797 560,770 651,854 665,379 659,551 666,503 7,877,596 ....... 23,875,983 990,132 . . . . . . . . . . 209,626 . . 13,433,506,918 ........ .......... .......... 3,680,268 214,807 . . . . . . . . . . . . 34,903 . . . 2,835,155,070 7,564,894 2,607,446 . . . . . . . 10,172,340 . . . . . . . . . . 371,508 . . . . . . . . . . . . 84,984 . . . 6,665,843,908 ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ..... ................... ..... ................... ................... ................... ................... ................... ................... ....... ....... ................... ................... ..... ..... .. 13,437,494,873 ................... .. .. 11,077,665,660 11,162,760,100 ... 2,767,154,317 ................... ... ... 2,075,899,864 2,087,696,538 ... 6,681,878,609 ................... ... ... 5,478,526,466 5,514,822,071 ..... 384,936,802 ................... ..... ..... 290,147,777 291,661,894 ................... ................... ........ . . . . . . . . . . 495,571 . . . . . . . . 133,979,975 89,639,614 90,136,351 (a) For health business: number of persons insured under PPO managed care products .......1,622,457 and number of persons insured under indemnity only products .........167,174. (b) For health premiums written: amount of Medicare Title XVIII exempt from state taxes or fees $...............0 ... 2,911,029,282 ................... ... ... 2,677,379,230 2,712,896,712 ................... ................... ................... 250,012 304,418 . . . . . . . . . . 554,430 . . . . . . . . . . . . 23,971 . . . . . . . . . . . . . 6,250 . . . . . 257,953,088 ................... ................... ................... 257,953,088 258,974,725 264,020,007 ................... ................... ................... ..... ..... 306,017,333 300,562,799 ................... ..... ..... 207,097,984 201,526,527 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201843045100 2018 Document Code: 430 EXHIBIT OF PREMIUMS, ENROLLMENT AND UTILIZATION (a) NAIC Group Code 0917 REPORT FOR: 1. CORPORATION: Health Care Service Corporation, a Mutual Legal Reserve Company BUSINESS IN THE STATE OF UTAH DURING THE YEAR 1 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 Utah 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 Total Individual Group 4,754 4,794 4,225 4,511 4,650 . . . . . . . . . . . . 55,066 . . . . . . . . . . . . . . . . . 29 . . . . . . . . . . . . . . . . . 25 . . . . . . . . . . . . . . . . . 24 . . . . . . . . . . . . . . . . . 25 . . . . . . . . . . . . . . . . . 21 NAIC Company Code 70670 4 5 6 Medicare Supplement Vision Only Dental Only 7 Federal Employees Health Benefits Plan 8 9 10 Title XVIII Medicare Title XIX Medicaid Other . . . . . . . . . . . . . . . . . 85 . . . . . . . . . . . . . . . . . 82 . . . . . . . . . . . . . . . . . 83 . . . . . . . . . . . . . . . . . 87 . . . . . . . . . . . . . . . . . 91 ................... ................... ................... ................... ................... . . . . . . . . . . . . . 1,144 . . . . . . . . . . . . . 1,038 . . . . . . . . . . . . . . . 783 . . . . . . . . . . . . . . . 895 . . . . . . . . . . . . . . . 951 ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... 1,019 ................... ............ 11,470 ................... ................... ................... ................... . . . . . . . . . . . . 16,027 . . . . . . . . . . . . . . . . . 76 . . . . . . . . . . . . 14,544 . . . . . . . . . . . . . 1,407 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11,494 . . . . . . . . . . . . . . . . . 23 . . . . . . . . . . . . . 8,970 . . . . . . . . . . . . . . . 561 . . . . . . . . . . . . . . . . . . . ................... ................... . . . . . . . . . . . . . 1,940 . . . . . . . . . . . . . . . . . . . ................... ................... ................... ................... ................... ................... . . . . . . . . . . . . 27,521 . . . . . . . . . . . . . . . . . 99 . . . . . . . . . . . . 23,514 936 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 277 . . . . . . . . . . . . 18,900 . . . . . . . 15,722,899 ............. ............. ................... ................... ................... ................... ................... 1,968 218 . . . . . . . . . . . . . . . . . 27 . . . . . . . . . . 120,333 ................... 1,154 . . . . . . . . . . . . . . . 304 . . . . . . . 16,177,309 ............... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... .......... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... .......... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... .......... .......... ................... ................... ................... ................... ................... ................... ................... ................... ............. ............. ............. ............. ............. ............. ....... 16,177,309 ................... ....... ....... 12,393,077 12,308,181 ............... 3,496 3,649 3,335 3,504 3,587 283 . . . . . . . . . . . . 42,294 2. LOCATION: ............. ............. ............. ............. ............. ............... . . . . . . . . . . . . 18,900 . . . . . . . ................... 15,722,899 ................... . . . . . . . . . . . . 42,016 . . . . . . . . . . . . . . . . . . . 36,570 . . . . . . . 11,766,489 11,685,936 ............. .......... 120,333 ................... .......... .......... 180,220 179,543 (a) For health business: number of persons insured under PPO managed care products ...........3,604 and number of persons insured under indemnity only products ..............95. (b) For health premiums written: amount of Medicare Title XVIII exempt from state taxes or fees $...............0 1,940 315,177 315,177 404,352 406,131 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201843047100 2018 Document Code: 430 EXHIBIT OF PREMIUMS, ENROLLMENT AND UTILIZATION (a) NAIC Group Code 0917 REPORT FOR: 1. CORPORATION: Health Care Service Corporation, a Mutual Legal Reserve Company BUSINESS IN THE STATE OF VIRGINIA DURING THE YEAR 1 Comprehensive (Hospital & Medical) 2 3 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 Virginia 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 . . . . . . Individual 252 250 269 261 269 3,118 Group 2. LOCATION: NAIC Company Code 70670 4 5 6 Medicare Supplement Vision Only Dental Only 7 Federal Employees Health Benefits Plan 8 9 10 Title XVIII Medicare Title XIX Medicaid Other ............... ............... ............... ............... ............... . . . . . . . . . . . . . . . . . 23 . . . . . . . . . . . . . . . . . 21 . . . . . . . . . . . . . . . . . 24 . . . . . . . . . . . . . . . . . 20 . . . . . . . . . . . . . . . . . 22 ................... ................... ................... ................... ................... ............... ............... ............... ............... ............... ................... ................... ................... ................... ................... . . . . . . . . . . . . . . . . . 12 . . . . . . . . . . . . . . . . . 10 . . . . . . . . . . . . . . . . . 10 .................. 8 .................. 6 ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ............. ............... 255 ................... ............. 217 219 235 233 241 2,756 ................... ............... 107 ................... ................... ................... ................... 4,758 1,979 . . . . . . . . . . . . . 6,737 . . . . . . . . . . . . . . . 601 . . . . . . . . . . . . . . . 127 . . . . . . . . . . 697,805 . . . . . . . . . . . . . . . 128 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 . . . . . . . . . . . . . . . . . . . ............. ............. ................... ................... ................... ................... . . . . . . . . . . . . . . . . . 45 . . . . . . . . . . . . . . . . . . . ................... ................... ................... ................... ................... ................... ................... . . . . . . . . . . . . . . . . . 45 . . . . . . . . . . . . . . . . . . . ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ............... ................... ................... ................... ................... ............... 198 2 .................. 1 . . . . . . . . . . 100,879 ................... .................. ................... ................... 4,630 1,864 . . . . . . . . . . . . . 6,494 . . . . . . . . . . . . . . . 599 . . . . . . . . . . . . . . . 126 . . . . . . . . . . 596,091 ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... .......... ................... ............... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... .......... .......... ................... ................... ............. ............. ................... ................... ................... ................... ................... ................... ................... ................... ............. ............. .......... 697,805 ................... .......... .......... 739,422 753,460 .......... 100,879 ................... .......... .......... 138,083 135,016 ................... 596,091 597,711 614,879 (a) For health business: number of persons insured under PPO managed care products ..............22 and number of persons insured under indemnity only products .............241. (b) For health premiums written: amount of Medicare Title XVIII exempt from state taxes or fees $...............0 835 835 3,629 3,566 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201843049100 2018 Document Code: 430 EXHIBIT OF PREMIUMS, ENROLLMENT AND UTILIZATION (a) NAIC Group Code 0917 REPORT FOR: 1. CORPORATION: Health Care Service Corporation, a Mutual Legal Reserve Company BUSINESS IN THE STATE OF WEST VIRGINIA DURING THE YEAR 1 Comprehensive (Hospital & Medical) 2 3 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 West Virginia 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 . . . . . . Individual . . . . . . . . . . . . . . . . . 32 . . . . . . . . . . . . . . . . . 28 . . . . . . . . . . . . . . . . . 28 . . . . . . . . . . . . . . . . . 29 . . . . . . . . . . . . . . . . . 28 Group 5 6 Medicare Supplement Vision Only Dental Only ................... ................... ................... ................... ................... . . . . . . . . . . . . . . . . . 20 . . . . . . . . . . . . . . . . . 16 . . . . . . . . . . . . . . . . . 16 . . . . . . . . . . . . . . . . . 17 . . . . . . . . . . . . . . . . . 16 ................... ................... ................... ................... ................... ................... ............... 200 280 116 . . . . . . . . . . . . . . . 396 . . . . . . . . . . . . . . . . . 47 . . . . . . . . . . . . . . . . . 10 . . . . . . . . . . . . 64,964 .................. 2 ................... ................... ................... ............... ............... NAIC Company Code 70670 7 Federal Employees Health Benefits Plan 8 9 10 Title XVIII Medicare Title XIX Medicaid Other ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... 5 5 5 5 5 . . . . . . . . . . . . . . . . . 60 ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... . . . . . . . . . . . . 22,513 . . . . . . . . . . . . . . . . . . . 278 116 . . . . . . . . . . . . . . . 394 . . . . . . . . . . . . . . . . . 47 . . . . . . . . . . . . . . . . . 10 . . . . . . . . . . . . 42,451 ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... . . . . . . . . . . . . . . . (25) . . . . . . . . . . . . . . . . . . . ................... ................... ................... ................... ................... ................... ............... 7 7 7 7 7 343 . . . . . . . . . . . . . . . . . 83 4 2. LOCATION: ............... ............... .................. .................. .................. .................. .................. .................. 2 ................... ................... ................... ................... ................... . . . . . . . . . . . . 64,964 . . . . . . . . . . . . 22,513 . . . . . . . . . . . . . . . . . . . ............ ................... ................... ................... ................... ................... ............ ............ ................... . . . . . . . . . . . . 63,968 . . . . . . . . . . . . . . . . . . . . . . . . . 65,146 . . . . . . . . . . . . . 3,037 3,353 42,451 60,931 61,818 .................. .................. .................. .................. .................. (a) For health business: number of persons insured under PPO managed care products ...............7 and number of persons insured under indemnity only products ..............16. (b) For health premiums written: amount of Medicare Title XVIII exempt from state taxes or fees $...............0 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201843050100 2018 Document Code: 430 EXHIBIT OF PREMIUMS, ENROLLMENT AND UTILIZATION (a) NAIC Group Code 0917 REPORT FOR: 1. CORPORATION: Health Care Service Corporation, a Mutual Legal Reserve Company BUSINESS IN THE STATE OF WISCONSIN DURING THE YEAR 1 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 Wisconsin 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 5 6 Medicare Supplement Vision Only Dental Only Individual 1,524 1,511 1,517 1,540 1,556 . . . . . . . . . . . . 18,304 . . . . . . . . . . . . . . . 128 . . . . . . . . . . . . . . . 106 . . . . . . . . . . . . . . . . . 99 . . . . . . . . . . . . . . . . . 91 . . . . . . . . . . . . . . . . . 96 ................... ................... ................... ................... ................... 1,194 ................... 1,373 1,384 1,397 1,429 1,444 . . . . . . . . . . . . 16,874 . . . . . . . . . . . . 22,020 . . . . . . . . . . . . . . . . . . . . . . . . . . . 10,316 . . . . . . . . . . . . . . . ................... ................... . . . . . . . . . . . . 32,336 ................... ............ 3,678 . . . . . . . . . . . . . . . 756 . . . . . . . . 4,076,548 679 352 . . . . . . . . . . . . . 1,031 . . . . . . . . . . . . . . . . . 43 .................. 7 . . . . . . . . . . 477,870 ................... ............. ................... ................... ............. ........ 4,076,548 ................... ........ ........ 4,514,028 4,378,851 NAIC Company Code 70670 4 Total ............. ............. ............. ............. ............. Group 2. LOCATION: 7 Federal Employees Health Benefits Plan 8 9 10 Title XVIII Medicare Title XIX Medicaid Other ................... ................... ................... ................... ................... . . . . . . . . . . . . . . . . . 23 . . . . . . . . . . . . . . . . . 21 . . . . . . . . . . . . . . . . . 21 . . . . . . . . . . . . . . . . . 20 . . . . . . . . . . . . . . . . . 16 ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ............... 236 ................... ................... ................... ................... . . . . . . . . . . . . 21,341 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9,808 . . . . . . . . . . . . . . . . . . . ................... ................... . . . . . . . . . . . . . . . 156 . . . . . . . . . . . . . . . . . . . ................... ................... ................... ................... ................... ................... ................... ............... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... 31,149 3,635 . . . . . . . . . . . . . . . 749 . . . . . . . . 3,595,928 ................... ............. ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ........ ................... ............. ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ............ ............ ................... ................... ................... ................... ................... ................... ................... ................... ............. .......... 477,870 ................... ................... . . . . . . . . 1,026,176 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 820,114 . . . . . . . . . . . . . . . . . . . ............. ............. ............. ............. ............. ........ ........ 3,595,928 3,469,219 3,540,574 (a) For health business: number of persons insured under PPO managed care products ..............96 and number of persons insured under indemnity only products ...........1,444. (b) For health premiums written: amount of Medicare Title XVIII exempt from state taxes or fees $...............0 156 2,750 2,750 18,633 18,163 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201843058100 2018 Document Code: 430 EXHIBIT OF PREMIUMS, ENROLLMENT AND UTILIZATION (a) NAIC Group Code 0917 REPORT FOR: 1. CORPORATION: 2. LOCATION: ACA Risk Adjustment and ACA Risk Corridor, Net BUSINESS IN THE STATE OF OTHER FOREIGN TOTAL DURING THE YEAR 1 Comprehensive (Hospital & Medical) 2 3 Group 4 5 6 Medicare Supplement Vision Only Dental Only 7 Federal Employees Health Benefits Plan NAIC Company Code 70670 8 9 10 Title XVIII Medicare Title XIX Medicaid Other Total Individual ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... 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 Other Foreign 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 . . . . . . ..... 922,141,880 ..... 850,385,855 ....... 71,756,025 ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ..... 922,141,880 ..... 850,385,855 ....... 71,756,025 ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... (a) For health business: number of persons insured under PPO managed care products ...............0 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 $...............0 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201843059100 2018 Document Code: 430 EXHIBIT OF PREMIUMS, ENROLLMENT AND UTILIZATION (a) NAIC Group Code 0917 REPORT FOR: 1. CORPORATION: Health Care Service Corporation, a Mutual Legal Reserve Company BUSINESS IN THE STATE OF GRAND TOTAL DURING THE YEAR 1 Comprehensive (Hospital & Medical) 2 3 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 . . . . . . 8,437,074 8,763,308 8,778,222 8,754,001 8,816,211 105,450,910 ........ ........ ........ ........ ........ ..... Individual Group 911,269 955,798 911,185 880,803 847,887 . . . . . . . 10,943,795 ........ ........ ........ ........ ........ .......... .......... .......... .......... .......... 2,916,013 2,935,305 2,939,582 2,970,708 3,059,102 . . . . . . . 35,603,863 4 5 6 Medicare Supplement Vision Only Dental Only 639,224 641,305 639,886 640,328 637,817 7,688,986 Title XIX Medicaid Other 139,524 104,981 105,932 106,312 105,461 1,269,135 416,162 474,526 502,701 470,654 442,244 5,753,783 .......... .......... .......... .......... .......... ........ ................... ........ ........ ........ ........ ................... 29,236,764,069 29,250,808,942 Title XVIII Medicare .......... .......... .......... .......... .......... ................... .. .. 10 .......... .......... .......... .......... .......... . . . . . . . 21,339,134 . . . . . . . 10,833,138 . . . . . . . . . . . . . . . . . . . . . . . . . . . 9,501,984 . . . . . . . . 2,789,771 . . . . . . . . . . . . . . . . . . . ................... 9 .......... .......... .......... .......... .......... 5,991,551 2,336,929 . . . . . . . . 8,328,480 . . . . . . . . . . 469,237 . . . . . . . . . . . . 90,259 . . . 7,455,600,402 35,990,164,668 795,150 789,921 788,243 787,099 787,334 9,464,614 8 ................... ................... ................... ................... ................... ........ ........ .. 766,685 817,139 816,881 834,608 859,417 9,980,576 NAIC Company Code 70670 7 Federal Employees Health Benefits Plan .......... .......... .......... .......... .......... 51,525,353 21,419,042 . . . . . . . 72,944,395 . . . . . . . . 4,820,744 . . . . . . . . . . 787,671 . . 36,033,735,818 ....... ....... 2. LOCATION: 1,853,047 2,044,333 2,073,812 2,063,489 2,076,949 . . . . . . . 24,746,158 ........ ........ ........ ........ ........ ....... 30,841,118 909,977 . . . . . . . . . . 221,745 . . 16,556,376,978 ....... 13,622,909 1,051,228 . . . . . . . . . . 186,722 . . . 1,613,857,004 ................... .......... ........ ................... ................... 7,723,572 2,604,998 . . . . . . . . 1,087,536 . . . . . . . 10,328,570 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 349,776 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90,924 . . . . . 293,865,643 . . . 5,171,891,211 ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ..... ................... ................... ................... ................... ..... ..... ... 7,392,356,457 ................... ... ... 4,736,028,873 4,728,629,571 .. 16,502,694,658 ................... .. .. 13,542,100,954 13,497,780,570 ... 1,606,625,076 ................... ... ... 1,271,144,339 1,281,001,339 ................... ................... ........ . . . . . . . . 1,087,536 . . . . . . . . 294,835,646 194,286,721 194,964,721 (a) For health business: number of persons insured under PPO managed care products .......3,590,125 and number of persons insured under indemnity only products .........645,042. (b) For health premiums written: amount of Medicare Title XVIII exempt from state taxes or fees $...1,306,273,647 ... 5,262,146,770 ................... ... ... 4,820,967,791 4,883,294,655 . . . . . . . . 1,703,723 . . . . . . . . . . . . . . . . . . 930,255 . . . . . . . . ................... ................... 2,633,978 695,898 . . . . . . . . . . . . 60,971 . . . 1,306,273,647 3,934,235 2,167,569 . . . . . . . . 6,101,804 . . . . . . . . 1,344,628 . . . . . . . . . . 137,050 . . . 2,811,720,398 ................... ........ .......... ... 1,305,675,257 ................... ... ... 1,274,431,937 1,279,484,758 ... 2,811,720,398 ................... ... ... 2,743,856,657 2,761,807,293 ................... ................... ..... ..... 824,150,535 814,110,407 ................... ..... ..... 653,946,797 623,846,034 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company SCHEDULE S - PART 1 - SECTION 2 Reinsurance Assumed Accident and Health Insurance Listed by Reinsured Company as of December 31, Current Year 1 2 NAIC Company ID Code Number Affiliates - U.S. - Other 3 Effective Date 4 Name of Reinsured 5 6 7 Domiciliary Jurisdiction Type of Reinsurance Assumed Type of Business Assumed 11814 . . . . 73-1191843 . . . 01/01/2009 GHS HMO INC DBA BLUELINCS HMO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OK . . . . . . . . . OTH/G . . . . . . . . . . CMM . . . . . 78611 . . . . 73-1350270 . . . 01/01/2014 HCSC INS SERV CO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . IL . . . . . . . . . . OTH/I . . . . . . . . . . . . MC . . . . . . 0299999 Subtotal - Affiliates - U.S. - Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0399999 Subtotal - Affiliates - U.S. - Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0699999 Subtotal - Affiliates - Non-U.S. - Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0799999 Total - Affiliates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1199999 Total U.S. (Sum of 0399999 and 0899999) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1299999 Total Non-U.S. (Sum of 0699999 and 0999999) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9999999 Total (Sum of 0799999 and 1099999) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Premiums ....... ....... ....... ....... 2,325,856 2,867,284 5,193,140 5,193,140 ................... ....... ....... 5,193,140 5,193,140 ................... ....... 5,193,140 9 Unearned Premiums 10 Reserve Liability Other Than for Unearned Premiums 11 12 13 Reinsurance Payable on Paid and Unpaid Losses Modified Coinsurance Reserve Funds Withheld Under Coinsurance 112,000 1,378,000 1,490,000 1,490,000 ................... ................... ......... ................... ................... ................... ................... ....... ................... ................... ................... ................... ....... ................... ................... ................... ................... ....... ................... ................... ................... ................... ................... ................... ................... ................... ................... ....... ................... ................... ................... ................... ....... ................... ................... ................... ................... ................... ................... ................... ................... ................... ....... ................... ................... 1,490,000 1,490,000 1,490,000 31 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 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 70025 . . . . 91-6027719 . . . 10/11/1998 GENWORTH LIFE INS CO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DE . . . . . 00000 . . . . AA-9990032 . . . 01/01/2014 US Dept of Hlth & Human Serv . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DC . . . . 14421 . . . . 27-1595679 . . . 01/01/2017 EYEMED INS CO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . AZ . . . . . 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 Paid Losses 7 Unpaid Losses ................... ................... ................... ..... ....... ................... 1,040,713 ................... ....... ....... ....... ....... 1,040,713 1,040,713 1,040,713 1,040,713 ................... ....... 1,040,713 17,856,000 191,000 18,047,000 18,047,000 18,047,000 18,047,000 ......... ..... ..... ..... ..... ................... ..... 18,047,000 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 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 8 9 Premiums Unearned Premiums (Estimated) 10 Reserve Credit Taken Other than for Unearned Premiums 56,287,612 1,767,275 58,054,887 58,054,887 58,054,887 33 62553 . . . . 37-0808781 . . . 01/01/2003 COUNTRY LIFE INS CO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . IL . . . . . . . . OTH/G . . CMM . . . . . . . 70025 . . . . 91-6027719 . . . 10/01/1998 GENWORTH LIFE INS CO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DE . . . . . . . . OTH/G . . LTC . . . . . . . . . 0899999 Subtotal - General Account - Authorized - Non-Affiliates - U.S. Non-Affiliates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1099999 Total - General Account - Authorized - Non-Affiliates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1199999 Total - General Account Authorized . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . General Account - Unauthorized - Non-Affiliates - U.S. Non-Affiliates .... 14421 . . . . 27-1595679 . . . 01/01/2017 EYEMED INS CO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . AZ . . . . . . . . . QA/I . . . . OH . . . . . . . . . . 14421 . . . . 27-1595679 . . . 01/01/2017 EYEMED INS CO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . AZ . . . . . . . . QA/G . . . OH . . . . . . . . . . 1999999 Subtotal - General Account - Unauthorized - Non-Affiliates - U.S. Non-Affiliates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2199999 Total - General Account - Unauthorized - Non-Affiliates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2299999 Total - General Account - Unauthorized . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3499999 Total - General Account - 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Outstanding Surplus Relief 11 12 13 14 Funds Withheld Under Coinsurance Current Year Prior Year Modified Coinsurance Reserve .................. .................. ................. ................. .................. .................. ...... .................. .................. ................. ................. .................. .................. .... .................. .................. ................. ................. .................. .................. .................. .................. ................. ................. .................. .................. .................. .................. ................. ................. .................. .................. ...... 2,017,543 7,714,649 . . . . . . 9,732,191 . . . . . . 9,732,191 . . . . . . 9,732,191 . . . . 67,787,078 . . . . 67,787,078 .................. .................. ................. ................. .................. .................. ...... .................. .................. ................. ................. .................. .................. .................. .................. ................. ................. .................. .................. .................. .................. ................. ................. .................. .................. .................. .................. ................. ................. .................. .................. .................. .................. ................. ................. .................. .................. .................. .................. ................. ................. .................. .................. .................. .................. .................. ................. ................. .................. .................. .................. .................. ................. ................. .................. .................. .... .... .... 67,787,078 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company SCHEDULE S - PART 4 Reinsurance Ceded To Unauthorized Companies 1 2 3 4 NAIC Company ID Effective Code Number Date Name of Reinsurer 1199999 Total - General Account - Life and Annuity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 6 Reserve Credit Taken Paid and Unpaid Losses Recoverable (Debit) ............... ............... ............... ...... ............... ...... ............... ...... ............... ...... ............... ...... ............... 7 8 9 10 11 Issuing or Confirming Bank Reference Number (a) .... X X X ... Trust Agreements 12 Funds Deposited by and Withheld from Reinsurers 13 14 15 Sum of Cols. 9+11+12 +13+14 Miscellaneous But Not in Balances Excess (Credit) of Col. 8 ............... ............... ............... ............... ............... Totals (Cols. 5 + 6 + 7) Letters of Credit ............... ............... ............... 191,000 ............... ...... 191,000 ...... 550,000 .... 0001 .... ............... ............... ............... ............... ...... 191,000 191,000 191,000 191,000 191,000 ............... ...... ............... ............... ............... ............... ...... ... ............... ............... ............... ............... ...... ...... ... ............... ............... ............... ............... ...... ............... ...... ... ............... ............... ............... ............... ...... 191,000 191,000 191,000 191,000 ............... ............... ............... ............... .... ... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... .... ... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... .... ... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... .... XXX XXX XXX XXX XXX XXX XXX XXX ... ............... 550,000 550,000 550,000 550,000 .... ...... 191,000 191,000 191,000 191,000 ...... ............... ... ............... ............... ............... ............... ............... ............... ...... ............... ...... .... XXX ... ............... ............... ............... ............... ...... ............... ............... ............... ............... .... ............... ............... ............... ............... ............... ...... ............... ...... XXX XXX ... ............... ... ............... ............... ............... ............... ...... Other Debits Other General Account - Accident and Health - Non-Affiliates - U.S. Non-Affiliates 34 14421 . . . . 27-1595679 . . . . . . 01/01/2017 EYEMED INS CO . . . . . . . . . . . . . . . . . . . . . . . . . 1999999 Subtotal - General Account - Accident and Health - Non-Affiliates - U.S. Non-Affiliates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2199999 Total - General Account - Accident and Health - Non-Affiliates . . . . . . . . . . . . . . . . . . 2299999 Total - General Account - Accident and Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2399999 Total - General Account . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2699999 Subtotal - Separate Accounts - Affiliates - U.S. - Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2999999 Subtotal - Separate Accounts - Affiliates - Non-U.S. - Total . . . . . . . . . . . . . . . . . . . . . . 3099999 Total - Separate Accounts - Affiliates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3499999 Total - Separate Accounts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3599999 Total U.S. (Sum of 0399999, 0899999, 1499999, 1999999, 2699999 and 3199999) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3699999 Total Non-U.S. (Sum of 0699999, 0999999, 1799999, 2099999, 2999999 and 3299999) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9999999 Total (Sum of 2399999 and 3499999) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a) Issuing or Confirming Bank Reference Number .... 0001 .... Letters of Credit Code ...... 1 ...... American Bankers Association (ABA) Routing Number ... 026008536 ... 191,000 191,000 191,000 191,000 ...... ...... ...... ...... 550,000 ............... ...... 550,000 .... .... .... .... Issuing or Confirming Bank Name UniCredit S.p.A. .......................................................................................................................... Letters of Credit Amount . . . . . . . . . . . . . . 550,000 191,000 191,000 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 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 9999999 Total (Sum of 2399999 and 3499999) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a) Issuing or Confirming Bank Reference Number Letters of Credit Code American Bankers Association (ABA) Routing Number Paid and Unpaid Losses Recoverable (Debit) Other Debits Total Recoverable /Reserve Credit Taken (Col. 9 + 10 + 11) ........... ........... ........... 17 18 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 Letters of Credit Issuing or Confirming Bank Reference Number (a) ........... ........... ........... ........... ... XXX .. ........... Collateral 19 20 Other Total Collateral Provided (Col. 16 + 17 + 19 + 20 + 21) 23 Percent of Collateral Provided for Net Obligation Subject to Collateral (Col. 22 / Col. 14) 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 .. ... XXX .. 21 22 Trust Agreements Funds Deposited by and Withheld from Reinsurers ........... ........... NONE ............................................................................................................................................ ....................... 35 Issuing or Confirming Bank Name Letters of Credit Amount ............... ............... ..................... ........... ........... ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company SCHEDULE S - PART 6 Five-Year Exhibit of Reinsurance Ceded Business ($000 Omitted) 1 2018 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 2017 67,370 417 ............ 3 2016 67,882 2,608 ............ 76,354 4 2015 ........... 102,071 5 2014 ............ 85,836 ................ .............. ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... 3,311 . . . . . . . . . . . 120,094 .............. 3,132 . . . . . . . . . . . 376,450 .............. 3,364 . . . . . . . . . . . 955,613 .............. ..................... ..................... ..................... ..................... ..................... 18,047 . . . . . . . . . . . . . . 1,041 . . . . . . . . . . . . . . . . 459 ............ 16,476 . . . . . . . . . . . . 49,613 . . . . . . . . . . . . . . 1,319 ............ 47,723 . . . . . . . . . . . 332,546 . . . . . . . . . . . . 23,994 ............ 93,357 . . . . . . . . . . . 849,049 . . . . . . . . . . . . . . . . 330 ........... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... 3,402 57,953 .............. ............ ............ ................ 550 .............. ................ 550 ........... 3,323 962,278 130,246 792,422 . . . . . . . . . . . . . . . . 304 ........... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... 36 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company SCHEDULE S - PART 7 Restatement of Balance Sheet to Identify Net Credit For Ceded Reinsurance 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 1 As Reported (net of ceded) 2 Restatement Adjustments . 13,206,403,811 3,153,686,319 . . . . . . . . 1,040,713 ...... X X X ...... . 10,364,433,393 . 26,725,564,236 ..................... . ... ..................... ... ... 2,981,074,887 311,699,000 . . . . . 540,993,371 ....... ..... ..................... ..................... 2,999,121,887 311,699,000 . . . . . 540,993,371 ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... 6,032,457,905 . . . 9,866,225,164 . 16,859,339,073 . 26,725,564,236 .............. (459) . . . . . . . 18,046,541 ...... X X X ...... . . . . . . . 18,046,541 ... ... ....... 18,047,000 ..................... ..................... ........ 1,040,713 ..................... ....... 19,087,713 ..................... ..................... ..................... ..................... ..................... 459 459 . . . . . . . 19,087,254 ................ ................ 3 Restated (gross of ceded) 13,206,403,811 3,153,686,319 . . . . . . . (1,040,713) . . . . . . . . . . . . . . . . . . . 0 . . . . . . . 19,087,254 . . . . . . . 19,087,254 . . . . . . . . . . . . . . . . . . . . . . 10,364,433,393 . . . . . . . 18,046,541 . 26,743,610,777 18,047,000 ... ..... 6,032,457,446 9,884,271,705 16,859,339,073 26,743,610,777 ... . . ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company SCHEDULE T - PART 2 INTERSTATE COMPACT - EXHIBIT OF PREMIUMS WRITTEN ALLOCATED BY STATES AND TERRITORIES 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) Direct Business only 2 3 Disability Annuities Income (Group and (Group and Individual) Individual) 4 Long-Term Care (Group and Individual) 5 6 Deposit-Type Contracts Totals ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... 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..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ........ ..................... ........ 39 172,567 1,963,639 2,136,206 172,567 1,963,639 2,136,206 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company SCHEDULE Y PART 1A - DETAIL OF INSURANCE HOLDING COMPANY SYSTEM 1 Group Code 2 3 Group Name NAIC Company Code 4 ID Number 5 FEDERAL RSSD CIK 7 Name of Securities Exchange if Publicly Traded (U.S. or International) ........... 0000350793 ......................... ............. ......................... . 917 . HCSC GROUP ................ 70670 36-1236610 . 917 . HCSC GROUP ................ 71129 36-2598882 003857522 . 917 . ........ ........ 41 ........ HCSC GROUP ................ ................................. ................................. ................................. 85090 22-3026145 00000 36-3339483 00000 36-3339483 00000 38-2612298 ........... ........... ........... ........... 6 ............. ............. ............. ............. ......................... ......................... ......................... ......................... 8 9 10 Names of Parent, Subsidiaries or Affiliates Domiciliary Location Relationship to Reporting Entity HEALTH CARE SERVICE CORPORATION, A MUTUAL LEGAL RESERVE COMPANY . . . . . . . . . . . . . . . . . . . . DEARBORN NATIONAL LIFE INSURANCE COMPANY . . . . . . . . . . . . . . . . . .. ......................... HCSC PURCHASING, LLC ........ . 917 . ................................. HCSC GROUP ................ 00000 59-3715944 29718 73-1507369 ........... ........... ........... ............. ............. ............. ......................... ......................... ......................... .............. .. ............... .. HCSC INSURANCE SERVICES COMPANY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PRIME THERAPEUTICS LLC AVAILITY, LLC .. ......................... .. ............. 00000 26-0076803 DEARBORN NATIONAL LIFE INSURANCE Ownership, Board of COMPANY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Directors, Management DS ........... ................................. .. ... 00000 36-4186601 ........ DS . ................................. ......................... ... DE ........ ............. .. .. DENTAL SOLUTIONS, INC. ........... IL DENTAL NETWORK OF AMERICA, LLC ......................... 78611 73-1350270 .. HEALTH CARE SERVICE CORPORATION, Ownership, Board of A MUTUAL LEGAL RESERVE COMPANY . . Directors, Management .. ............. ................ . DS ........... HCSC GROUP UDP ... 00000 20-1067299 . .. . ................................. 917 .. NY ........ . IL .. DENTEMAX, LLC .. ............ .. ............................ .. GHS INSURANCE COMPANY 12 Type of Control (Ownership, Board, Management, Attorney-in-Fact, Influence, Other) .. DEARBORN NATIONAL LIFE INSURANCE COMPANY OF NEW YORK DENTAL NETWORK OF AMERICA, LLC 11 Directly Controlled by (Name of Entity / Person) ........... . DE DE . . ... ... DS DS .. .. ................................................. Ownership, Board of Directors, Management ... DS .. DENTEMAX, LLC DE ... DS .. HEALTH CARE SERVICE CORPORATION, Ownership, Board of A MUTUAL LEGAL RESERVE COMPANY . . Directors, Management . IL .. ... DS .. DE . ... DS .. DE OK . . ... ... DS DS .. .. 16 If Control is Ownership Provide Percentage Ultimate Controlling Entity(ies) / Person(s) Is an SCA Filing Required? (Y/N) * ................................ .... N .... ........ .... N .... ........ .... N .... ........ .... N .... ........ .... N .... 0000001 .... N .... ........ .... N .... 0000002 .... N .... ........ .... N .... ........ .... N .... ........ .... N .... ........ .... N .... ........ .... ..... .................. ..... MI . ............................. 15 .... ..... DEARBORN NATIONAL LIFE INSURANCE Board of Directors, COMPANY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Management . . . . . . . . . . . . . . . . .... 14 .............................. ........... HEALTH CARE SERVICE CORPORATION, A MUTUAL LEGAL RESERVE COMPANY . . Ownership DENTAL NETWORK OF AMERICA, LLC 13 HEALTH CARE SERVICE CORPORATION, Ownership, Board of A MUTUAL LEGAL RESERVE COMPANY . . Directors, Management .. ..... .... ..... .... ..... HEALTH CARE SERVICE CORPORATION, Ownership, Board of A MUTUAL LEGAL RESERVE COMPANY . . Directors . . . . . . . . . . . . . . . . . . . . HEALTH CARE SERVICE CORPORATION, Ownership, Board of A MUTUAL LEGAL RESERVE COMPANY . . Directors . . . . . . . . . . . . . . . . . . . . HEALTH CARE SERVICE CORPORATION, Ownership, Board of A MUTUAL LEGAL RESERVE COMPANY . . Directors, Management 100.0 100.0 ........... .... ..... Ownership, Management 100.0 100.0 100.0 100.0 100.0 ...... ...... .... ..... 39.9 21.7 100.0 HEALTH CARE SERVICE CORPORATION, A MUTUAL LEGAL RESERVE COMPANY . . . . . . . . . . . . . . . . . . . HEALTH CARE SERVICE CORPORATION, A MUTUAL LEGAL RESERVE COMPANY . . . . . . . . . . . . . . . . . . . HEALTH CARE SERVICE CORPORATION, A MUTUAL LEGAL RESERVE COMPANY . . . . . . . . . . . . . . . . . . . HEALTH CARE SERVICE CORPORATION, A MUTUAL LEGAL RESERVE COMPANY . . . . . . . . . . . . . . . . . . . HEALTH CARE SERVICE CORPORATION, A MUTUAL LEGAL RESERVE COMPANY . . . . . . . . . . . . . . . . . . . HEALTH CARE SERVICE CORPORATION, A MUTUAL LEGAL RESERVE COMPANY . . . . . . . . . . . . . . . . . . . HEALTH CARE SERVICE CORPORATION, A MUTUAL LEGAL RESERVE COMPANY . . . . . . . . . . . . . . . . . . . HEALTH CARE SERVICE CORPORATION, A MUTUAL LEGAL RESERVE COMPANY . . . . . . . . . . . . . . . . . . . HEALTH CARE SERVICE CORPORATION, A MUTUAL LEGAL RESERVE COMPANY . . . . . . . . . . . . . . . . . . . HEALTH CARE SERVICE CORPORATION, A MUTUAL LEGAL RESERVE COMPANY . . . . . . . . . . . . . . . . . . . HEALTH CARE SERVICE CORPORATION, A MUTUAL LEGAL RESERVE COMPANY . . . . . . . . . . . . . . . . . . . ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company SCHEDULE Y PART 1A - DETAIL OF INSURANCE HOLDING COMPANY SYSTEM 1 2 3 Group Code Group Name ........ ................................. . . 917 917 . . ........ HCSC GROUP HCSC GROUP ................ ................ ................................. 4 5 NAIC Company ID FEDERAL Code Number RSSD 00000 73-1514691 . . . . . . . . . . . 11814 73-1191843 14048 27-4183696 00000 23-2530889 ........... ........... ........... 6 CIK 7 Name of Securities Exchange if Publicly Traded (U.S. or International) ............. ......................... ............. ............. 0001367705 ......................... ......................... ......................... 8 11 12 Directly Type of Control Names of RelationControlled (Ownership, Parent, Domic- ship to by Board, Subsidiaries iliary Report(Name of Management, or Locaing Entity / Attorney-in-Fact, Affiliates tion Entity Person) Influence, Other) GHS GENERAL INSURANCE AGENCY, HEALTH CARE SERVICE CORPORATION, Ownership, Board of INC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OK . . . . DS . . A MUTUAL LEGAL RESERVE COMPANY . . Directors, Management .... ..... 100.0 GHS HEALTH MAINTENANCE ORGANIZATION, INC. . . . . . . . . . . . . . . . . . . . . . OK . ... DS .. HEALTH CARE SERVICE CORPORATION, Ownership, Board of A MUTUAL LEGAL RESERVE COMPANY . . Directors, Management .... ..... 100.0 GHS MANAGED HEALTH CARE PLANS, INC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OK . ... DS .. GHS HEALTH MAINTENANCE Ownership, Board of ORGANIZATION, INC. . . . . . . . . . . . . . . . . . . . . . . . . Directors, Management .... ..... 100.0 PA . ... DS .. HEALTH CARE SERVICE CORPORATION, Ownership, Board of A MUTUAL LEGAL RESERVE COMPANY . . Directors, Management .... ..... 100.0 MEDECISION, INC. 9 ....................... .. 41.1 ........ ................................. 00000 84-1683303 ........... ............. ......................... COLLABORACARE CONSORTIUM, LLC ........ ................................. 00000 23-2530889 ........... ............. ......................... OPTIMED MEDICAL SYSTEMS, LLC ........ ................................. 00000 11-3644814 ........... 0001404274 ......................... HX TECHNOLOGIES, INC. ........ ................................. 00000 33-0711280 ........... ............. ......................... UNLIMITED INNOVATIONS, INC. 10 13 If Control is Ownership Provide Percentage .. PA . ... DS .. MEDECISION, INC. ........................... Ownership .................. ..... 100.0 ... .. PA . ... DS .. MEDECISION, INC. ........................... Ownership .................. ..... 100.0 ............... .. DE . ... DS .. MEDECISION, INC. ........................... Ownership .................. ..... 100.0 CA . ... DS .. MEDECISION, INC. ........................... Ownership, Board of Directors, Management ....... .. 100.0 .................. ..... 100.0 ........ ................................. 00000 82-4418148 ........... ............. ......................... CMH TECHNOLOGY SUBSIDIARY, LLC .. DE . ... DS .. MEDECISION, INC. ........ ................................. 00000 20-5426675 ........... ............. ......................... TMA PRACTICEEDGE, LLC .. TX . ... DS .. HEALTH CARE SERVICE CORPORATION, Ownership, Board of A MUTUAL LEGAL RESERVE COMPANY . . Directors . . . . . . . . . . . . . . . . . . . . ...... 35.0 HEALTH CARE SERVICE CORPORATION, Ownership, Board of A MUTUAL LEGAL RESERVE COMPANY . . Directors . . . . . . . . . . . . . . . . . . . . ...... 10.6 ........ ........ ................................. ................................. 00000 27-4269034 00000 30-0802612 ........... ........... 0001508432 ............. ......................... ......................... ............. HEALTH INTELLIGENCE COMPANY LLC D/B/A BLUE HEALTH INTELLIGENCE . . . . . . . . . . . . . . . . . . . . . . . . . . . INNOVISTA, LLC .. DE . ... DS .. .......................... .. DE . ... DS .. ........................... Ownership .... ..... HEALTH CARE SERVICE CORPORATION, Ownership, Board of A MUTUAL LEGAL RESERVE COMPANY . . Directors, Management .... ..... 100.0 14 15 16 Is an Ultimate SCA Controlling Filing Entity(ies) Required? / Person(s) (Y/N) * HEALTH CARE SERVICE CORPORATION, A MUTUAL LEGAL RESERVE COMPANY . . . . . . . . . . . . . . . . . . . . . . . N . . . . . . . . . . . . HEALTH CARE SERVICE CORPORATION, A MUTUAL LEGAL RESERVE COMPANY . . . . . . . . . . . . . . . . . . . . . . . N . . . . . . . . . . . . HEALTH CARE SERVICE CORPORATION, A MUTUAL LEGAL RESERVE COMPANY . . . . . . . . . . . . . . . . . . . . . . . N . . . . . . . . . . . . HEALTH CARE SERVICE CORPORATION, A MUTUAL LEGAL RESERVE COMPANY . . . . . . . . . . . . . . . . . . . . . . . Y . . . . . . . . . . . . HEALTH CARE SERVICE CORPORATION, A MUTUAL LEGAL RESERVE COMPANY . . . . . . . . . . . . . . . . . . . . . . . N . . . . 0000002 HEALTH CARE SERVICE CORPORATION, A MUTUAL LEGAL RESERVE COMPANY . . . . . . . . . . . . . . . . . . . . . . . N . . . . 0000002 HEALTH CARE SERVICE CORPORATION, A MUTUAL LEGAL RESERVE COMPANY . . . . . . . . . . . . . . . . . . . . . . . N . . . . 0000002 HEALTH CARE SERVICE CORPORATION, A MUTUAL LEGAL RESERVE COMPANY . . . . . . . . . . . . . . . . . . . . . . . N . . . . . . . . . . . . HEALTH CARE SERVICE CORPORATION, A MUTUAL LEGAL RESERVE COMPANY . . . . . . . . . . . . . . . . . . . . . . . N . . . . . . . . . . . . HEALTH CARE SERVICE CORPORATION, A MUTUAL LEGAL RESERVE COMPANY . . . . . . . . . . . . . . . . . . . . . . . N . . . . . . . . . . . . HEALTH CARE SERVICE CORPORATION, A MUTUAL LEGAL RESERVE COMPANY . . . . . . . . . . . . . . . . . . . . . . . N . . . . . . . . . . . . HEALTH CARE SERVICE CORPORATION, A MUTUAL LEGAL RESERVE COMPANY . . . . . . . . . . . . . . . . . . . . . . . N . . . . . . . . . . . . ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company SCHEDULE Y PART 1A - DETAIL OF INSURANCE HOLDING COMPANY SYSTEM 1 2 Group Code Group Name ........ ................................. 3 4 5 NAIC Company ID FEDERAL Code Number RSSD 00000 83-2055033 . . . . . . . . . . . 6 CIK 7 Name of Securities Exchange if Publicly Traded (U.S. or International) ............. ......................... 8 9 Names of Parent, Subsidiaries or Affiliates GENESIS MEDICAL GROUP MANAGEMENT COMPANY, LLC ........ 41.2 ........ ................................. 00000 45-0510673 ........... ............. ......................... VERITY HEALTHNET, LLC ............... ........ ................................. 00000 86-0813402 ........... ............. ......................... TRIWEST ALLIANCE, INC. ............... ........ ................................. 00000 37-1789176 ........... ............. ......................... HCSC VENTURES, INC. ........ ................................. 00000 83-2215567 ........... ............. ......................... ALACURA HOLDINGS, INC. ........ ................................. 00000 46-3019902 ........... ............. ......................... AVALON HEALTH SERVICES, LLC ........ ................................. 00000 27-1038374 ........... 0001478786 ......................... BH ASSETS LLC ........ ................................. 00000 26-2930757 ........... 0001439779 ......................... BLUECROSS BLUESHIELD VENTURES, INC. . . . . . . . . . . . . . . . . . . . . . . . . . ........ ................................. 00000 26-2936839 ........... 0001439778 ......................... BLUECROSS BLUESHIELD VENTURE PARTNERS, L.P. . . . . . . . . . . . . . . . . . . . . . . . . . . ........ ................................. 00000 26-2936839 ........... 0001439778 ......................... BLUECROSS BLUESHIELD VENTURE PARTNERS, L.P. . . . . . . . . . . . . . . . . . . . . . . . . . . ........ ................................. 00000 47-1692551 ........... ............. ......................... COGITATIVO, INC ........ ................................. 00000 82-1682951 ........... ............. ......................... HCSC ITC, LLC ................. ............. ..... .......................... ........................ ........................... 10 11 Directly Controlled by (Name of Entity / Person) 12 13 14 15 16 Type of Control Relation(Ownership, If Control Is an Domic- ship to Board, is Ultimate SCA iliary ReportManagement, Ownership Controlling Filing Locaing Attorney-in-Fact, Provide Entity(ies) Required? tion Entity Influence, Other) Percentage / Person(s) (Y/N) * Ownership, Board of HEALTH CARE SERVICE . . TX . . . . DS . . INNOVISTA, LLC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Directors . . . . . . . . . . . . . . . . . . . . . . . . . . 49.0 CORPORATION, A MUTUAL LEGAL RESERVE COMPANY . . . . . . . . . . . . . . . . . . . . . . . N . . . . . . . . . . . . . . LA . . . . DS . . INNOVISTA, LLC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ownership, Board of HEALTH CARE SERVICE Directors . . . . . . . . . . . . . . . . . . . . . . . . . . 25.0 CORPORATION, A MUTUAL LEGAL RESERVE COMPANY . . . . . . . . . . . . . . . . . . . . . . . N . . . . . . . . . . . . . . DE . . . . DS . . HEALTH CARE SERVICE CORPORATION, Ownership, Board of HEALTH CARE SERVICE A MUTUAL LEGAL RESERVE COMPANY . . Directors . . . . . . . . . . . . . . . . . . . . . . . . . . 12.8 CORPORATION, A MUTUAL LEGAL RESERVE COMPANY . . . . . . . . . . . . . . . . . . . . . . . Y . . . . . . . . . . . . . . DE . . . . DS . . HEALTH CARE SERVICE CORPORATION, Ownership, Board of HEALTH CARE SERVICE A MUTUAL LEGAL RESERVE COMPANY . . Directors, Management . . . . . . . . . 100.0 CORPORATION, A MUTUAL LEGAL RESERVE COMPANY . . . . . . . . . . . . . . . . . . . . . . . Y . . . . . . . . . . . . . . DE . . . . DS . . HCSC VENTURES, INC. . . . . . . . . . . . . . . . . . . . . . Ownership, Board of HEALTH CARE SERVICE Directors . . . . . . . . . . . . . . . . . . . . . . . . . . 20.3 CORPORATION, A MUTUAL LEGAL RESERVE COMPANY . . . . . . . . . . . . . . . . . . . . . . . N . . . . 0000008 . . DE . . . . DS . . HCSC VENTURES, INC. . . . . . . . . . . . . . . . . . . . . . Ownership, Board of HEALTH CARE SERVICE Directors . . . . . . . . . . . . . . . . . . . . . . . . . . 19.5 CORPORATION, A MUTUAL LEGAL RESERVE COMPANY . . . . . . . . . . . . . . . . . . . . . . . N . . . . . . . . . . . . . . DE . . . . DS . . HCSC VENTURES, INC. . . . . . . . . . . . . . . . . . . . . . Ownership, Other . . . . . . . . . . . . . . . . . 35.7 HEALTH CARE SERVICE CORPORATION, A MUTUAL LEGAL RESERVE COMPANY . . . . . . . . . . . . . . . . . . . . . . . N . . . . . . . . . . . . Ownership, Board of HEALTH CARE SERVICE . . DE . . . . DS . . HCSC VENTURES, INC. . . . . . . . . . . . . . . . . . . . . . Directors . . . . . . . . . . . . . . . . . . . . . . . . . . 21.6 CORPORATION, A MUTUAL LEGAL RESERVE COMPANY . . . . . . . . . . . . . . . . . . . . . . . N . . . . . . . . . . . . BLUECROSS BLUESHIELD VENTURES, HEALTH CARE SERVICE . . DE . . . . DS . . INC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ownership, Management . . . . . . . . . . 1.0 CORPORATION, A MUTUAL LEGAL RESERVE COMPANY . . . . . . . . . . . . . . . . . . . . . . . N . . . . 0000003 Ownership, Board of HEALTH CARE SERVICE . . DE . . . . DS . . HCSC VENTURES, INC. . . . . . . . . . . . . . . . . . . . . . Directors . . . . . . . . . . . . . . . . . . . . . . . . . . 21.3 CORPORATION, A MUTUAL LEGAL RESERVE COMPANY . . . . . . . . . . . . . . . . . . . . . . . N . . . . 0000003 . . DE . . . . DS . . HCSC VENTURES, INC. . . . . . . . . . . . . . . . . . . . . . Ownership, Board of HEALTH CARE SERVICE Directors . . . . . . . . . . . . . . . . . . . . . . . . . . 18.2 CORPORATION, A MUTUAL LEGAL RESERVE COMPANY . . . . . . . . . . . . . . . . . . . . . . . N . . . . . . . . . . . . . . DE . . . . DS . . HCSC VENTURES, INC. . . . . . . . . . . . . . . . . . . . . . Ownership, Board of HEALTH CARE SERVICE Directors, Management . . . . . . . . . 100.0 CORPORATION, A MUTUAL LEGAL RESERVE COMPANY . . . . . . . . . . . . . . . . . . . . . . . N . . . . . . . . . . . . ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company SCHEDULE Y PART 1A - DETAIL OF INSURANCE HOLDING COMPANY SYSTEM 1 2 3 4 5 6 CIK 7 Name of Securities Exchange if Publicly Traded (U.S. or International) 8 9 ............. ......................... Names of Parent, Subsidiaries or Affiliates USB RETC FUND 2017-2, LLC Group Code Group Name ........ ................................. NAIC Company ID FEDERAL Code Number RSSD 00000 82-1285164 . . . . . . . . . . . ........ ................................. 00000 82-3349261 ........... ............. ......................... USB HTC FUND 2017-2, LLC ........ ................................. 00000 47-0970280 ........... 0001612123 ......................... HEALTHBOX CHICAGO III LLC 16013 61-1782332 ........... ............. ......................... ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY . . . . . . . . . . . . . . . . . . 41.3 . 917 917 . . ........ . . 917 917 . . ........ . 917 . ........ . 917 . HCSC GROUP HCSC GROUP ................ ................ ................................. HCSC GROUP HCSC GROUP ................ ................ ................................. HCSC GROUP 16022 61-1790731 16359 38-3984430 15907 30-0892376 15941 36-4836697 00000 47-4840919 ........... ........... ........... ........... ........... ............. ............. ............. ............. ............. ......................... ......................... ......................... ......................... ......................... .......... 10 Domiciliary Location . . DE . Relationship to Reporting Entity . . . DS . . HCSC ITC, LLC 11 Directly Controlled by (Name of Entity / Person) ............................... DE . ... DS .. HCSC ITC, LLC DE . ... DS .. HCSC VENTURES, INC. .. IL .. ... DS .. HEALTH CARE SERVICE CORPORATION, A MUTUAL LEGAL RESERVE COMPANY . . MONTANA BLUE INSURANCE COMPANY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . MT . ... DS .. HEALTH CARE SERVICE CORPORATION, A MUTUAL LEGAL RESERVE COMPANY . . BLUE CROSS AND BLUE SHIELD OF NEW MEXICO INSURANCE COMPANY . NM . ... DS .. HEALTH CARE SERVICE CORPORATION, A MUTUAL LEGAL RESERVE COMPANY . . OKLAHOMA BLUE INSURANCE COMPANY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OK . ... DS .. HEALTH CARE SERVICE CORPORATION, A MUTUAL LEGAL RESERVE COMPANY . . TEXAS BLUE CROSS BLUE SHIELD INSURANCE COMPANY . . . . . . . . . . . . . . . . . .. TX . ... DS .. HEALTH CARE SERVICE CORPORATION, A MUTUAL LEGAL RESERVE COMPANY . . HCSC GOVERNMENT PROGRAMS HOLDING COMPANY, NFP . . . . . . . . . . . . . . .. IL .. ... NIA .. HEALTH CARE SERVICE CORPORATION, A MUTUAL LEGAL RESERVE COMPANY . . ................... .. IL .. ... IA ... ............ .. .......... .. ............................... ..................... ................ 16030 47-4875772 ........... ............. ......................... BCBSIL GP HMO, NFP ................................. 00000 47-4862340 ........... ............. ......................... BLUE CROSS AND BLUE SHIELD OF NEW MEXICO GOVERNMENT PROGRAMS HMO, NFP . . . . . . . . . . . . . . . . . . .. IL .. ... IA ... HCSC GOVERNMENT PROGRAMS HOLDING COMPANY, NFP . . . . . . . . . . . . . . . . . . BCBSTX GOVERNMENT PROGRAMS HMO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. TX . ... IA ... HCSC GOVERNMENT PROGRAMS HOLDING COMPANY, NFP . . . . . . . . . . . . . . . . . . HCSC GROUP ................ 15964 47-4889581 ........... ............. ......................... HCSC GOVERNMENT PROGRAMS HOLDING COMPANY, NFP . . . . . . . . . . . . . . . . . . 12 13 14 15 16 Type of Control (Ownership, If Control Is an Board, is Ultimate SCA Management, Ownership Controlling Filing Attorney-in-Fact, Provide Entity(ies) Required? Influence, Other) Percentage / Person(s) (Y/N) * Ownership . . . . . . . . . . . . . . . . . . . . . . . 100.0 HEALTH CARE SERVICE CORPORATION, A MUTUAL LEGAL RESERVE COMPANY . . . . . . . . . . . . . . . . . . . . . . . N . . . . . . . . . . . . Ownership . . . . . . . . . . . . . . . . . . . . . . . 100.0 HEALTH CARE SERVICE CORPORATION, A MUTUAL LEGAL RESERVE COMPANY . . . . . . . . . . . . . . . . . . . . . . . N . . . . . . . . . . . . Ownership . . . . . . . . . . . . . . . . . . . . . . . . 36.3 HEALTH CARE SERVICE CORPORATION, A MUTUAL LEGAL RESERVE COMPANY . . . . . . . . . . . . . . . . . . . . . . . N . . . . . . . . . . . . Ownership, Board of HEALTH CARE SERVICE Directors, Management . . . . . . . . . 100.0 CORPORATION, A MUTUAL LEGAL RESERVE COMPANY . . . . . . . . . . . . . . . . . . . . . . . N . . . . . . . . . . . . Ownership, Board of HEALTH CARE SERVICE Directors, Management . . . . . . . . . 100.0 CORPORATION, A MUTUAL LEGAL RESERVE COMPANY . . . . . . . . . . . . . . . . . . . . . . . N . . . . . . . . . . . . Ownership, Board of HEALTH CARE SERVICE Directors, Management . . . . . . . . . 100.0 CORPORATION, A MUTUAL LEGAL RESERVE COMPANY . . . . . . . . . . . . . . . . . . . . . . . N . . . . . . . . . . . . Ownership, Board of HEALTH CARE SERVICE Directors, Management . . . . . . . . . 100.0 CORPORATION, A MUTUAL LEGAL RESERVE COMPANY . . . . . . . . . . . . . . . . . . . . . . . N . . . . . . . . . . . . Ownership, Board of HEALTH CARE SERVICE Directors, Management . . . . . . . . . 100.0 CORPORATION, A MUTUAL LEGAL RESERVE COMPANY . . . . . . . . . . . . . . . . . . . . . . . N . . . . . . . . . . . . Board of Directors, HEALTH CARE SERVICE Management . . . . . . . . . . . . . . . . . . . . . . . . . . . CORPORATION, A MUTUAL LEGAL RESERVE COMPANY . . . . . . . . . . . . . . . . . . . . . . . N . . . . 0000007 Board of Directors, HEALTH CARE SERVICE Management . . . . . . . . . . . . . . . . . . . . . . . . . . . CORPORATION, A MUTUAL LEGAL RESERVE COMPANY . . . . . . . . . . . . . . . . . . . . . . . N . . . . 0000007 HEALTH CARE SERVICE Board of Directors, CORPORATION, A Management . . . . . . . . . . . . . . . . . . . . . . . . . . . MUTUAL LEGAL RESERVE COMPANY . . . . . . . . . . . . . . . . . . . . . . . N . . . . 0000007 Board of Directors, HEALTH CARE SERVICE Management . . . . . . . . . . . . . . . . . . . . . . . . . . . CORPORATION, A MUTUAL LEGAL RESERVE COMPANY . . . . . . . . . . . . . . . . . . . . . . . N . . . . 0000007 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company SCHEDULE Y PART 1A - DETAIL OF INSURANCE HOLDING COMPANY SYSTEM 1 2 3 NAIC Company ID FEDERAL Code Number RSSD 15851 47-5287374 . . . . . . . . . . . CIK 7 Name of Securities Exchange if Publicly Traded (U.S. or International) ............. ......................... ................ 15958 47-4907557 ........... ............. ......................... MONTANA BLUE GOVERNMENT PROGRAMS HMO . . . . . . . . . . . . . . . . . . . . . . . . ................................. 00000 75-2393811 ........... ............. ......................... CARING FOR CHILDREN FOUNDATION OF TEXAS, INC. Group Code Group Name . 917 . HCSC GROUP . . . . . . . . . . . . . . . . . 917 . ........ HCSC GROUP 4 5 6 8 9 Names of Parent, Subsidiaries or Affiliates BCBSOK GOVERNMENT PROGRAMS HMO COMPANY . . . . . . . . . . . . . . . . . . . . . . . . . . ......... 41.4 ........ ................................. 00000 35-2613131 ........... ............. ......................... THE CARING FOUNDATION OF MONTANA, INC. . . . . . . . . . . . . . . . . . . . . . . . . . . ........ ................................. 00000 73-1470846 ........... ............. ......................... THE OKLAHOMA CARING FOUNDATION, INC. . . . . . . . . . . . . . . . . . . . . . . ........ ................................. 00000 36-6057472 ........... ............. ......................... PLANITES CREDIT UNION ........ ................................. 00000 75-6020171 ........... ............. ......................... LIFETIME FEDERAL CREDIT UNION Asterisk 0000001 0000002 0000003 0000004 0000005 0000006 0000007 0000008 .............. ... 10 11 12 13 14 15 16 Directly Type of Control RelationControlled (Ownership, If Control Is an Domic- ship to by Board, is Ultimate SCA iliary Report(Name of Management, Ownership Controlling Filing Locaing Entity / Attorney-in-Fact, Provide Entity(ies) Required? tion Entity Person) Influence, Other) Percentage / Person(s) (Y/N) * HCSC GOVERNMENT PROGRAMS Board of Directors, HEALTH CARE SERVICE . OK . . . . IA . . . HOLDING COMPANY, NFP . . . . . . . . . . . . . . . . . . Management . . . . . . . . . . . . . . . . . . . . . . . . . . . CORPORATION, A MUTUAL LEGAL RESERVE COMPANY . . . . . . . . . . . . . . . . . . . . . . . N . . . . 0000007 HCSC GOVERNMENT PROGRAMS Board of Directors, HEALTH CARE SERVICE . MT . . . . IA . . . HOLDING COMPANY, NFP . . . . . . . . . . . . . . . . . . Management . . . . . . . . . . . . . . . . . . . . . . . . . . . CORPORATION, A MUTUAL LEGAL RESERVE COMPANY . . . . . . . . . . . . . . . . . . . . . . . N . . . . 0000007 HEALTH CARE SERVICE CORPORATION, Board of Directors, HEALTH CARE SERVICE . . TX . . . OTH . A MUTUAL LEGAL RESERVE COMPANY . . Management . . . . . . . . . . . . . . . . . . . . . . . . . . . CORPORATION, A MUTUAL LEGAL RESERVE COMPANY . . . . . . . . . . . . . . . . . . . . . . . N . . . . 0000004 HEALTH CARE SERVICE CORPORATION, Board of Directors, HEALTH CARE SERVICE . MT . . . OTH . A MUTUAL LEGAL RESERVE COMPANY . . Management . . . . . . . . . . . . . . . . . . . . . . . . . . . CORPORATION, A MUTUAL LEGAL RESERVE COMPANY . . . . . . . . . . . . . . . . . . . . . . . N . . . . 0000004 HEALTH CARE SERVICE CORPORATION, Board of Directors, HEALTH CARE SERVICE . OK . . . OTH . A MUTUAL LEGAL RESERVE COMPANY . . Management . . . . . . . . . . . . . . . . . . . . . . . . . . . CORPORATION, A MUTUAL LEGAL RESERVE COMPANY . . . . . . . . . . . . . . . . . . . . . . . N . . . . 0000005 . . IL . . . . OTH . HEALTH CARE SERVICE CORPORATION, Board of Directors, HEALTH CARE SERVICE A MUTUAL LEGAL RESERVE COMPANY . . Management . . . . . . . . . . . . . . . . . . . . . . . . . . . CORPORATION, A MUTUAL LEGAL RESERVE COMPANY . . . . . . . . . . . . . . . . . . . . . . . N . . . . 0000006 . . TX . . . OTH . HEALTH CARE SERVICE CORPORATION, Board of Directors, HEALTH CARE SERVICE A MUTUAL LEGAL RESERVE COMPANY . . Management . . . . . . . . . . . . . . . . . . . . . . . . . . . CORPORATION, A MUTUAL LEGAL RESERVE COMPANY . . . . . . . . . . . . . . . . . . . . . . . N . . . . 0000006 Explanation Except in this case, Column 11 includes only those entities with an ownership interest in a corresponding downstream subsidiary ("DS") listed in Column 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ownership (shell company) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Reflect direct ownership percentages only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Majority of the directors are employees or directors of HCSC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 of 8 directors are employees of HCSC, all officers are HCSC employees, and HCSC provides support and staffing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . All members and directors are current or former HCSC and affiliate employees and their families, and HCSC provides support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The Corporation is the sole member of HCSC Government Programs Holding Company, NFP which, in turn is the sole member of its subsidiaries. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Includes 4.74% passive investment through a private equity entity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company SCHEDULE Y PART 2 - SUMMARY OF INSURER'S TRANSACTIONS WITH ANY AFFILIATES 1 2 NAIC Company Code Names of Insurers and Parent, Subsidiaries or Affiliates 4 Shareholder Dividends 5 Capital Contributions 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) 8 9 10 Management Agreements and Service Contracts Income/ (Disbursements) Incurred Under Reinsurance Agreements * 11 Any Other Material Activity not in the Ordinary Course of the Insurer's Business 12 Totals 13 Reinsurance Recoverable/ (Payable) on Losses and/or Reserve Credit Taken/ (Liability) 36-1236610 . . HEALTH CARE SERVICE CORPORATION, A MUTUAL LEGAL RE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67,880,946 . (334,043,487) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197,722,540 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (68,440,002) . . . . . (1,490,000) . . 78611 . . . . 73-1350270 . . HCSC INSURANCE SERVICES COMPANY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (197,722,540) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (47,722,540) . . . . . . . 1,378,000 . . 11814 . . . . 73-1191843 . . GHS HMO INC DBA BLUELINCS HMO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112,000 . . 00000 . . . . 36-3339483 . . DENTAL NETWORK OF AMERICA, LLC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (15,000,000) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (15,000,000) . . . . . . . . . . . . . . . . . . . . . 71129 . . . . 36-2598882 . . DEARBORN NATL LIFE INS CO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (40,000,000) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (40,000,000) . . . . . . . . . . . . . . . . . . . . . 00000 . . . . 37-1789176 . . HCSC VENTURES, INC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (7,341,039) . . . 100,835,487 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93,494,448 . . . . . . . . . . . . . . . . . . . . . 00000 . . . . 47-4840919 . . HCSC GOVERNMENT PROGRAMS HOLDING COMPANY, NFP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,500,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,500,000 . . . . . . . . . . . . . . . . . . . . . 16359 . . . . 38-3984430 . . BCBS OF NM INS CO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 430,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 430,000 . . . . . . . . . . . . . . . . . . . . . 15941 . . . . 36-4836697 . . TEXAS BLUE CROSS BLUE SHIELD INSURANCE CO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10,000 . . . . . . . . . . . . . . . . . . . . . 00000 . . . . 30-0802612 . . INNOVISTA, LLC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29,000,000 . . . . . . . . . . . . . . . . . . . . . 00000 . . . . 26-0076803 . . PRIME THERAPUTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37,268,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37,268,000 . . . . . . . . . . . . . . . . . . . . . 29718 . . . . 73-1507369 . . GHS INS CO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15,000,000 . . . . . . . . . . . . . . . . . . . . . 00000 . . . . 23-2530889 . . MEDECISION, INC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (1,000,000) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (1,000,000) . . . . . . . . . . . . . . . . . . . . . 00000 . . . . 43-2084847 . . ACADEMIC HEALTHPLANS, INC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (4,539,907) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (4,539,907) . . . . . . . . . . . . . . . . . . . 9999999 Control Totals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X X X . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Schedule Y Part 2 Explanation: (1) Dental Network of America (DNoA) paid a $15M dividend to HCSC, of which $11M came from a dividend paid to DNoA from DenteMax. (2) Dearborn National Life Insurance Company (DNL) paid a $40M dividend to HCSC, of which $1.1M came from a dividend paid to DNL from Dearborn National Life Insurance Company of New York. (3) As of March 31st, 2018, HCSC completed the sale of stock for Academic HealthPlans, Inc. and no longer is a wholly-owned subsidiary. .. 70670 . . ID Number 3 .. 42 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 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 if your company is engaged in the type of business covered by the supplement. 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. 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 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 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 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? 24. Will the Life, Health & Annuity Guaranty Association Model Act Assessment Base Reconciliation Exhibit be filed with the state of domicile and the NAIC by April 1? 25. Will the Adjustments to the Life, Health & Annuity Guaranty Association Model Act Assessment Base Reconciliation Exhibit (if required) be filed with the state of domicile and the NAIC by April 1? 20. 21. 22. 23. Yes Yes Yes Yes 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: 1. 2. Bar Code: Schedule SIS 70670201842000000 Actuarial Opinion on Participating and Non-Participating Policies 2018 Document Code: 420 70670201837100000 Statement of Non-Guaranteed Elements for Exhibit 5 70670201837000000 2018 2018 Approval for Relief related to five-year rotation for lead Audit Partner Document Code: 370 70670201822400000 2018 Approval for Relief related to one-year cooling off period for inde. CPA Approval for Relief related to Require. for Audit Committees 70670201822500000 70670201822600000 2018 Document Code: 371 Document Code: 225 43 2018 Document Code: 224 Document Code: 226 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company OVERFLOW PAGE FOR WRITE-INS ASSETS 1197. 2504. 2505. 2506. 2507. 2597. Summary of remaining write-ins for Line 11 (Lines 1104 through 1196) . . . . . PREMIUM TAX RECOVERABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CASH SURRENDER VALUE OF SPLIT DOLLAR INSURANCE . . . . . . . . . . . . . ANNUITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PREMIUM TAX CREDITS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Summary of remaining write-ins for Line 25 (Lines 2504 through 2596) . . . . . 1 Current Year 2 Assets Prior Year 4 Nonadmitted Assets 3 Net Admitted Assets (Cols.1-2) Net Admitted Assets ....................... ....................... ....................... ....................... 15,772,052 . . . . . . . . . 28,428,585 . . . . . . . . . . 9,179,741 . . . . . . . . . . 6,477,488 . . . . . . . . . 59,857,866 ....................... ......... 15,772,052 . . . . . . . . . 28,428,585 . . . . . . . . . . 9,179,741 . . . . . . . . . . 6,477,488 . . . . . . . . . 59,857,866 .......... ......... ....................... ....................... ....................... ....................... 6,924,203 28,620,940 . . . . . . . . . 12,073,345 . . . . . . . . . . 3,923,011 . . . . . . . . . 51,541,499 ......... LIABILITIES, CAPITAL AND SURPLUS 2304. 2397. 2597. 3097. IL DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Summary of remaining write-ins for Line 23 (Lines 2304 through 2396) . . . . . . . . . . . . . . . . . . . . . . . . . . Summary of remaining write-ins for Line 25 (Lines 2504 through 2596) . . . . . . . . . . . . . . . . . . . . . . . . . . Summary of remaining write-ins for Line 30 (Lines 3004 through 3096) . . . . . . . . . . . . . . . . . . . . . . . . . . 44 1 Covered . . . . 38,899,966 . . . . 38,899,966 ..... X X X .... ..... X X X .... Current Year 2 Uncovered .................. .... .................. .... ..... ..... X X X .... X X X .... 3 Total 38,899,966 38,899,966 Prior Year 4 Total .................. .................. .................. .................. .................. .................. ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company OVERFLOW PAGE FOR WRITE-INS EXHIBIT 1 - ENROLLMENT BY PRODUCT TYPE FOR HEALTH BUSINESS ONLY 0604. 0605. 0606. 0697. Source of Enrollment Medicaid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Medicare Advantage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Medicare Part D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Summary of remaining write-ins for Line 6 (Lines 0604 through 0696) . . . . . . . . 1 Prior Year . . . . . . . . 416,162 . . . . . . . . 139,524 . . . . . . . . . . . 9,416 . . . . . . . . 565,102 Total Members at End of 2 3 4 First Second Third Quarter Quarter Quarter . . . . . . . . 474,526 . . . . . . . . 502,701 . . . . . . . . 470,654 . . . . . . . . 104,981 . . . . . . . . 105,932 . . . . . . . . 106,312 . . . . . . . . . . . 9,593 . . . . . . . . . . . 9,605 . . . . . . . . . . . 9,633 . . . . . . . . 589,100 . . . . . . . . 618,238 . . . . . . . . 586,599 6 5 Current Year Current Member Year Months . . . . . . . . 442,244 . . . . . . 5,753,783 . . . . . . . . 105,461 . . . . . . 1,269,135 . . . . . . . . . . . 9,576 . . . . . . . . 115,212 . . . . . . . . 557,281 . . . . . . 7,138,130 44.1 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company OVERFLOW PAGE FOR WRITE-INS SCHEDULE E - PART 3 - SPECIAL DEPOSITS 1 States, Etc. 5804. 5805. 5897. Type of Deposit 2 Deposits For the Benefit of All Policyholders 3 4 Book/Adjusted Fair Carrying Value Value Purpose of Deposit All Other Special Deposits 5 6 Book/Adjusted Fair Carrying Value Value ...................................... ........ ........................................................... .................. .................. .................. .................. ...................................... ........ ........................................................... .................. .................. .................. .................. Summary of remaining write-ins for Line 58 (Lines 5804 through 5896) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . XXX .................. .................. .................. ......................... XXX ......................... 44.2 .................. ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company MEDICARE SUPPLEMENT INSURANCE EXPERIENCE EXHIBIT For The Year Ended DECEMBER 31, 2018 70670201836014100 2018 Document Code: 360 (To be filed by March 1) FOR THE STATE OF ILLINOIS 1 NAIC Group Code: 0917 NAIC Company Code: 70670 Address (City, State and Zip Code): Chicago, IL 60601-5099 Person Completing This Exhibit: Kathryn Hedke Title: Actuary Telephone Number: (312)653-5702 3 4 5 6 7 8 9 2 10 Policies Issued Through 2015 Incurred Claims 14 12 13 Percent of Number of Premiums Premiums Covered Earned Amount Earned Lives Policies Issued in 2016, 2017, 2018 Incurred Claims 18 16 17 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 15 Total Experience on Individual Policies Supp12 Illinois N/A . . . . CB-34 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P . . . . . . . . No . . . . . . . . 2,5,6 . . . . . . 01/01/1982 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12/31/1984 Super Supplement/High . . . . . . . . . . . . N/A . . . . CB-41.1 . . . . . . . . . . . . . . . . . . . . . . . . . . . P . . . . . . . . No . . . . . . . . 2,5,6 . . . . . . 08/27/1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12/31/1987 Senior Supplement 1 . . . . . . . . . . . . . . . N/A . . . . CB-41.2 . . . . . . . . . . . . . . . . . . . . . . . . . . . P . . . . . . . . No . . . . . . . . 2,5,6 . . . . . . 08/27/1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12/31/1987 Senior Supplement 2 . . . . . . . . . . . . . . . N/A . . . . CB-41.3 . . . . . . . . . . . . . . . . . . . . . . . . . . . P . . . . . . . . No . . . . . . . . 2,5,6 . . . . . . 08/26/1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12/31/1987 Senior Supplement 3 . . . . . . . . . . . . . . . N/A . . . . CB-41.4 . . . . . . . . . . . . . . . . . . . . . . . . . . . P . . . . . . . . No . . . . . . . . 2,5,6 . . . . . . 08/26/1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12/31/1987 Senior Supplement 4 . . . . . . . . . . . . . . . N/A . . . . CB-41.5 . . . . . . . . . . . . . . . . . . . . . . . . . . . P . . . . . . . . No . . . . . . . . 2,5,6 . . . . . . 02/18/1987 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12/31/1987 Senior Supplement 1+ . . . . . . . . . . . . . . N/A . . . . CB-41.7 . . . . . . . . . . . . . . . . . . . . . . . . . . . P . . . . . . . . No . . . . . . . . 2,5,6 . . . . . . 02/18/1987 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12/31/1988 Senior Supplement 3+ . . . . . . . . . . . . . . N/A . . . . CB-44.1 . . . . . . . . . . . . . . . . . . . . . . . . . . . P . . . . . . . . No . . . . . . . . 2,5,6 . . . . . . 01/06/1989 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12/31/1991 New Low . . . . . . . . . . . . . . . . . . . . . . . . . . . . N/A . . . . CB-44.2 . . . . . . . . . . . . . . . . . . . . . . . . . . . P . . . . . . . . No . . . . . . . . 2,5,6 . . . . . . 01/06/1989 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12/31/1991 New Mid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . N/A . . . . CB-44.3 . . . . . . . . . . . . . . . . . . . . . . . . . . . P . . . . . . . . No . . . . . . . . 2,5,6 . . . . . . 01/06/1989 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12/31/1991 New High . . . . . . . . . . . . . . . . . . . . . . . . . . . . N/A . . . . CB-44.4 . . . . . . . . . . . . . . . . . . . . . . . . . . . P . . . . . . . . No . . . . . . . . 2,5,6 . . . . . . 01/06/1989 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12/31/1991 New 1+ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes . . . . CB-45.1, CB-45.1 HCSC rev . . . . . A . . . . . . . . No . . . . . . . . 2,3,5 . . . . . . 12/02/1991 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Plan A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes . . . . CB-45.10 HCSC . . . . . . . . . . . . . . . . . . N . . . . . . . . No . . . . . . . 2,3,5,6 . . . . . 03/31/2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Plan N . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes . . . . CB-45.11 HCSC . . . . . . . . . . . . . . . . . . G . . . . . . . . No . . . . . . . 2,3,5,6 . . . . . 03/31/2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Plan G . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes . . . . CB-45.2, CB-45.2 HCSC rev . . . . . B . . . . . . . . No . . . . . . . . 2,3,5 . . . . . . 12/02/1991 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Plan B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes . . . . CB-45.3, CB-45.3 HCSC rev . . . . . C . . . . . . . . No . . . . . . . . 2,3,5 . . . . . . 06/01/1997 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Plan C . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes . . . . CB-45.4 . . . . . . . . . . . . . . . . . . . . . . . . . . . D . . . . . . . . No . . . . . . . . 2,3,5 . . . . . . 12/02/1991 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 05/31/2010 Plan D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes . . . . CB-45.5 . . . . . . . . . . . . . . . . . . . . . . . . . . . E . . . . . . . . No . . . . . . . . 2,3,5 . . . . . . 12/02/1991 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 05/31/2010 Plan E . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes . . . . CB-45.6, CB-45.6 HCSC rev . . . . . F . . . . . . . . No . . . . . . . . 2,3,5 . . . . . . 11/29/1993 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Plan F . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes . . . . CB-45.7, CB-45.7 HCSC rev . . . . . F . . . . . . . . No . . . . . . . . 2,3,5 . . . . . . 09/03/2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Plan F - High Deductible . . . . . . . . . . . Yes . . . . CB-45.8 . . . . . . . . . . . . . . . . . . . . . . . . . . . K . . . . . . . . No . . . . . . . . 2,3,5 . . . . . . 01/01/2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Plan K . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes . . . . CB-45.9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . L . . . . . . . . No . . . . . . . . 2,3,5 . . . . . . 01/01/2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Plan L . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes . . . . CB-46.0, CB-46.0 HCSC rev . . . . . B . . . . . . . . Yes . . . . . . . 2,3,5 . . . . . . 07/25/1995 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Select Plan B . . . . . . . . . . . . . . . . . . . . . . . Yes . . . . CB-46.1, CB-46.1 HCSC rev . . . . . C . . . . . . . . Yes . . . . . . . 2,3,5 . . . . . . 06/01/1997 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Select Plan C . . . . . . . . . . . . . . . . . . . . . . . Yes . . . . CB-46.2 . . . . . . . . . . . . . . . . . . . . . . . . . . . D . . . . . . . . Yes . . . . . . . 2,3,5 . . . . . . 07/25/1995 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 05/31/2010 Select Plan D . . . . . . . . . . . . . . . . . . . . . . . Yes . . . . CB-46.3 . . . . . . . . . . . . . . . . . . . . . . . . . . . E . . . . . . . . Yes . . . . . . . 2,3,5 . . . . . . 07/25/1995 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 05/31/2010 Select Plan E . . . . . . . . . . . . . . . . . . . . . . . Yes . . . . CB-46.4, CB-46.4 HCSC rev . . . . . F . . . . . . . . Yes . . . . . . . 2,3,5 . . . . . . 07/25/1995 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Select Plan F . . . . . . . . . . . . . . . . . . . . . . . . Yes . . . . CB-46.5 . . . . . . . . . . . . . . . . . . . . . . . . . . . K . . . . . . . . Yes . . . . . . . 2,3,5 . . . . . . 01/01/2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Select Plan K . . . . . . . . . . . . . . . . . . . . . . . Yes . . . . CB-46.6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . L . . . . . . . . Yes . . . . . . . 2,3,5 . . . . . . 01/01/2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Select Plan L . . . . . . . . . . . . . . . . . . . . . . . . Yes . . . . CB-46.7 HCSC . . . . . . . . . . . . . . . . . . . . G . . . . . . . . Yes . . . . . . 2,3,5,6 . . . . . 03/31/2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Select Plan G . . . . . . . . . . . . . . . . . . . . . . . Yes . . . . CB-46.8 HCSC . . . . . . . . . . . . . . . . . . . . N . . . . . . . . Yes . . . . . . 2,3,5,6 . . . . . 03/31/2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Select Plan N . . . . . . . . . . . . . . . . . . . . . . . 0199999 Total Experience on Individual Policies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... . . . . . . . . . . . . 5,415 . . . . . . . . . 114,262 . . . . . . . . . . 76,180 . . . . . . . . . . 63,445 . . . . . . . . . 136,342 . . . . . . . 1,518,425 . . . . . . . . . 533,238 . . . . . . . . . . 12,934 . . . . . . . 2,506,010 . . . . . . . . . 540,167 . . . . . . . . . 208,906 . . . . . . . 1,552,959 . . . . . 15,542,078 . . . . . 15,549,374 . . . . . . . 1,853,323 . . . . . . . 9,650,554 . . . . . 27,581,842 . . . . . . . 2,906,444 . . . . 479,351,212 . . . . . 12,248,016 . . . . . . . . . 194,985 . . . . . . . . . . 88,122 . . . . . . . 1,421,609 . . . . . 23,172,007 . . . . . 20,749,449 . . . . . . . . . 874,409 . . . . 196,538,231 . . . . . . . . . 109,374 . . . . . . . . . . 80,905 . . . . . . . 7,013,120 . . . . . . . 8,560,321 .... 830,753,658 . . . . . . . . . . . . . . . 83 . . . . . . . . . . 69,198 . . . . . . . . . . 38,879 . . . . . . . . . . 42,315 . . . . . . . . . . 70,367 . . . . . . . 1,233,116 . . . . . . . . . 350,719 . . . . . . . . . . 46,079 . . . . . . . 1,861,099 . . . . . . . . . 463,119 . . . . . . . . . 172,498 . . . . . . . 1,354,656 . . . . . 14,464,263 . . . . . 13,724,703 . . . . . . . 1,908,028 . . . . . . . 8,676,923 . . . . . 20,196,320 . . . . . . . 1,929,437 . . . . 371,099,650 . . . . . . . 6,991,916 . . . . . . . . . . 93,465 . . . . . . . . . . 33,491 . . . . . . . 1,156,446 . . . . . 20,065,668 . . . . . 15,411,718 . . . . . . . . . 647,605 . . . . 150,686,214 . . . . . . . . . 102,476 . . . . . . . . . . 33,713 . . . . . . . 6,071,791 . . . . . . . 6,909,700 . . . . . . . . 1.5 . . . . . . 60.6 . . . . . . 51.0 . . . . . . 66.7 . . . . . . 51.6 . . . . . . 81.2 . . . . . . 65.8 . . . . . 356.3 . . . . . . 74.3 . . . . . . 85.7 . . . . . . 82.6 . . . . . . 87.2 . . . . . . 93.1 . . . . . . 88.3 . . . . . 103.0 . . . . . . 89.9 . . . . . . 73.2 . . . . . . 66.4 . . . . . . 77.4 . . . . . . 57.1 . . . . . . 47.9 . . . . . . 38.0 . . . . . . 81.3 . . . . . . 86.6 . . . . . . 74.3 . . . . . . 74.1 . . . . . . 76.7 . . . . . . 93.7 . . . . . . 41.7 . . . . . . 86.6 . . . . . . 80.7 .......... 1 . . . . . . . . 41 . . . . . . . . 15 . . . . . . . . 13 . . . . . . . . 20 . . . . . . . 383 . . . . . . . 125 .......... 6 . . . . . . . 667 . . . . . . . 123 . . . . . . . . 50 . . . . . . . 959 . . . . . 7,405 . . . . . 5,525 . . . . . . . 676 . . . . . 2,748 . . . . . 7,934 . . . . . . . 784 . . 152,040 . . . . 13,361 . . . . . . . 121 . . . . . . . . 40 . . . . . . . 662 . . . . . 8,438 . . . . . 7,754 . . . . . . . 310 . . . . 71,518 . . . . . . . . 70 . . . . . . . . 38 . . . . . 2,845 . . . . . 4,676 ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... . . . . . . . 154 . . . . . 5,824 . . . . . 7,835 . . . . . . . . 59 . . . . . . . 320 ........... ........... . . . . 46,838 . . . . . 6,073 . . . . . . . . 59 . . . . . . . . 20 . . . . . . . . 87 . . . . . 1,366 ........... ........... . . . . 13,113 . . . . . . . . 29 .......... 6 . . . . . 4,651 . . . . . 3,395 97.5 . . . . 89,829 77.7 .. . . . . . . . . . . 29,501 . . . . . . . 3,356,146 . . . . . . . 1,013,540 . . . . . . . . . 141,788 . . . . . . . 1,189,685 . . . . . . . . . 415,052 ...... ...... ...... ...... ...... ...... . . . . . . . . 16 . . . . . 1,135 . . . . . . . 295 . . . . . . . . 40 . . . . . . . 315 . . . . . . . 124 .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... 6,145,712 ...... 83.1 75.6 77.6 71.6 77.1 86.4 76.8 1,925 .................. .................. ........... ........... .... 169,092,714 ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... . . . . . 109.4 . . . . . . 84.8 . . . . . . 93.9 . . . . . 100.7 . . . . . 175.7 ........... ........... . . . . . 101.8 . . . . . . 67.2 . . . . . . 55.6 . . . . . . 44.5 . . . . . . 97.8 . . . . . 110.3 ........... ........... . . . . . . 93.4 . . . . . . 49.1 . . . . . . 27.1 . . . . . . 92.1 . . . . . . 88.0 ...... .... 173,504,049 .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. . . . . . . . . . 213,117 . . . . . . . 8,155,541 . . . . . 16,840,439 . . . . . . . . . 112,684 . . . . . . . 1,472,019 .................. .................. . . . . . 98,906,478 . . . . . . . 2,960,675 . . . . . . . . . . 38,800 . . . . . . . . . . 13,284 . . . . . . . . . 134,029 . . . . . . . 3,165,492 .................. .................. . . . . . 23,459,668 . . . . . . . . . . 19,164 . . . . . . . . . . . . 3,442 . . . . . . . 9,089,535 . . . . . . . 4,508,347 645,905,655 .... 289,348 .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. . . . . . . . . . 194,768 . . . . . . . 9,616,356 . . . . . 17,934,765 . . . . . . . . . 111,948 . . . . . . . . . 837,944 .................. .................. . . . . . 97,145,735 . . . . . . . 4,408,290 . . . . . . . . . . 69,728 . . . . . . . . . . 29,876 . . . . . . . . . 137,057 . . . . . . . 2,870,509 .................. .................. . . . . . 25,105,005 . . . . . . . . . . 39,002 . . . . . . . . . . 12,687 . . . . . . . 9,869,660 . . . . . . . 5,120,719 ...... Total Experience on Group Policies N/A . . . . CB-44.5 . . . . . . . . . . . . . . . . . . . . . . . . . . . P . . . . . . . . No . . . . . . . . 2,5,6 . . . . . . 01/06/1989 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12/31/1991 New Low . . . . . . . . . . . . . . . . . . . . . . . . . . . . N/A . . . . CB-44.6 . . . . . . . . . . . . . . . . . . . . . . . . . . . P . . . . . . . . No . . . . . . . . 2,5,6 . . . . . . 01/06/1989 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12/31/1991 New Mid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . N/A . . . . CB-44.7 . . . . . . . . . . . . . . . . . . . . . . . . . . . P . . . . . . . . No . . . . . . . . 2,5,6 . . . . . . 01/06/1989 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12/31/1991 New High . . . . . . . . . . . . . . . . . . . . . . . . . . . . N/A . . . . CB-44.8 . . . . . . . . . . . . . . . . . . . . . . . . . . . P . . . . . . . . No . . . . . . . . 2,5,6 . . . . . . 01/06/1989 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12/31/1991 New 1+ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . N/A . . . . GB 10.A2.1 . . . . . . . . . . . . . . . . . . . . . . . . P . . . . . . . . No . . . . . . . . 2,5,6 . . . . . . 11/18/1988 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12/31/1986 Plan 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . N/A . . . . GB 10.A2.2 . . . . . . . . . . . . . . . . . . . . . . . . P . . . . . . . . No . . . . . . . . 2,5,6 . . . . . . 11/18/1988 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12/31/1986 Plan 1A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0299999 Total Experience on Group Policies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..... ..... ..... ..... ..... ..... . . . . . . . . . . 35,497 . . . . . . . 4,440,054 . . . . . . . 1,306,941 . . . . . . . . . 197,904 . . . . . . . 1,543,475 . . . . . . . . . 480,370 ....... 8,004,241 ....... ..... ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company Medicare Supplement Ins. Exp. Exh. (continued) GENERAL INTERROGATORIES 1. If response in Column 1 is no, give full and complete details: 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: 300 East Randolph Street, Chicago IL 60601-5099 2.2 Contact Person and Phone Number: Tom Ellenwood (312)653-5998 3. Billing address and contact person for user fees established under 41 U.S.C. 1395u(h)(3)(B) 3.1 Address: 300 East Randolph, Chicago IL 60601-5099 3.2 Contact Person and Phone Number: Tom Ellenwood (312)653-5998 4. Explain any policies identified above as policy type "O": Supp12.1 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company MEDICARE SUPPLEMENT INSURANCE EXPERIENCE EXHIBIT For The Year Ended DECEMBER 31, 2018 70670201836027100 2018 Document Code: 360 (To be filed by March 1) FOR THE STATE OF MONTANA 1 NAIC Group Code: 0917 NAIC Company Code: 70670 Address (City, State and Zip Code): Chicago, IL 60601-5099 Person Completing This Exhibit: Kathryn Hedke Title: Actuary Telephone Number: (312)653-5702 3 4 5 6 7 8 9 2 10 Policies Issued Through 2015 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 2016, 2017, 2018 Incurred Claims 18 16 17 Percent of Number of Premiums Premiums Covered Earned Amount Earned Lives 15 Total Experience on Individual Policies Supp12 Montana Yes . . . . MSPLAN1062010 . . . . . . . . . . . . . . . . A . . . . . . . . No . . . . . . . . . . 3,4 . . . . . . . 02/25/2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Simply Blue A . . . . . . . . . . . . . . . . . . . . . . . Yes . . . . MSPLANC062010 . . . . . . . . . . . . . . . . C . . . . . . . . No . . . . . . . . . . 3,4 . . . . . . . 02/25/2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Simply Blue C . . . . . . . . . . . . . . . . . . . . . . . Yes . . . . MSPLANF062010 . . . . . . . . . . . . . . . . F . . . . . . . . No . . . . . . . . . . 3,4 . . . . . . . 02/25/2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Simply Blue F . . . . . . . . . . . . . . . . . . . . . . . Yes . . . . MSHIGHDEDPLANF062010 . . . . . F . . . . . . . . No . . . . . . . . . . 3,4 . . . . . . . 02/25/2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Simply Blue FHD . . . . . . . . . . . . . . . . . . . Yes . . . . MSPLANG062010 . . . . . . . . . . . . . . . . G . . . . . . . . No . . . . . . . . . . 3,4 . . . . . . . 09/14/2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Simply Blue G . . . . . . . . . . . . . . . . . . . . . . . Yes . . . . MSPLANN062010 . . . . . . . . . . . . . . . . N . . . . . . . . No . . . . . . . . . . 3,4 . . . . . . . 02/25/2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Simply Blue N . . . . . . . . . . . . . . . . . . . . . . . Yes . . . . MSPLAN1062010 . . . . . . . . . . . . . . . . A . . . . . . . . No . . . . . . . . . . 3,4 . . . . . . . 02/25/2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Simply Blue A (age rtd) . . . . . . . . . . . . . Yes . . . . MSPLANC062010 . . . . . . . . . . . . . . . . C . . . . . . . . No . . . . . . . . . . 3,4 . . . . . . . 02/25/2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Simply Blue C (age rtd) . . . . . . . . . . . . . Yes . . . . MSPLANF062010 . . . . . . . . . . . . . . . . F . . . . . . . . No . . . . . . . . . . 3,4 . . . . . . . 02/25/2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Simply Blue F (age rtd) . . . . . . . . . . . . . Yes . . . . MSHIGHDEDPLANF062010 . . . . . F . . . . . . . . No . . . . . . . . . . 3,4 . . . . . . . 02/25/2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Simply Blue FHD (age rtd) . . . . . . . . . Yes . . . . MSPLANM062010 . . . . . . . . . . . . . . . . M . . . . . . . . No . . . . . . . . . . 3,4 . . . . . . . 02/25/2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Simply Blue M (age rtd) . . . . . . . . . . . . Yes . . . . MSPLANN062010 . . . . . . . . . . . . . . . . N . . . . . . . . No . . . . . . . . . . 3,4 . . . . . . . 02/25/2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Simply Blue N (age rtd) . . . . . . . . . . . . . Yes . . . . SC-A 3/03 . . . . . . . . . . . . . . . . . . . . . . . . . A . . . . . . . . No . . . . . . . . . . 3,4 . . . . . . . 02/19/2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 05/31/2010 Senior Plan A . . . . . . . . . . . . . . . . . . . . . . . Yes . . . . SC-C 3/03 . . . . . . . . . . . . . . . . . . . . . . . . . C . . . . . . . . No . . . . . . . . . . 3,4 . . . . . . . 02/19/2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 05/31/2010 Senior Plan C . . . . . . . . . . . . . . . . . . . . . . . Yes . . . . SC-F 3/03 . . . . . . . . . . . . . . . . . . . . . . . . . F . . . . . . . . No . . . . . . . . . . 3,4 . . . . . . . 02/19/2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 05/31/2010 Senior Plan F . . . . . . . . . . . . . . . . . . . . . . . Yes . . . . SC-J 3/03 . . . . . . . . . . . . . . . . . . . . . . . . . . J . . . . . . . . No . . . . . . . . . . 3,4 . . . . . . . 02/19/2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 01/01/2007 Senior Plan J . . . . . . . . . . . . . . . . . . . . . . . . Yes . . . . MSPLANA2003 . . . . . . . . . . . . . . . . . . . A . . . . . . . . No . . . . . . . . . . 3,4 . . . . . . . 02/28/2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 05/31/2010 Senior Blue Plan A (age rtd) . . . . . . . Yes . . . . MSPLANB2003 . . . . . . . . . . . . . . . . . . . B . . . . . . . . No . . . . . . . . . . 3,4 . . . . . . . 02/28/2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 05/31/2010 Senior Blue Plan B . . . . . . . . . . . . . . . . . Yes . . . . MSPLANC2003 . . . . . . . . . . . . . . . . . . . C . . . . . . . . No . . . . . . . . . . 3,4 . . . . . . . 02/28/2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 05/31/2010 Senior Blue Plan C . . . . . . . . . . . . . . . . . Yes . . . . MSPLANF2003 . . . . . . . . . . . . . . . . . . . F . . . . . . . . No . . . . . . . . . . 3,4 . . . . . . . 02/28/2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 05/31/2010 Senior Blue Plan F . . . . . . . . . . . . . . . . . . Yes . . . . MSPLANG2003 . . . . . . . . . . . . . . . . . . . G . . . . . . . . No . . . . . . . . . . 3,4 . . . . . . . 02/28/2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 05/31/2010 Senior Blue Plan G . . . . . . . . . . . . . . . . . Yes . . . . MSPLANJ2003 . . . . . . . . . . . . . . . . . . . . J . . . . . . . . No . . . . . . . . . . 3,4 . . . . . . . 02/28/2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 01/01/2007 Senior Blue Plan J . . . . . . . . . . . . . . . . . . Yes . . . . SCP 9-1-90 . . . . . . . . . . . . . . . . . . . . . . . P . . . . . . . . No . . . . . . . . . . 3,4 . . . . . . . 10/09/1990 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 01/01/2006 Senior Care Plus . . . . . . . . . . . . . . . . . . . Yes . . . . SCG 9-1-90 . . . . . . . . . . . . . . . . . . . . . . . P . . . . . . . . No . . . . . . . . . . 3,4 . . . . . . . 10/09/1990 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 01/01/2006 Senior Care Gold . . . . . . . . . . . . . . . . . . . Yes . . . . MSPLANA062010 . . . . . . . . . . . . . . . . A . . . . . . . . No . . . . . . . . . . 3,4 . . . . . . . 11/27/2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Simply Blue Disabled Plan A . . . . . . . Yes . . . . MSPLANC062010 . . . . . . . . . . . . . . . . C . . . . . . . . No . . . . . . . . . . 3,4 . . . . . . . 11/27/2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Simply Blue Disabled Plan C . . . . . . . Yes . . . . MSPLANF062010 . . . . . . . . . . . . . . . . F . . . . . . . . No . . . . . . . . . . 3,4 . . . . . . . 11/27/2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Simply Blue Disabled Plan F . . . . . . . Yes . . . . MSHIGHDEDPLANF062010 . . . . . F . . . . . . . . No . . . . . . . . . . 3,4 . . . . . . . 11/27/2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Simply Blue Disabled Plan FHD . . . Yes . . . . MSPLANG062010 . . . . . . . . . . . . . . . . G . . . . . . . . No . . . . . . . . . . 3,4 . . . . . . . 09/14/2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Simply Blue Disabled Plan G . . . . . . Yes . . . . MSPLANM062010 . . . . . . . . . . . . . . . . M . . . . . . . . No . . . . . . . . . . 3,4 . . . . . . . 11/27/2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Simply Blue Disabled Plan M . . . . . . Yes . . . . MSPLANN062010 . . . . . . . . . . . . . . . . N . . . . . . . . No . . . . . . . . . . 3,4 . . . . . . . 11/27/2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Simply Blue Disabled Plan N . . . . . . . 0199999 Total Experience on Individual Policies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0299999 Total Experience on Group Policies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . GENERAL INTERROGATORIES 1. If response in Column 1 is no, give full and complete details: 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: 300 East Randolph Street, Chicago IL 60601-5099 2.2 Contact Person and Phone Number: Tom Ellenwood (312)653-5998 3. Billing address and contact person for user fees established under 41 U.S.C. 1395u(h)(3)(B) 3.1 Address: 300 East Randolph, Chicago IL 60601-5099 3.2 Contact Person and Phone Number: Tom Ellenwood (312)653-5998 ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... . . . . . . . . . . 12,798 . . . . . . . . . . 95,611 . . . . . . . 1,792,112 . . . . . . . . . . 86,262 .................. . . . . . . . . . . 20,646 . . . . . . . . . . . . 3,327 . . . . . . . . . 194,911 . . . . . 16,602,541 . . . . . . . . . 262,839 . . . . . . . . . . . . 3,715 . . . . . . . . . 210,622 . . . . . . . . . 106,707 . . . . . . . 5,134,944 . . . . . . . 7,349,191 . . . . . . . 2,749,363 . . . . . . . . . . . . 5,788 . . . . . . . . . . 14,414 . . . . . . . 1,781,071 . . . . . . . 3,361,485 . . . . . . . . . . 66,337 . . . . . . . . . . 33,659 . . . . . . . . . 133,355 . . . . . . . . . 301,777 .................. . . . . . . . . . . . . 4,931 . . . . . . . . . 455,978 . . . . . . . . . . 31,558 .................. . . . . . . . . . . . . 4,193 . . . . . . . . . . 35,330 ..... 40,855,465 .................. . . . . . . . . . . . . 3,621 . . . . . . . . . . 64,452 . . . . . . . 1,181,573 . . . . . . . . . . . . 9,262 .................. . . . . . . . . . . 18,607 . . . . . . . . . . . . . . (72) . . . . . . . . . 174,373 . . . . . 12,279,099 . . . . . . . . . 127,779 . . . . . . . . . . . . 1,119 . . . . . . . . . 171,434 . . . . . . . . . . 90,284 . . . . . . . 3,945,080 . . . . . . . 5,017,966 . . . . . . . 2,015,160 . . . . . . . . . . . . 1,588 . . . . . . . . . . . . 5,651 . . . . . . . 1,201,575 . . . . . . . 2,143,362 . . . . . . . . . . 71,834 . . . . . . . . . . 16,953 . . . . . . . . . . 53,729 . . . . . . . . . 138,377 .................. . . . . . . . . . . . . 9,386 . . . . . . . . . 551,043 . . . . . . . . . . 83,231 .................. . . . . . . . . . . . . 1,677 . . . . . . . . . . 29,971 ..... 29,408,114 .................. . . . . . . 28.3 . . . . . . 67.4 . . . . . . 65.9 . . . . . . 10.7 ........... . . . . . . 90.1 . . . . . . (2.2) . . . . . . 89.5 . . . . . . 74.0 . . . . . . 48.6 . . . . . . 30.1 . . . . . . 81.4 . . . . . . 84.6 . . . . . . 76.8 . . . . . . 68.3 . . . . . . 73.3 . . . . . . 27.4 . . . . . . 39.2 . . . . . . 67.5 . . . . . . 63.8 . . . . . 108.3 . . . . . . 50.4 . . . . . . 40.3 . . . . . . 45.9 ........... . . . . . 190.3 . . . . . 120.8 . . . . . 263.7 ........... . . . . . . 40.0 . . . . . . 84.8 ...... 72.0 ........... .......... 7 . . . . . . . . 38 . . . . . . . 695 . . . . . . . . 73 ........... . . . . . . . . 11 .......... 2 . . . . . . . . 73 . . . . . 6,908 . . . . . . . 241 .......... 2 . . . . . . . 108 . . . . . . . . 61 . . . . . 1,640 . . . . . 2,081 . . . . . . . 691 .......... 3 .......... 5 . . . . . . . 519 . . . . . . . 933 . . . . . . . . 20 .......... 7 . . . . . . . . 33 . . . . . . . . 53 ........... .......... 1 . . . . . . . . 83 . . . . . . . . 13 ........... .......... 1 .......... 9 . . . . . . . . . . . . 1,788 . . . . . . . . . . . . 2,489 . . . . . . . . . 348,060 . . . . . . . . . . 25,444 . . . . . . . . . . 94,339 . . . . . . . . . . . . 9,441 . . . . . . . . . . . . 1,062 . . . . . . . . . . 54,777 . . . . . 10,109,558 . . . . . . . . . 327,666 . . . . . . . . . . . . 4,114 . . . . . . . . . 724,286 .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. . . . . . . . . . . . . 8,113 .................. . . . . . . . . . 857,261 . . . . . . . . . 126,368 . . . . . . . . . . 30,676 .................. . . . . . . . . . 120,936 . . . . 14,311 . . . . . ........... 12,846,378 .................. . . . . . . . . . . . . 5,177 . . . . . . . . . . . . (158) . . . . . . . . . 180,268 . . . . . . . . . . . . 3,304 . . . . . . . . . . 91,613 . . . . . . . . . . . . 1,362 . . . . . . . . . . . . (221) . . . . . . . . . . 71,116 . . . . . . . 8,547,310 . . . . . . . . . 146,512 . . . . . . . . . . . . . . 898 . . . . . . . . . 629,511 .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. . . . . . . . . . . 15,276 .................. . . . . . . . 1,368,778 . . . . . . . . . . 86,060 . . . . . . . . . . 34,993 .................. . . . . . . . . . 188,491 ..... 11,370,290 .................. . . . . . 289.5 . . . . . . (6.3) . . . . . . 51.8 . . . . . . 13.0 . . . . . . 97.1 . . . . . . 14.4 . . . . . (20.8) . . . . . 129.8 . . . . . . 84.5 . . . . . . 44.7 . . . . . . 21.8 . . . . . . 86.9 ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... . . . . . 188.3 ........... . . . . . 159.7 . . . . . . 68.1 . . . . . 114.1 ........... . . . . . 155.9 ...... 88.5 ........... .......... 1 .......... 1 . . . . . . . 133 . . . . . . . . 22 . . . . . . . 198 .......... 5 ........... . . . . . . . . 24 . . . . . 4,800 . . . . . . . 336 .......... 2 . . . . . . . 404 ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... .......... 2 ........... . . . . . . . 174 . . . . . . . . 67 . . . . . . . . 20 ........... . . . . . . . . 35 ..... 6,224 ........... ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company Medicare Supplement Ins. Exp. Exh. (continued) 4. Explain any policies identified above as policy type "O": Supp12.1 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company MEDICARE SUPPLEMENT INSURANCE EXPERIENCE EXHIBIT For The Year Ended DECEMBER 31, 2018 70670201836032100 2018 Document Code: 360 (To be filed by March 1) FOR THE STATE OF NEW MEXICO 1 NAIC Group Code: 0917 NAIC Company Code: 70670 Address (City, State and Zip Code): Chicago, IL 60601-5099 Person Completing This Exhibit: Kathryn Hedke Title: Actuary Telephone Number: (312)653-5702 3 4 5 6 7 8 9 2 10 Policies Issued Through 2015 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 2016, 2017, 2018 Incurred Claims 18 16 17 Percent of Number of Premiums Premiums Covered Earned Amount Earned Lives 15 Total Experience on Individual Policies Supp12 New Mexico N/A . . . . M297 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P . . . . . . . . No . . . . . . . . . . . 4 . . . . . . . . 12/31/1988 . . . . . . . . . . . . . . . . 04/30/1990 . 06/30/1992 Senior Advantage . . . . . . . . . . . . . . . . . . N/A . . . . M296 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P . . . . . . . . No . . . . . . . . . . . 4 . . . . . . . . 12/31/1988 . . . . . . . . . . . . . . . . 04/30/1990 . 06/30/1992 Senior Preferred . . . . . . . . . . . . . . . . . . . . Yes . . . . MSP.A2.MN, M568 (6/10) . . . . . . . . A . . . . . . . . No . . . . . . . 2,3,4,6 . . . . . 07/01/1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Plan A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes . . . . MSP.B3.MN, M569 (6/10) . . . . . . . . B . . . . . . . . No . . . . . . . 2,3,4,6 . . . . . 07/01/1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Plan B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes . . . . MSP.F4.MN, M570 (6/10) . . . . . . . . F . . . . . . . . No . . . . . . . 2,3,4,6 . . . . . 07/01/1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Plan F . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes . . . . 81246.0110, NM81245 (6/10 . . . . . F . . . . . . . . No . . . . . . . 2,3,4,6 . . . . . 12/09/2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Plan F High Deductible . . . . . . . . . . . . . Yes . . . . MSP.I5.MN . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . No . . . . . . . 2,3,4,6 . . . . . 07/01/1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 05/31/2010 Plan I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes . . . . NMN81249 . . . . . . . . . . . . . . . . . . . . . . . . N . . . . . . . . No . . . . . . . 2,3,4,6 . . . . . 05/04/2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Plan N . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0199999 Total Experience on Individual Policies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0299999 Total Experience on Group Policies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . GENERAL INTERROGATORIES 1. If response in Column 1 is no, give full and complete details: 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: 300 East Randolph Street, Chicago IL 60601-5099 2.2 Contact Person and Phone Number: Tom Ellenwood (312)653-5998 3. Billing address and contact person for user fees established under 41 U.S.C. 1395u(h)(3)(B) 3.1 Address: 300 East Randolph, Chicago IL 60601-5099 3.2 Contact Person and Phone Number: Tom Ellenwood (312)653-5998 4. Explain any policies identified above as policy type "O": ..... ..... ..... ..... ..... ..... ..... ..... . . . . . . . . . 173,659 . . . . . . . . . . 58,069 . . . . . . . . . . 76,685 . . . . . . . . . 504,233 . . . . . 11,248,861 . . . . . . . . . 441,609 . . . . . . . . . 530,405 . . . . . . . . . 543,635 ..... 13,577,156 .................. . . . . . . . . . 103,997 . . . . . . . . . . 29,274 . . . . . . . . . . 57,439 . . . . . . . . . 365,492 . . . . . . . 8,115,567 . . . . . . . . . 302,640 . . . . . . . . . 307,753 . . . . . . . . . 496,522 ...... ...... ...... ...... ...... ...... ...... ...... 9,778,684 ...... ....... .................. 59.9 50.4 74.9 72.5 72.1 68.5 58.0 91.3 72.0 ........... . . . . . . . . 47 . . . . . . . . 14 . . . . . . . . 35 . . . . . . . 206 . . . . . 3,959 . . . . . . . 576 . . . . . . . 161 . . . . . . . 275 ..... 5,273 ........... .................. .................. . . . . . . . . . . . . 4,037 . . . . . . . . . . . . 7,673 . . . . . . . 3,050,946 . . . . . . . . . 277,523 .................. . . . . . . . . . 307,341 ....... 3,647,520 .................. .................. .................. . . . . . . . . . . 18,570 . . . . . . . . . . . . 3,807 . . . . . . . 3,002,467 . . . . . . . . . 183,440 .................. . . . . . . . . . 248,415 ....... 3,456,699 .................. ........... ........... . . . . . 460.0 . . . . . . 49.6 . . . . . . 98.4 . . . . . . 66.1 ........... . . . . . . 80.8 ...... 94.8 ........... ........... ........... .......... 2 .......... 3 . . . . . 1,343 . . . . . . . 394 ........... . . . . . . . 179 ..... 1,921 ........... ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company MEDICARE SUPPLEMENT INSURANCE EXPERIENCE EXHIBIT For The Year Ended DECEMBER 31, 2018 70670201836037100 2018 Document Code: 360 (To be filed by March 1) FOR THE STATE OF OKLAHOMA 1 NAIC Group Code: 0917 NAIC Company Code: 70670 Address (City, State and Zip Code): Chicago, IL 60601-5099 Person Completing This Exhibit: Kathryn Hedke Title: Actuary Telephone Number: (312)653-5702 3 4 5 6 7 8 9 2 10 Policies Issued Through 2015 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 2016, 2017, 2018 Incurred Claims 18 16 17 Percent of Number of Premiums Premiums Covered Earned Amount Earned Lives 15 Total Experience on Individual Policies Supp12 Oklahoma Yes . . . . 4021-1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P . . . . . . . . No . . . . . . . . . . . . . . . . . . . . . . 04/20/1990 . . . . . . . . . . . . . . . . 06/30/1991 . 07/01/1992 Plan 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes . . . . 4021-2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P . . . . . . . . No . . . . . . . . . . . . . . . . . . . . . . 04/20/1990 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 07/01/1992 Plan 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes . . . . 4021-3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P . . . . . . . . No . . . . . . . . . . . . . . . . . . . . . . 04/20/1990 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 07/01/1992 Plan 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes . . . . 4021-4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P . . . . . . . . No . . . . . . . . . . . . . . . . . . . . . . 04/20/1990 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 07/01/1992 Plan 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes . . . . 4021-5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P . . . . . . . . No . . . . . . . . . . . . . . . . . . . . . . 04/20/1990 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 07/01/1992 Plan 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes . . . . 4021-7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P . . . . . . . . No . . . . . . . . . . . . . . . . . . . . . . 04/20/1990 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 07/01/1992 Plan 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes . . . . 7460-A, 71141.0210-Plan A . . . . . . A . . . . . . . . No . . . . . . . . . . 2,5 . . . . . . . 02/24/1992 . . . . . . . . . . . . . . . . 05/15/1992 . . . . . . . . . . . . . . . Plan A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes . . . . 7840-A, 71140.0210-MediPl . . . . . A . . . . . . . . No . . . . . . . . . . 4,6 . . . . . . . 06/30/1994 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Mediplan A . . . . . . . . . . . . . . . . . . . . . . . . . . Yes . . . . 7460-B . . . . . . . . . . . . . . . . . . . . . . . . . . . . B . . . . . . . . No . . . . . . . . . . 2,5 . . . . . . . 02/24/1992 . . . . . . . . . . . . . . . . 05/15/1992 . 05/31/2010 Plan B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes . . . . 7460-C . . . . . . . . . . . . . . . . . . . . . . . . . . . . C . . . . . . . . No . . . . . . . . . . 2,5 . . . . . . . 02/24/1992 . . . . . . . . . . . . . . . . 05/15/1992 . 05/31/2010 Plan C . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes . . . . 7460-D . . . . . . . . . . . . . . . . . . . . . . . . . . . . D . . . . . . . . No . . . . . . . . . . 2,5 . . . . . . . 02/24/1992 . . . . . . . . . . . . . . . . 05/15/1992 . 05/31/2010 Plan D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes . . . . 7460-E . . . . . . . . . . . . . . . . . . . . . . . . . . . . E . . . . . . . . No . . . . . . . . . . 2,5 . . . . . . . 02/24/1992 . . . . . . . . . . . . . . . . 05/15/1992 . 05/31/2010 Plan E . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes . . . . 7460-F, 71142.0210-Plan F . . . . . . F . . . . . . . . No . . . . . . . . . . 2,5 . . . . . . . 02/24/1992 . . . . . . . . . . . . . . . . 05/15/1992 . . . . . . . . . . . . . . . Plan F . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes . . . . 7300, 71144.0210-Plan F S . . . . . . F . . . . . . . . Yes . . . . . . . . . 2,5 . . . . . . . 01/30/1996 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Blue Plan 65 Select . . . . . . . . . . . . . . . . . Yes . . . . 7320, 71143.0210-Plan F-H . . . . . . F . . . . . . . . Yes . . . . . . . . . 2,5 . . . . . . . 11/30/1998 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Plan F High Deductible . . . . . . . . . . . . . Yes . . . . 7460-G . . . . . . . . . . . . . . . . . . . . . . . . . . . . G . . . . . . . . No . . . . . . . . . . 2,5 . . . . . . . 02/24/1992 . . . . . . . . . . . . . . . . 05/15/1992 . 05/31/2010 Plan G . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes . . . . 7460-H . . . . . . . . . . . . . . . . . . . . . . . . . . . . H . . . . . . . . No . . . . . . . . . . 2,4 . . . . . . . 02/24/1992 . . . . . . . . . . . . . . . . 05/15/1992 . 05/31/2010 Plan H . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes . . . . 7460-I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . No . . . . . . . . . . 2,4 . . . . . . . 02/24/1992 . . . . . . . . . . . . . . . . 05/15/1992 . 05/31/2010 Plan I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes . . . . 7460-J . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J . . . . . . . . No . . . . . . . . . . 2,4 . . . . . . . 02/24/1992 . . . . . . . . . . . . . . . . 05/15/1992 . 05/31/2010 Plan J . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes . . . . 4900-K . . . . . . . . . . . . . . . . . . . . . . . . . . . . K . . . . . . . . No . . . . . . . . . . 2,5 . . . . . . . 08/25/2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 05/31/2010 Plan K . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes . . . . 4901-L . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . L . . . . . . . . No . . . . . . . . . . 2,5 . . . . . . . 08/25/2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 05/31/2010 Plan L . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes . . . . 71145.0210-Plan N . . . . . . . . . . . . . . . N . . . . . . . . No . . . . . . . . 2,3,4 . . . . . . 04/01/2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Plan N . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes . . . . 71146.0210-Plan N Select . . . . . . . N . . . . . . . . Yes . . . . . . . 2,3,4 . . . . . . 04/01/2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Plan N Select . . . . . . . . . . . . . . . . . . . . . . . 0199999 Total Experience on Individual Policies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0299999 Total Experience on Group Policies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . GENERAL INTERROGATORIES 1. If response in Column 1 is no, give full and complete details: 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: 300 East Randolph Street, Chicago IL 60601-5099 2.2 Contact Person and Phone Number: Tom Ellenwood (312)653-5998 3. Billing address and contact person for user fees established under 41 U.S.C. 1395u(h)(3)(B) 3.1 Address: 300 East Randolph, Chicago IL 60601-5099 3.2 Contact Person and Phone Number: Tom Ellenwood (312)653-5998 4. Explain any policies identified above as policy type "O": ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... . . . . . . . . . . 36,453 . . . . . . . . . 133,232 . . . . . . . 1,006,898 . . . . . . . . . 594,670 . . . . . . . . . 155,860 . . . . . . . . . 233,970 . . . . . . . . . 596,523 .................. . . . . . . . . . 620,671 . . . . . . . 1,701,068 . . . . . . . 2,516,861 . . . . . . . . . 277,791 . . . . . 92,488,375 . . . . . . . 7,287,994 . . . . . . . 3,629,594 . . . . . . . 1,175,804 . . . . . . . . . . 36,060 . . . . . . . . . 311,144 . . . . . . . 2,004,535 . . . . . . . . . . 38,524 . . . . . . . . . . . . 3,541 . . . . . . . 2,638,084 . . . . . . . . . 261,420 .... 117,749,072 .................. . . . . . . . . . . 20,353 . . . . . . . . . . 52,820 . . . . . . . . . 518,624 . . . . . . . . . 331,885 . . . . . . . . . . 61,912 . . . . . . . . . 128,518 . . . . . . . . . 749,124 . . . . . . . . . . . . (176) . . . . . . . . . 425,310 . . . . . . . 1,278,664 . . . . . . . 2,097,173 . . . . . . . . . 179,271 . . . . . 73,951,621 . . . . . . . 6,413,005 . . . . . . . 4,369,085 . . . . . . . . . 769,927 . . . . . . . . . . 13,974 . . . . . . . . . 188,920 . . . . . . . 1,160,876 . . . . . . . . . . . . 8,121 . . . . . . . . . . . . 2,079 . . . . . . . 2,228,896 . . . . . . . . . 264,599 ..... 95,214,581 .................. . . . . . . 55.8 . . . . . . 39.6 . . . . . . 51.5 . . . . . . 55.8 . . . . . . 39.7 . . . . . . 54.9 . . . . . 125.6 ........... . . . . . . 68.5 . . . . . . 75.2 . . . . . . 83.3 . . . . . . 64.5 . . . . . . 80.0 . . . . . . 88.0 . . . . . 120.4 . . . . . . 65.5 . . . . . . 38.8 . . . . . . 60.7 . . . . . . 57.9 . . . . . . 21.1 . . . . . . 58.7 . . . . . . 84.5 . . . . . 101.2 ...... 80.9 ........... . . . . . . . . 15 . . . . . . . . 35 . . . . . . . 273 . . . . . . . 151 . . . . . . . . 37 . . . . . . . . 50 . . . . . . . 310 ........... . . . . . . . 249 . . . . . . . 539 . . . . . . . 840 . . . . . . . 104 . . . . 35,446 . . . . . 3,015 . . . . . 6,947 . . . . . . . 431 . . . . . . . . 10 . . . . . . . . 81 . . . . . . . 488 . . . . . . . . 23 .......... 2 . . . . . 1,489 . . . . . . . 165 .................. .................. .................. .................. .................. .................. . . . . . . . . . 151,973 .................. .................. .................. .................. .................. . . . . . 15,837,316 . . . . . . . . . 870,663 . . . . . . . . . 850,191 .................. .................. .................. .................. .................. .................. . . . . . . . 1,447,487 . . . . . . . . . 102,730 . . . . 50,700 . . . . . ........... 19,260,360 .................. .................. .................. .................. .................. .................. .................. . . . . . . . . . 697,173 .................. .................. .................. .................. .................. . . . . . 13,330,725 . . . . . . . . . 718,262 . . . . . . . . . 784,556 .................. .................. .................. .................. .................. .................. . . . . . . . 1,164,182 . . . . . . . . . . 82,305 ..... 16,777,203 .................. ........... ........... ........... ........... ........... ........... . . . . . 458.7 ........... ........... ........... ........... ........... . . . . . . 84.2 . . . . . . 82.5 . . . . . . 92.3 ........... ........... ........... ........... ........... ........... . . . . . . 80.4 . . . . . . 80.1 ........... ........... ........... ........... ........... ........... . . . . . . . 179 ........... ........... ........... ........... ........... . . . . . 8,428 . . . . . . . 511 . . . . . 2,097 ........... ........... ........... ........... ........... ........... . . . . . 1,018 . . . . . . . . 80 87.1 . . . . 12,313 ...... ........... ........... ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company MEDICARE SUPPLEMENT INSURANCE EXPERIENCE EXHIBIT For The Year Ended DECEMBER 31, 2018 70670201836044100 2018 Document Code: 360 (To be filed by March 1) FOR THE STATE OF TEXAS 1 NAIC Group Code: 0917 NAIC Company Code: 70670 Address (City, State and Zip Code): Chicago, IL 60601-5099 Person Completing This Exhibit: Kathryn Hedke Title: Actuary Telephone Number: (312)653-5702 3 4 5 6 7 8 9 2 10 Policies Issued Through 2015 Incurred Claims 14 12 13 Percent of Number of Premiums Premiums Covered Earned Amount Earned Lives Policies Issued in 2016, 2017, 2018 Incurred Claims 18 16 17 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 . . . . . 2,5,6 . . . . . . . . . . . . 2,5 . . . . . . . . . . . . . 2,5 . . . . . . . . . . . . . 2,5 . . . . . . . . . . . 2,3,4 . . . . . . 09/16/1992 . 04/29/1996 . 09/16/1992 ............... ............... ............... ............... ............... ............... ............... Date Last Amended Date Closed ............... ............... ............... ............... ............... ............... . 01/01/2001 . 05/31/2010 ............... ............... Policy Marketing Trade Name 15 Total Experience on Individual Policies Supp12 Texas ..... ..... ..... ..... ..... Yes Yes Yes Yes Yes .... .... .... .... .... MSP(A)-1, UWMSP(A)-2010 MSP(C)-1 . . . . . . . . . . . . . . . . . . . . MSP(D)-1 . . . . . . . . . . . . . . . . . . . . MSP(F)-1, UWMSP(F)-2010 UWMSP(F-HD)-2010 . . . . . . . . ..... Yes .... ..... ..... ..... ..... ..... ..... Yes . . . . Yes . . . . Yes . . . . N/A . . . . N/A . . . . Yes . . . . UWMSP(G), UWMSP(G)-2010 . . . . . . . . . . . . MSP(K)-1, UWMSP(K)-2010 MSP(L)-1, UWMSP(L)-2010 UWMSP(N)-2010 . . . . . . . . . . . . SCS-MS-3 . . . . . . . . . . . . . . . . . . . . STCS-MS-3 . . . . . . . . . . . . . . . . . . UWMSP-SEL(D) . . . . . . . . . . . . . ..... Yes .... ..... Yes .... ..... Yes .... ..... Yes .... ..... Yes .... UWMSP-SEL(F), UWMSP-SEL(F . . . . . . . . . . . . . . UWMSP-SEL(G), UWMSP-SEL(G . . . . . . . . . . . . . . UWMSP-SEL(K), UWMSP-SEL(K . . . . . . . . . . . . . . UWMSP-SEL(L), UWMSP-SEL(L . . . . . . . . . . . . . . UWMSP-SEL(N)-2010 . . . . . . . ..... ..... ..... ..... ..... ..... ..... ...... ..... ..... ..... ..... A ..... C ..... D ..... F ..... F ..... G ..... K ..... L ..... N ..... P ..... P ..... D ..... ... ... ... ... ... ... ... ... ... ... ... ... No No No No No ... ... ... ... ... No . . . No . . . No . . . No . . . No . . . No . . . Yes . . . . . . . 2,3,4 . . . . . . . . . . 2,5,6 . . . . . . . . . . 2,5,6 . . . . . . . . . . 2,3,4 . . . . . . . . . . . . 2,5 . . . . . . . . . . . . . 2,5 . . . . . . . . . . . 2,3,4 . . . . . . . . . . . . 02/16/2007 11/10/2005 11/10/2005 12/10/2009 03/16/1990 03/16/1990 10/24/2007 ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... . 03/01/1992 . 03/01/1992 . 05/31/2010 ..... F ..... ... Yes .. ..... 2,3,4 ..... . 10/24/2007 ............... ............... ............... ..... G ..... ... Yes .. ..... 2,3,4 ..... . 10/24/2007 ............... ............... ..... K ..... ... Yes .. ..... 2,3,4 ..... . 10/24/2007 ............... ...... ..... L ..... N ..... ... ... Yes Yes .. .. ..... ..... 2,3,4 2,3,4 ..... ..... . . 10/24/2007 12/10/2009 ............... ............... Medicare Supp Policy A . . . . . . . . . . . . Medicare Supp Policy C . . . . . . . . . . . . Medicare Supp Policy D . . . . . . . . . . . . Medicare Supp Policy F . . . . . . . . . . . . Medicare Supp Policy F High Deductible . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 676,568 . . . . . . . . . 860,415 . . . . . . . 7,647,913 . . . . 243,639,442 Medicare Supplement Plan G . . . . . . Medicare Supp Policy K . . . . . . . . . . . . Medicare Supp Policy L . . . . . . . . . . . . Medicare Supplement Plan N . . . . . . Special Companion Service . . . . . . . . Special Companion Service . . . . . . . . Medicare Supplement Select Plan D ..................................... . . . . . . . 6,723,577 . . . . . . . . . 309,813 . . . . . . . . . 279,867 . . . . . 14,860,565 . . . . . . . . . 574,514 . . . . . . . . . . 54,980 6,523,045 ............ 2,129 ...... ...... ...... ...... 72.2 71.1 69.2 75.0 . . . . . . . 137 . . . . . . . 257 . . . . . 2,216 . . . . 89,601 4,014,816 ...... 61.5 ..... ....... . . . . . . . 5,248,157 . . . . . . . . . 123,832 . . . . . . . . . 158,155 . . . . . 11,040,325 . . . . . . . . . 480,073 . . . . . . . . . . 78,991 ........ 2,579 ...... 51.6 .......... 4 ............ 715 ...... 50.7 .......... 1 ............... ............... ............... Medicare Supplement Select Plan L Medicare Supplement Select Plan N ..................................... Senior Texan II Basic . . . . . . . . . . . . . . . Senior Texan II Plus . . . . . . . . . . . . . . . . .............. . . . . . . . . . 145,086 . . . . . . . . . 142,813 . . . . . . 98.4 . . . . . . . . . . . . . . . . . . 34,164 . . . . . . . . . . 67,548 . . . . . 197.7 . . . . . . . . . . . . . . . . . 114,105 . . . . . . . . . . 77,499 . . . . . . 67.9 . . . . . . . . .... 283,553,378 .... ........... 86.7 ............... ............... 211,588,674 ...... 74.6 .. 83 19 52 111,101 4,741 ........... ...... ............ ..... .................. 95,934 Medicare Supplement Select Plan K . . . . . . . . . . . . 4,994 58.0 .................. ....... ............... ...... . . . . . 4,842 . . . . . . . . 35 . . . . . . . . 18 . . . . . 6,483 ........... ........... 86.0 ............... 2,079,807 . . . . . . . 128 ........... ........... . . . . 37,941 . . . . . . 79.6 . . . . . . 23.6 . . . . . . 87.4 . . . . . . 72.5 ........... ........... ...... 50 ....... . . . . . 103.9 ........... ........... . . . . . . 81.8 . . . . . . . 6,711,787 . . . . . . . . . . . . 9,566 . . . . . . . . . . 30,001 . . . . . . . 8,272,273 .................. .................. 851,819 444 . . . . . . . . . 541,315 .................. .................. . . . . . 63,349,446 . . . . . . . 8,435,032 . . . . . . . . . . 40,575 . . . . . . . . . . 34,319 . . . . . 11,409,995 .................. .................. .......... .......... 1 3,588,650 95.3 ............... 1,410 . . . . . 2,758 . . . . . . . 210 . . . . . . . 132 . . . . . 7,403 . . . . . . . 166 . . . . . . . . 17 ....... ...... ......... ............ . . . . . . 78.1 . . . . . . 40.0 . . . . . . 56.5 . . . . . . 74.3 . . . . . . 83.6 . . . . . 143.7 7,550 . . . . . . . . . 521,175 .................. .................. . . . . . 77,410,053 2,029 ............ Medicare Supplement Select Plan F . . . . . . . . . 990,141 Medicare Supplement Select Plan G . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110,650 N/A . . . . ST-II(B)-1 . . . . . . . . . . . . . . . . . . . . . . . . . . P . . . . . . . . No . . . . . . . . . . 2,5 . . . . . . . 02/08/1991 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 03/01/1992 N/A . . . . ST-II(P)-1 . . . . . . . . . . . . . . . . . . . . . . . . . . P . . . . . . . . No . . . . . . . . . . 2,5 . . . . . . . 02/08/1991 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 03/01/1992 0199999 Total Experience on Individual Policies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..... ..... ....... . . . . . . . . . 488,236 . . . . . . . . . 611,722 . . . . . . . 5,289,976 . . . . 182,813,455 ......... 376,421 .......... 95,756 ......... 358,588 ...... 95.3 ....... 78,646 ...... 82.1 ........ .......... 1,478 .............. 129 ........ 88 .............. 368 ..... 8.7 418.2 202 51 .......... 1 ........... . . . . . . . . . . 93,105 . . . . . . . . . . 98,035 . . . . . 105.3 . . . . . . . . 65 .................. .................. ........... ........... .................. .................. ........... ........... .... 102,006,647 ..... 81,529,961 ...... 79.9 . . . . 54,507 344,620 271,176 117,258 733,054 ...... ...... ...... 86.0 91.8 68.5 84.5 ....... ....... ....... Total Experience on Group Policies Yes . . . . CMS-CB-MS-C-0610 . . . . . . . . . . . . . C . . . . . . . . No . . . . . . . . . . 3,5 . . . . . . . 03/12/2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Medicare Supp Policy C . . . . . . . . . . . . Yes . . . . CMS-CB-MS-F-0610 . . . . . . . . . . . . . F . . . . . . . . No . . . . . . . . . . 3,5 . . . . . . . 03/12/2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Medicare Supp Policy F . . . . . . . . . . . . Yes . . . . CMS-CB-MS-G-0610 . . . . . . . . . . . . . G . . . . . . . . No . . . . . . . . . 3,5,. . . . . . . 03/12/2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Medicare Supp Policy G . . . . . . . . . . . . 0299999 Total Experience on Group Policies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . GENERAL INTERROGATORIES 1. If response in Column 1 is no, give full and complete details: 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: 300 East Randolph Street, Chicago IL 60601-5099 2.2 Contact Person and Phone Number: Tom Ellenwood (312)653-5998 3. Billing address and contact person for user fees established under 41 U.S.C. 1395u(h)(3)(B) 3.1 Address: 300 East Randolph, Chicago IL 60601-5099 ..... ..... ..... .................. .................. .................. .................. .................. .................. ........... ........... ........... ........... ........... ........... ......... ......... ......... .................. .................. ........... ........... ......... 400,767 295,303 171,088 867,158 ......... ......... ......... ......... ...... ....... 149 109 107 365 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company Medicare Supplement Ins. Exp. Exh. (continued) 3.2 Contact Person and Phone Number: Tom Ellenwood (312)653-5998 4. Explain any policies identified above as policy type "O": Supp12.1 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201836500100 2018 Document Code: 365 Medicare Part D Coverage Supplement (Net of Reinsurance) NAIC Group Code: 0917 (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 6,165,391 ...................... ....... ....... . . . . . . . . . . . . . . 57,889 . . . . . . . 190,074 ............ ....... . . . . . . . . . . . . . . 60,321 . . . . . . . ...................... ....... ............ (10,173) ....... ............ (10,995) ....... ...................... ....... ...................... ....... .......... (596,225) ....... . . . . . . . . . . . . . . 26,070 . . . . . . . .......... 6,236,707 ....... ...................... ....... .......... (512,267) 179,901 . . . . . . . . . . 5,904,341 ....... ............ ....... 5,063,431 ....... .......... ...................... ....... ....... . . . . . . . . . . . . . . 74,216 . . . . . . . ...................... ....... ...................... ....... ...................... ....... ............ 256,841 ...................... .......... ....... ....... (6,083) ....... 4,806,590 ....... ............. ...................... ....... . . . . . . . . . . . . . . 80,300 . . . . . . . .......... NAIC Company Code: 70670 Group Coverage 3 4 5 Total Insured Uninsured Cash 4,886,890 ....... ....... 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 ...... 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 ...... 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 ...... ....... 6,165,391 ...................... . . . . . . . . . . . . . . 57,889 ............ ....... ....... ....... ....... ....... 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 ...... . . . . . . . . . . 6,413,353 ....... 5,063,431 ...................... . . . . . . . . . . . . . . 74,216 ....... ....... ....... ....... 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 ...... . . . . . . . . . . 5,137,648 ....... (1,145,824) ....... X X X ...... ...................... ........ ............. (5,426) 2,433,085 . . . . . . . . . . . . 535,910 ....... ............. ....... X X X ...... X X X ...... X X X ...... ...................... .......... ...................... ....... ...................... ...................... ...................... ...................... 2,631,437 . . . . . . . . . . 2,711,532 . . . . . . . . (1,694,080) ....... X X X ...... ....... X X X ...... X X X ...... X X X ...... X X X ...... ...................... ....... ...................... ....... ...................... ....... X X X ...... ....... ....... ....... .......... ....... ....... ....... Supp17 ....... ....... ...................... X X X ...... X X X ...... X X X ...... X X X ...... 190,074 (1,145,824) (5,426) X X X ...... ....... X X X ...... ....... X X X ...... . . . . . . . . . . 2,631,437 ....... X X X ...... ....... X X X ...... . . . . . . . . . . (215,332) ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201820500100 2018 Document Code: 205 LIFE SUPPLEMENTS For the Year Ended December 31, 2018 To Be Filed By March 1 Of The Health Care Service Corporation, a Mutual Legal Reserve Company Address (City, State and Zip Code) NAIC Group Code Insurance Company Chicago, IL 60601-5099 0917 NAIC Company Code 70670 Supp25 Employer's ID Number 36-1236610 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company EXHIBIT 5 - AGGREGATE RESERVE FOR LIFE CONTRACTS 1 2 Valuation Standard 0199998 Reinsurance Ceded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0199999 Totals - (Net) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0299998 Reinsurance Ceded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0299999 Totals - (Net) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0399998 Reinsurance Ceded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0399999 Totals - (Net) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0499998 Reinsurance Ceded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0499999 Totals - (Net) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0599998 Reinsurance Ceded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0599999 Totals - (Net) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0699998 Reinsurance Ceded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0699999 Totals - (Net) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0799997 Subtotal - Miscellaneous Reserves (Gross) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0799998 Reinsurance Ceded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0799999 Totals - (Net) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9999999 Totals - (Net) -Page 3, Line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Total Industrial Ordinary 5 Credit (Group and Individual) .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. ..... ..... .................. ..... .................. ..... ..... .................. ..... XXX XXX ..... .................. XXX XXX ..... .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. Supp26 3 4 6 Group ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 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 Supp27 $. . . . . . . . . . . . . . . . . . . . . . . . . 0 $. . . . . . . . . . . . . . . . . . . . . . . . . 0 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 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 4 5 6 Total Guaranteed Interest Contracts Annuities Certain ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... Dividend Premium and Supplemental Accumulations Other Deposit Contracts or Refunds Funds Supp28 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 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 4 5 6 7 NAIC Type of Type of Company ID Effective Domiciliary Reinsurance Business Code Number Date Name of Reinsured Jurisdiction Assumed Assumed 1199999 Total - General Account . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2299999 Total - Separate Accounts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Amount of In force at End of Year 9 Reserve 10 Premiums 11 Reinsurance Payable on Paid and Unpaid Losses 12 Modified Coinsurance Reserve 13 Funds Withheld Under Coinsurance ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... Supp29 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 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 2 3 4 5 6 7 8 NAIC Type of Type of Amount in Company ID Effective Domiciliary Reinsurance Business Force at End Code Number Date Name of Company Jurisdiction Ceded Ceded of Year 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Reserve Credit Taken 9 10 Current Prior Year Year 11 Premiums Outstanding Surplus Relief 12 13 Current Prior Year Year 14 Modified Coinsurance Reserve 15 Funds Withheld Under Coinsurance ................. ................. .................. ................. ................. .................. ................... ................. ................. .................. ................. ................. .................. ................... ................. ................. .................. ................. ................. .................. ................... Supp30 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201820602100 DIRECT BUSINESS IN THE STATE OF ALASKA NAIC Group Code: 0917 Document Code: 206 DURING THE YEAR 2018 NAIC Company Code: 70670 LIFE INSURANCE 1 Ordinary 2 Credit Life (Group and Individual) ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... .......... XXX ......... ........................... .......... XXX ......... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... 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) . . . . . . . . . . . . . . . . ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... DIRECT PREMIUMS AND ANNUITY CONSIDERATIONS 1. 2. 3. 4. 5. 2018 Life Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Annuity considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Deposit-type contract funds . . . . . . . . . . . . . . . . . . . . . . . . . . . Other considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TOTALS (sum of Lines 1 to 4) . . . . . . . . . . . . . . . . . . . . . . . . 3 4 Group 5 Industrial Total DIRECT DIVIDENDS TO POLICYHOLDERS Life Insurance: 6.1 6.2 6.3 6.4 6.5 Annuities: 8. 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ordinary 1 DIRECT DEATH BENEFITS AND MATURED ENDOWMENTS INCURRED No. of Certificates Industrial 6 7 Total 8 9 10 Amount Number Amount Number Amount ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. 20. In force December 31, prior year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21. Issued during year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22. Other changes to in force (Net) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23. In force December 31 of current year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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. ................. .......... .................. ................. .......... .................. ................. .......... .................. ................. .......... .................. 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) . . . . . . . . . . . . . . . . . . . . . . . . . Amount Group 5 .......... 16. 17. Number 2 Credit Life (Group and Individual) 3 4 No. of Ind.Pols & Group Certifs. Amount No. of Policies POLICY EXHIBIT 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,152,235 . . . . . . . . . . . 4,060,554 . . . . . . . . . . . . . . . . . . . . . . . Federal Employees Health Benefits Plan Premium (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Credit (Group and Individual) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Collectively Renewable Policies (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Medicare Title XVIII exempt from state taxes or fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Other Individual Policies 25.1 Non-cancelable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.2 Guaranteed renewable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20,775 . . . . . . . . . . . . . . . 20,775 . . . . . . . . . . . . . . . . . . . . . . . 25.3 Non-renewable for stated reasons only (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.4 Other accident only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.5 All other (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.6 TOTALS (sum of Lines 25.1 to 25.5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20,775 . . . . . . . . . . . . . . . 20,775 . . . . . . . . . . . . . . . . . . . . . . . 26. TOTALS (Lines 24 + 24.1 + 24.2 + 24.3 + 24.4 + 25.6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,173,010 . . . . . . . . . . . 4,081,329 . . . . . . . . . . . . . . . . . . . . . . . (b) For health business on indicated lines report: Number of persons insured under PPO managed care products .............733 and number of persons insured under indemnity only products ..............20. Supp31 Alaska 4 5 Direct Losses Paid Direct Losses Incurred ........... 5,110,859 ........... 4,978,719 ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ............... 51,571 ............... 53,357 ....................... ....................... ....................... ....................... (16,427) . . . . . . . . . . . . . . . 35,144 . . . . . . . . . . . 5,146,003 ............. ............. (16,412) 36,945 5,015,664 ............... ........... ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201820603100 DIRECT BUSINESS IN THE STATE OF ARIZONA NAIC Group Code: 0917 Document Code: 206 DURING THE YEAR 2018 NAIC Company Code: 70670 LIFE INSURANCE 1 Ordinary 2 Credit Life (Group and Individual) ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... .......... XXX ......... ........................... .......... XXX ......... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... 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) . . . . . . . . . . . . . . . . ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... DIRECT PREMIUMS AND ANNUITY CONSIDERATIONS 1. 2. 3. 4. 5. 2018 Life Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Annuity considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Deposit-type contract funds . . . . . . . . . . . . . . . . . . . . . . . . . . . Other considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TOTALS (sum of Lines 1 to 4) . . . . . . . . . . . . . . . . . . . . . . . . 3 4 Group 5 Industrial Total DIRECT DIVIDENDS TO POLICYHOLDERS Life Insurance: 6.1 6.2 6.3 6.4 6.5 Annuities: 8. 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ordinary 1 DIRECT DEATH BENEFITS AND MATURED ENDOWMENTS INCURRED No. of Certificates Industrial 6 7 Total 8 9 10 Amount Number Amount Number Amount ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. 20. In force December 31, prior year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21. Issued during year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22. Other changes to in force (Net) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23. In force December 31 of current year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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. ................. .......... .................. ................. .......... .................. ................. .......... .................. ................. .......... .................. 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) . . . . . . . . . . . . . . . . . . . . . . . . . Amount Group 5 .......... 16. 17. Number 2 Credit Life (Group and Individual) 3 4 No. of Ind.Pols & Group Certifs. Amount No. of Policies POLICY EXHIBIT 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Federal Employees Health Benefits Plan Premium (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Credit (Group and Individual) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Collectively Renewable Policies (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Medicare Title XVIII exempt from state taxes or fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Other Individual Policies 25.1 Non-cancelable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.2 Guaranteed renewable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,120,177 . . . . . . . . . . . 4,120,177 . . . . . . . . . . . . . . . . . . . . . . . 25.3 Non-renewable for stated reasons only (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.4 Other accident only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.5 All other (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 368,719 . . . . . . . . . . . . . . 368,719 . . . . . . . . . . . . . . . . . . . . . . . 25.6 TOTALS (sum of Lines 25.1 to 25.5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,488,896 . . . . . . . . . . . 4,488,896 . . . . . . . . . . . . . . . . . . . . . . . 26. TOTALS (Lines 24 + 24.1 + 24.2 + 24.3 + 24.4 + 25.6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,488,896 . . . . . . . . . . . 4,488,896 . . . . . . . . . . . . . . . . . . . . . . . (b) For health business on indicated lines report: Number of persons insured under PPO managed care products .............103 and number of persons insured under indemnity only products ...........1,956. Supp31 Arizona 4 5 Direct Losses Paid Direct Losses Incurred ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ........... 4,690,042 ........... 4,775,258 ....................... ....................... ....................... ....................... . . . . . . . . . . . . . . 601,498 . . . . . . . . . . . . . . 576,121 ........... ........... 5,291,540 5,291,540 ........... ........... 5,351,379 5,351,379 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201820604100 DIRECT BUSINESS IN THE STATE OF ARKANSAS NAIC Group Code: 0917 Document Code: 206 DURING THE YEAR 2018 NAIC Company Code: 70670 LIFE INSURANCE 1 Ordinary 2 Credit Life (Group and Individual) ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... .......... XXX ......... ........................... .......... XXX ......... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... 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) . . . . . . . . . . . . . . . . ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... DIRECT PREMIUMS AND ANNUITY CONSIDERATIONS 1. 2. 3. 4. 5. 2018 Life Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Annuity considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Deposit-type contract funds . . . . . . . . . . . . . . . . . . . . . . . . . . . Other considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TOTALS (sum of Lines 1 to 4) . . . . . . . . . . . . . . . . . . . . . . . . 3 4 Group 5 Industrial Total DIRECT DIVIDENDS TO POLICYHOLDERS Life Insurance: 6.1 6.2 6.3 6.4 6.5 Annuities: 8. 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ordinary 1 DIRECT DEATH BENEFITS AND MATURED ENDOWMENTS INCURRED No. of Certificates Industrial 6 7 Total 8 9 10 Amount Number Amount Number Amount ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. 20. In force December 31, prior year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21. Issued during year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22. Other changes to in force (Net) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23. In force December 31 of current year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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. ................. .......... .................. ................. .......... .................. ................. .......... .................. ................. .......... .................. 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) . . . . . . . . . . . . . . . . . . . . . . . . . Amount Group 5 .......... 16. 17. Number 2 Credit Life (Group and Individual) 3 4 No. of Ind.Pols & Group Certifs. Amount No. of Policies POLICY EXHIBIT 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29,741,148 . . . . . . . . . . 29,746,129 . . . . . . . . . . . . . . . . . . . . . . . Federal Employees Health Benefits Plan Premium (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Credit (Group and Individual) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Collectively Renewable Policies (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Medicare Title XVIII exempt from state taxes or fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Other Individual Policies 25.1 Non-cancelable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.2 Guaranteed renewable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 594,763 . . . . . . . . . . . . . . 594,763 . . . . . . . . . . . . . . . . . . . . . . . 25.3 Non-renewable for stated reasons only (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.4 Other accident only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.5 All other (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25,301 . . . . . . . . . . . . . . . 25,301 . . . . . . . . . . . . . . . . . . . . . . . 25.6 TOTALS (sum of Lines 25.1 to 25.5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 620,064 . . . . . . . . . . . . . . 620,064 . . . . . . . . . . . . . . . . . . . . . . . 26. TOTALS (Lines 24 + 24.1 + 24.2 + 24.3 + 24.4 + 25.6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30,361,212 . . . . . . . . . . 30,366,193 . . . . . . . . . . . . . . . . . . . . . . . (b) For health business on indicated lines report: Number of persons insured under PPO managed care products ...........6,416 and number of persons insured under indemnity only products .............349. Supp31 Arkansas 4 5 Direct Losses Paid Direct Losses Incurred .......... 20,562,807 .......... 20,876,217 ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... . . . . . . . . . . . . . . 751,073 . . . . . . . . . . . . . . 759,580 ....................... ....................... ....................... ....................... . . . . . . . . . . . . . . 185,788 . . . . . . . . . . . . . . 193,120 . . . . . . . . . . . . . . 936,861 . . . . . . . . . . . . . . 952,700 .......... 21,499,668 .......... 21,828,917 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201820606100 DIRECT BUSINESS IN THE STATE OF COLORADO NAIC Group Code: 0917 Document Code: 206 DURING THE YEAR 2018 NAIC Company Code: 70670 LIFE INSURANCE 1 Ordinary 2 Credit Life (Group and Individual) ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... .......... XXX ......... ........................... .......... XXX ......... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... 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) . . . . . . . . . . . . . . . . ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... DIRECT PREMIUMS AND ANNUITY CONSIDERATIONS 1. 2. 3. 4. 5. 2018 Life Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Annuity considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Deposit-type contract funds . . . . . . . . . . . . . . . . . . . . . . . . . . . Other considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TOTALS (sum of Lines 1 to 4) . . . . . . . . . . . . . . . . . . . . . . . . 3 4 Group 5 Industrial Total DIRECT DIVIDENDS TO POLICYHOLDERS Life Insurance: 6.1 6.2 6.3 6.4 6.5 Annuities: 8. 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ordinary 1 DIRECT DEATH BENEFITS AND MATURED ENDOWMENTS INCURRED No. of Certificates Industrial 6 7 Total 8 9 10 Amount Number Amount Number Amount ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. 20. In force December 31, prior year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21. Issued during year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22. Other changes to in force (Net) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23. In force December 31 of current year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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. ................. .......... .................. ................. .......... .................. ................. .......... .................. ................. .......... .................. 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) . . . . . . . . . . . . . . . . . . . . . . . . . Amount Group 5 .......... 16. 17. Number 2 Credit Life (Group and Individual) 3 4 No. of Ind.Pols & Group Certifs. Amount No. of Policies POLICY EXHIBIT 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Federal Employees Health Benefits Plan Premium (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Credit (Group and Individual) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Collectively Renewable Policies (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Medicare Title XVIII exempt from state taxes or fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Other Individual Policies 25.1 Non-cancelable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.2 Guaranteed renewable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,350,708 . . . . . . . . . . . 1,350,708 . . . . . . . . . . . . . . . . . . . . . . . 25.3 Non-renewable for stated reasons only (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.4 Other accident only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.5 All other (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 280,631 . . . . . . . . . . . . . . 280,631 . . . . . . . . . . . . . . . . . . . . . . . 25.6 TOTALS (sum of Lines 25.1 to 25.5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,631,339 . . . . . . . . . . . 1,631,339 . . . . . . . . . . . . . . . . . . . . . . . 26. TOTALS (Lines 24 + 24.1 + 24.2 + 24.3 + 24.4 + 25.6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,631,339 . . . . . . . . . . . 1,631,339 . . . . . . . . . . . . . . . . . . . . . . . (b) For health business on indicated lines report: Number of persons insured under PPO managed care products .............102 and number of persons insured under indemnity only products .............709. Supp31 Colorado 4 5 Direct Losses Paid Direct Losses Incurred ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ........... 1,631,529 ........... 1,665,294 ....................... ....................... ....................... ....................... . . . . . . . . . . . . . . 547,185 . . . . . . . . . . . . . . 576,363 ........... ........... 2,178,714 2,178,714 ........... ........... 2,241,657 2,241,657 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201820607100 2018 DIRECT BUSINESS IN THE STATE OF CONNECTICUT NAIC Group Code: 0917 LIFE INSURANCE 1 DURING THE YEAR 2018 NAIC Company Code: 70670 Ordinary 2 Credit Life (Group and Individual) ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... .......... XXX ......... ........................... .......... XXX ......... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... 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) . . . . . . . . . . . . . . . . ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... DIRECT PREMIUMS AND ANNUITY CONSIDERATIONS 1. 2. 3. 4. 5. Document Code: 206 Life Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Annuity considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Deposit-type contract funds . . . . . . . . . . . . . . . . . . . . . . . . . . . Other considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TOTALS (sum of Lines 1 to 4) . . . . . . . . . . . . . . . . . . . . . . . . 3 4 Group 5 Industrial Total DIRECT DIVIDENDS TO POLICYHOLDERS Life Insurance: 6.1 6.2 6.3 6.4 6.5 Annuities: 8. 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ordinary 1 DIRECT DEATH BENEFITS AND MATURED ENDOWMENTS INCURRED No. of Certificates Industrial 6 7 Total 8 9 10 Amount Number Amount Number Amount ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. 20. In force December 31, prior year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21. Issued during year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22. Other changes to in force (Net) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23. In force December 31 of current year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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. ................. .......... .................. ................. .......... .................. ................. .......... .................. ................. .......... .................. 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) . . . . . . . . . . . . . . . . . . . . . . . . . Amount Group 5 .......... 16. 17. Number 2 Credit Life (Group and Individual) 3 4 No. of Ind.Pols & Group Certifs. Amount No. of Policies POLICY EXHIBIT 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Federal Employees Health Benefits Plan Premium (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Credit (Group and Individual) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Collectively Renewable Policies (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Medicare Title XVIII exempt from state taxes or fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Other Individual Policies 25.1 Non-cancelable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.2 Guaranteed renewable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133,771 . . . . . . . . . . . . . . 133,771 . . . . . . . . . . . . . . . . . . . . . . . 25.3 Non-renewable for stated reasons only (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.4 Other accident only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.5 All other (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,012 . . . . . . . . . . . . . . . . 6,012 . . . . . . . . . . . . . . . . . . . . . . . 25.6 TOTALS (sum of Lines 25.1 to 25.5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139,783 . . . . . . . . . . . . . . 139,783 . . . . . . . . . . . . . . . . . . . . . . . 26. TOTALS (Lines 24 + 24.1 + 24.2 + 24.3 + 24.4 + 25.6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139,783 . . . . . . . . . . . . . . 139,783 . . . . . . . . . . . . . . . . . . . . . . . (b) For health business on indicated lines report: Number of persons insured under PPO managed care products ..............14 and number of persons insured under indemnity only products ..............45. Supp31 Connecticut 4 5 Direct Losses Paid Direct Losses Incurred ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ............... 97,375 ............... 95,208 ....................... ....................... ....................... ....................... 10,875 . . . . . . . . . . . . . . 108,250 . . . . . . . . . . . . . . 108,250 ................ ............... 6,843 . . . . . . . . . . . . . . 102,051 . . . . . . . . . . . . . . 102,051 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201820608100 DIRECT BUSINESS IN THE STATE OF DELAWARE NAIC Group Code: 0917 Document Code: 206 DURING THE YEAR 2018 NAIC Company Code: 70670 LIFE INSURANCE 1 Ordinary 2 Credit Life (Group and Individual) ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... .......... XXX ......... ........................... .......... XXX ......... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... 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) . . . . . . . . . . . . . . . . ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... DIRECT PREMIUMS AND ANNUITY CONSIDERATIONS 1. 2. 3. 4. 5. 2018 Life Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Annuity considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Deposit-type contract funds . . . . . . . . . . . . . . . . . . . . . . . . . . . Other considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TOTALS (sum of Lines 1 to 4) . . . . . . . . . . . . . . . . . . . . . . . . 3 4 Group 5 Industrial Total DIRECT DIVIDENDS TO POLICYHOLDERS Life Insurance: 6.1 6.2 6.3 6.4 6.5 Annuities: 8. 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ordinary 1 DIRECT DEATH BENEFITS AND MATURED ENDOWMENTS INCURRED No. of Certificates Industrial 6 7 Total 8 9 10 Amount Number Amount Number Amount ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. 20. In force December 31, prior year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21. Issued during year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22. Other changes to in force (Net) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23. In force December 31 of current year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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. ................. .......... .................. ................. .......... .................. ................. .......... .................. ................. .......... .................. 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) . . . . . . . . . . . . . . . . . . . . . . . . . Amount Group 5 .......... 16. 17. Number 2 Credit Life (Group and Individual) 3 4 No. of Ind.Pols & Group Certifs. Amount No. of Policies POLICY EXHIBIT 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,135,834 . . . . . . . . . . . 4,124,623 . . . . . . . . . . . . . . . . . . . . . . . Federal Employees Health Benefits Plan Premium (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Credit (Group and Individual) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Collectively Renewable Policies (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Medicare Title XVIII exempt from state taxes or fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Other Individual Policies 25.1 Non-cancelable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.2 Guaranteed renewable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36,616 . . . . . . . . . . . . . . . 36,616 . . . . . . . . . . . . . . . . . . . . . . . 25.3 Non-renewable for stated reasons only (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.4 Other accident only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.5 All other (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7,676 . . . . . . . . . . . . . . . . 7,676 . . . . . . . . . . . . . . . . . . . . . . . 25.6 TOTALS (sum of Lines 25.1 to 25.5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44,292 . . . . . . . . . . . . . . . 44,292 . . . . . . . . . . . . . . . . . . . . . . . 26. TOTALS (Lines 24 + 24.1 + 24.2 + 24.3 + 24.4 + 25.6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,180,126 . . . . . . . . . . . 4,168,915 . . . . . . . . . . . . . . . . . . . . . . . (b) For health business on indicated lines report: Number of persons insured under PPO managed care products .............773 and number of persons insured under indemnity only products ..............25. Supp31 Delaware 4 5 Direct Losses Paid Direct Losses Incurred ........... 3,155,985 ........... 3,200,678 ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ............... 67,872 ............... 69,018 ....................... ....................... ....................... ....................... 2,065 . . . . . . . . . . . . . . . 69,937 . . . . . . . . . . . 3,225,922 ................ ................ 2,507 71,525 3,272,203 ............... ........... ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201820609100 2018 DIRECT BUSINESS IN THE STATE OF DISTRICT OF COLUMBIA NAIC Group Code: 0917 LIFE INSURANCE 1 DURING THE YEAR 2018 NAIC Company Code: 70670 Ordinary 2 Credit Life (Group and Individual) ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... .......... XXX ......... ........................... .......... XXX ......... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... 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) . . . . . . . . . . . . . . . . ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... DIRECT PREMIUMS AND ANNUITY CONSIDERATIONS 1. 2. 3. 4. 5. Document Code: 206 Life Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Annuity considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Deposit-type contract funds . . . . . . . . . . . . . . . . . . . . . . . . . . . Other considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TOTALS (sum of Lines 1 to 4) . . . . . . . . . . . . . . . . . . . . . . . . 3 4 Group 5 Industrial Total DIRECT DIVIDENDS TO POLICYHOLDERS Life Insurance: 6.1 6.2 6.3 6.4 6.5 Annuities: 8. 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ordinary 1 DIRECT DEATH BENEFITS AND MATURED ENDOWMENTS INCURRED No. of Certificates Industrial 6 7 Total 8 9 10 Amount Number Amount Number Amount ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. 20. In force December 31, prior year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21. Issued during year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22. Other changes to in force (Net) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23. In force December 31 of current year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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. ................. .......... .................. ................. .......... .................. ................. .......... .................. ................. .......... .................. 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) . . . . . . . . . . . . . . . . . . . . . . . . . Amount Group 5 .......... 16. 17. Number 2 Credit Life (Group and Individual) 3 4 No. of Ind.Pols & Group Certifs. Amount No. of Policies POLICY EXHIBIT 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Federal Employees Health Benefits Plan Premium (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Credit (Group and Individual) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Collectively Renewable Policies (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Medicare Title XVIII exempt from state taxes or fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Other Individual Policies 25.1 Non-cancelable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.2 Guaranteed renewable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32,146 . . . . . . . . . . . . . . . 32,146 . . . . . . . . . . . . . . . . . . . . . . . 25.3 Non-renewable for stated reasons only (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.4 Other accident only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.5 All other (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44,969 . . . . . . . . . . . . . . . 44,969 . . . . . . . . . . . . . . . . . . . . . . . 25.6 TOTALS (sum of Lines 25.1 to 25.5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77,115 . . . . . . . . . . . . . . . 77,115 . . . . . . . . . . . . . . . . . . . . . . . 26. TOTALS (Lines 24 + 24.1 + 24.2 + 24.3 + 24.4 + 25.6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77,115 . . . . . . . . . . . . . . . 77,115 . . . . . . . . . . . . . . . . . . . . . . . (b) For health business on indicated lines report: Number of persons insured under PPO managed care products ...............6 and number of persons insured under indemnity only products ...............7. Supp31 District of Columbia 4 5 Direct Losses Paid Direct Losses Incurred ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ............... 36,041 ............... 35,663 ....................... ....................... ....................... ....................... ............... ............... ............... 14,883 50,924 50,924 ............... ............... ............... 13,590 49,253 49,253 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201820610100 DIRECT BUSINESS IN THE STATE OF FLORIDA NAIC Group Code: 0917 Document Code: 206 DURING THE YEAR 2018 NAIC Company Code: 70670 LIFE INSURANCE 1 Ordinary 2 Credit Life (Group and Individual) ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... .......... XXX ......... ........................... .......... XXX ......... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... 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) . . . . . . . . . . . . . . . . ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... DIRECT PREMIUMS AND ANNUITY CONSIDERATIONS 1. 2. 3. 4. 5. 2018 Life Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Annuity considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Deposit-type contract funds . . . . . . . . . . . . . . . . . . . . . . . . . . . Other considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TOTALS (sum of Lines 1 to 4) . . . . . . . . . . . . . . . . . . . . . . . . 3 4 Group 5 Industrial Total DIRECT DIVIDENDS TO POLICYHOLDERS Life Insurance: 6.1 6.2 6.3 6.4 6.5 Annuities: 8. 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ordinary 1 DIRECT DEATH BENEFITS AND MATURED ENDOWMENTS INCURRED No. of Certificates Industrial 6 7 Total 8 9 10 Amount Number Amount Number Amount ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. 20. In force December 31, prior year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21. Issued during year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22. Other changes to in force (Net) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23. In force December 31 of current year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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. ................. .......... .................. ................. .......... .................. ................. .......... .................. ................. .......... .................. 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) . . . . . . . . . . . . . . . . . . . . . . . . . Amount Group 5 .......... 16. 17. Number 2 Credit Life (Group and Individual) 3 4 No. of Ind.Pols & Group Certifs. Amount No. of Policies POLICY EXHIBIT 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113,943,430 . . . . . . . . . 113,406,288 . . . . . . . . . . . . . . . . . . . . . . . Federal Employees Health Benefits Plan Premium (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Credit (Group and Individual) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Collectively Renewable Policies (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Medicare Title XVIII exempt from state taxes or fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Other Individual Policies 25.1 Non-cancelable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.2 Guaranteed renewable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11,807,232 . . . . . . . . . . 11,807,232 . . . . . . . . . . . . . . . . . . . . . . . 25.3 Non-renewable for stated reasons only (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.4 Other accident only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.5 All other (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,082,913 . . . . . . . . . . . 1,082,913 . . . . . . . . . . . . . . . . . . . . . . . 25.6 TOTALS (sum of Lines 25.1 to 25.5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12,890,145 . . . . . . . . . . 12,890,145 . . . . . . . . . . . . . . . . . . . . . . . 26. TOTALS (Lines 24 + 24.1 + 24.2 + 24.3 + 24.4 + 25.6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126,833,575 . . . . . . . . . 126,296,433 . . . . . . . . . . . . . . . . . . . . . . . (b) For health business on indicated lines report: Number of persons insured under PPO managed care products ..........20,458 and number of persons insured under indemnity only products ...........4,940. Supp31 Florida 4 5 Direct Losses Paid Direct Losses Incurred . . . . . . . . . 103,761,074 . . . . . . . . . 104,113,158 ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... .......... 11,813,602 .......... 11,974,407 ....................... ....................... ....................... ....................... 1,606,788 . . . . . . . . . . 13,420,390 . . . . . . . . . 117,181,464 ........... ........... 1,638,114 13,612,521 . . . . . . . . . 117,725,679 .......... ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201820611100 DIRECT BUSINESS IN THE STATE OF GEORGIA NAIC Group Code: 0917 Document Code: 206 DURING THE YEAR 2018 NAIC Company Code: 70670 LIFE INSURANCE 1 Ordinary 2 Credit Life (Group and Individual) ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... .......... XXX ......... ........................... .......... XXX ......... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... 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) . . . . . . . . . . . . . . . . ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... DIRECT PREMIUMS AND ANNUITY CONSIDERATIONS 1. 2. 3. 4. 5. 2018 Life Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Annuity considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Deposit-type contract funds . . . . . . . . . . . . . . . . . . . . . . . . . . . Other considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TOTALS (sum of Lines 1 to 4) . . . . . . . . . . . . . . . . . . . . . . . . 3 4 Group 5 Industrial Total DIRECT DIVIDENDS TO POLICYHOLDERS Life Insurance: 6.1 6.2 6.3 6.4 6.5 Annuities: 8. 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ordinary 1 DIRECT DEATH BENEFITS AND MATURED ENDOWMENTS INCURRED No. of Certificates Industrial 6 7 Total 8 9 10 Amount Number Amount Number Amount ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. 20. In force December 31, prior year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21. Issued during year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22. Other changes to in force (Net) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23. In force December 31 of current year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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. ................. .......... .................. ................. .......... .................. ................. .......... .................. ................. .......... .................. 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) . . . . . . . . . . . . . . . . . . . . . . . . . Amount Group 5 .......... 16. 17. Number 2 Credit Life (Group and Individual) 3 4 No. of Ind.Pols & Group Certifs. Amount No. of Policies POLICY EXHIBIT 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Federal Employees Health Benefits Plan Premium (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Credit (Group and Individual) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Collectively Renewable Policies (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Medicare Title XVIII exempt from state taxes or fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Other Individual Policies 25.1 Non-cancelable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.2 Guaranteed renewable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 920,880 . . . . . . . . . . . . . . 920,880 . . . . . . . . . . . . . . . . . . . . . . . 25.3 Non-renewable for stated reasons only (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.4 Other accident only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.5 All other (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66,460 . . . . . . . . . . . . . . . 66,460 . . . . . . . . . . . . . . . . . . . . . . . 25.6 TOTALS (sum of Lines 25.1 to 25.5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 987,340 . . . . . . . . . . . . . . 987,340 . . . . . . . . . . . . . . . . . . . . . . . 26. TOTALS (Lines 24 + 24.1 + 24.2 + 24.3 + 24.4 + 25.6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 987,340 . . . . . . . . . . . . . . 987,340 . . . . . . . . . . . . . . . . . . . . . . . (b) For health business on indicated lines report: Number of persons insured under PPO managed care products ..............24 and number of persons insured under indemnity only products .............468. Supp31 Georgia 4 5 Direct Losses Paid Direct Losses Incurred ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ........... 1,142,298 ........... 1,155,847 ....................... ....................... ....................... ....................... . . . . . . . . . . . . . . 104,873 . . . . . . . . . . . . . . . ........... ........... 1,247,171 1,247,171 ........... ........... 82,715 1,238,562 1,238,562 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201820613100 DIRECT BUSINESS IN THE STATE OF IDAHO NAIC Group Code: 0917 Document Code: 206 DURING THE YEAR 2018 NAIC Company Code: 70670 LIFE INSURANCE 1 Ordinary 2 Credit Life (Group and Individual) ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... .......... XXX ......... ........................... .......... XXX ......... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... 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) . . . . . . . . . . . . . . . . ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... DIRECT PREMIUMS AND ANNUITY CONSIDERATIONS 1. 2. 3. 4. 5. 2018 Life Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Annuity considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Deposit-type contract funds . . . . . . . . . . . . . . . . . . . . . . . . . . . Other considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TOTALS (sum of Lines 1 to 4) . . . . . . . . . . . . . . . . . . . . . . . . 3 4 Group 5 Industrial Total DIRECT DIVIDENDS TO POLICYHOLDERS Life Insurance: 6.1 6.2 6.3 6.4 6.5 Annuities: 8. 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ordinary 1 DIRECT DEATH BENEFITS AND MATURED ENDOWMENTS INCURRED No. of Certificates Industrial 6 7 Total 8 9 10 Amount Number Amount Number Amount ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. 20. In force December 31, prior year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21. Issued during year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22. Other changes to in force (Net) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23. In force December 31 of current year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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. ................. .......... .................. ................. .......... .................. ................. .......... .................. ................. .......... .................. 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) . . . . . . . . . . . . . . . . . . . . . . . . . Amount Group 5 .......... 16. 17. Number 2 Credit Life (Group and Individual) 3 4 No. of Ind.Pols & Group Certifs. Amount No. of Policies POLICY EXHIBIT 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Federal Employees Health Benefits Plan Premium (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Credit (Group and Individual) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Collectively Renewable Policies (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Medicare Title XVIII exempt from state taxes or fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Other Individual Policies 25.1 Non-cancelable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.2 Guaranteed renewable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219,657 . . . . . . . . . . . . . . 219,657 . . . . . . . . . . . . . . . . . . . . . . . 25.3 Non-renewable for stated reasons only (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.4 Other accident only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.5 All other (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16,368 . . . . . . . . . . . . . . . 16,368 . . . . . . . . . . . . . . . . . . . . . . . 25.6 TOTALS (sum of Lines 25.1 to 25.5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 236,025 . . . . . . . . . . . . . . 236,025 . . . . . . . . . . . . . . . . . . . . . . . 26. TOTALS (Lines 24 + 24.1 + 24.2 + 24.3 + 24.4 + 25.6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 236,025 . . . . . . . . . . . . . . 236,025 . . . . . . . . . . . . . . . . . . . . . . . (b) For health business on indicated lines report: Number of persons insured under PPO managed care products ..............20 and number of persons insured under indemnity only products .............140. Supp31 Idaho 4 5 Direct Losses Paid Direct Losses Incurred ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... . . . . . . . . . . . . . . 201,107 . . . . . . . . . . . . . . 202,940 ....................... ....................... ....................... ....................... 70,518 . . . . . . . . . . . . . . 271,625 . . . . . . . . . . . . . . 271,625 ............... ............... 57,305 . . . . . . . . . . . . . . 260,245 . . . . . . . . . . . . . . 260,245 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201820614100 DIRECT BUSINESS IN THE STATE OF ILLINOIS NAIC Group Code: 0917 Document Code: 206 DURING THE YEAR 2018 NAIC Company Code: 70670 LIFE INSURANCE 1 Ordinary 2 Credit Life (Group and Individual) ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... .......... XXX ......... ........................... .......... XXX ......... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... 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) . . . . . . . . . . . . . . . . ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... DIRECT PREMIUMS AND ANNUITY CONSIDERATIONS 1. 2. 3. 4. 5. 2018 Life Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Annuity considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Deposit-type contract funds . . . . . . . . . . . . . . . . . . . . . . . . . . . Other considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TOTALS (sum of Lines 1 to 4) . . . . . . . . . . . . . . . . . . . . . . . . 3 4 Group 5 Industrial Total DIRECT DIVIDENDS TO POLICYHOLDERS Life Insurance: 6.1 6.2 6.3 6.4 6.5 Annuities: 8. 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ordinary 1 DIRECT DEATH BENEFITS AND MATURED ENDOWMENTS INCURRED No. of Certificates Industrial 6 7 Total 8 9 10 Amount Number Amount Number Amount ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. 20. In force December 31, prior year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21. Issued during year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22. Other changes to in force (Net) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23. In force December 31 of current year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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. ................. .......... .................. ................. .......... .................. ................. .......... .................. ................. .......... .................. 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) . . . . . . . . . . . . . . . . . . . . . . . . . Amount Group 5 .......... 16. 17. Number 2 Credit Life (Group and Individual) 3 4 No. of Ind.Pols & Group Certifs. Amount No. of Policies POLICY EXHIBIT 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,926,726,130 . . . . . . . 6,029,649,861 . . . . . . . . . . . . . . . . . . . . . . . Federal Employees Health Benefits Plan Premium (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,123,483,262 . . . . . . . 1,149,709,043 . . . . . . . . . . . . . . . . . . . . . . . Credit (Group and Individual) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Collectively Renewable Policies (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Medicare Title XVIII exempt from state taxes or fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265,816,326 . . . . . . . . . 244,269,946 . . . . . . . . . . . . . . . . . . . . . . . Other Individual Policies 25.1 Non-cancelable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.2 Guaranteed renewable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 986,665,378 . . . . . . . . . 981,500,265 . . . . . . . . . . . . . . . . . . . . . . . 25.3 Non-renewable for stated reasons only (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.4 Other accident only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.5 All other (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,803,671,491 . . . . . . . 1,815,454,985 . . . . . . . . . . . . . . . . . . . . . . . 25.6 TOTALS (sum of Lines 25.1 to 25.5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,790,336,869 . . . . . . . 2,796,955,250 . . . . . . . . . . . . . . . . . . . . . . . 26. TOTALS (Lines 24 + 24.1 + 24.2 + 24.3 + 24.4 + 25.6) . . . . . . . . . . . . . . . . . . . . . . . . 10,106,362,587 . . . . . 10,220,584,100 . . . . . . . . . . . . . . . . . . . . . . . (b) For health business on indicated lines report: Number of persons insured under PPO managed care products .......1,252,979 and number of persons insured under indemnity only products .........372,046. Supp31 Illinois 4 5 Direct Losses Paid Direct Losses Incurred . . . . . . . 5,135,986,901 . . . . . . . 5,057,722,751 . . . . . . . 1,044,563,442 . . . . . . . 1,065,991,869 ....................... ....................... ....................... ....................... . . . . . . . . . 240,320,633 . . . . . . . . . 235,524,054 ....................... ....................... . . . . . . . . . 774,106,460 . . . . . . . . . 781,430,648 ....................... ....................... ....................... ....................... . . . . . . . 1,251,646,016 . . . . . . . 1,234,759,371 . . . . . . . 2,025,752,476 . . . . . . . 2,016,190,019 . . . . . . . 8,446,623,452 . . . . . . . 8,375,428,693 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201820615100 DIRECT BUSINESS IN THE STATE OF INDIANA NAIC Group Code: 0917 Document Code: 206 DURING THE YEAR 2018 NAIC Company Code: 70670 LIFE INSURANCE 1 Ordinary 2 Credit Life (Group and Individual) ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... .......... XXX ......... ........................... .......... XXX ......... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... 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) . . . . . . . . . . . . . . . . ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... DIRECT PREMIUMS AND ANNUITY CONSIDERATIONS 1. 2. 3. 4. 5. 2018 Life Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Annuity considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Deposit-type contract funds . . . . . . . . . . . . . . . . . . . . . . . . . . . Other considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TOTALS (sum of Lines 1 to 4) . . . . . . . . . . . . . . . . . . . . . . . . 3 4 Group 5 Industrial Total DIRECT DIVIDENDS TO POLICYHOLDERS Life Insurance: 6.1 6.2 6.3 6.4 6.5 Annuities: 8. 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ordinary 1 DIRECT DEATH BENEFITS AND MATURED ENDOWMENTS INCURRED No. of Certificates Industrial 6 7 Total 8 9 10 Amount Number Amount Number Amount ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. 20. In force December 31, prior year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21. Issued during year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22. Other changes to in force (Net) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23. In force December 31 of current year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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. ................. .......... .................. ................. .......... .................. ................. .......... .................. ................. .......... .................. 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) . . . . . . . . . . . . . . . . . . . . . . . . . Amount Group 5 .......... 16. 17. Number 2 Credit Life (Group and Individual) 3 4 No. of Ind.Pols & Group Certifs. Amount No. of Policies POLICY EXHIBIT 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,709,962 . . . . . . . . . . . 1,709,962 . . . . . . . . . . . . . . . . . . . . . . . Federal Employees Health Benefits Plan Premium (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Credit (Group and Individual) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Collectively Renewable Policies (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Medicare Title XVIII exempt from state taxes or fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Other Individual Policies 25.1 Non-cancelable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.2 Guaranteed renewable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,187,265 . . . . . . . . . . . 3,187,265 . . . . . . . . . . . . . . . . . . . . . . . 25.3 Non-renewable for stated reasons only (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.4 Other accident only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.5 All other (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 484,991 . . . . . . . . . . . . . . 484,991 . . . . . . . . . . . . . . . . . . . . . . . 25.6 TOTALS (sum of Lines 25.1 to 25.5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,672,256 . . . . . . . . . . . 3,672,256 . . . . . . . . . . . . . . . . . . . . . . . 26. TOTALS (Lines 24 + 24.1 + 24.2 + 24.3 + 24.4 + 25.6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,382,218 . . . . . . . . . . . 5,382,218 . . . . . . . . . . . . . . . . . . . . . . . (b) For health business on indicated lines report: Number of persons insured under PPO managed care products .............108 and number of persons insured under indemnity only products ...........1,272. Supp31 Indiana 4 5 Direct Losses Paid Direct Losses Incurred 1,028,030 . . . . . . . . . . . . . . 850,354 ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ........... ........... 3,474,490 ........... 3,526,197 ....................... ....................... ....................... ....................... ........... ........... ........... 1,450,647 4,925,137 5,953,167 ........... ........... ........... 1,376,897 4,903,094 5,753,448 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201820618100 DIRECT BUSINESS IN THE STATE OF KENTUCKY NAIC Group Code: 0917 Document Code: 206 DURING THE YEAR 2018 NAIC Company Code: 70670 LIFE INSURANCE 1 Ordinary 2 Credit Life (Group and Individual) ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... .......... XXX ......... ........................... .......... XXX ......... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... 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) . . . . . . . . . . . . . . . . ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... DIRECT PREMIUMS AND ANNUITY CONSIDERATIONS 1. 2. 3. 4. 5. 2018 Life Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Annuity considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Deposit-type contract funds . . . . . . . . . . . . . . . . . . . . . . . . . . . Other considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TOTALS (sum of Lines 1 to 4) . . . . . . . . . . . . . . . . . . . . . . . . 3 4 Group 5 Industrial Total DIRECT DIVIDENDS TO POLICYHOLDERS Life Insurance: 6.1 6.2 6.3 6.4 6.5 Annuities: 8. 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ordinary 1 DIRECT DEATH BENEFITS AND MATURED ENDOWMENTS INCURRED No. of Certificates Industrial 6 7 Total 8 9 10 Amount Number Amount Number Amount ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. 20. In force December 31, prior year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21. Issued during year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22. Other changes to in force (Net) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23. In force December 31 of current year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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. ................. .......... .................. ................. .......... .................. ................. .......... .................. ................. .......... .................. 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) . . . . . . . . . . . . . . . . . . . . . . . . . Amount Group 5 .......... 16. 17. Number 2 Credit Life (Group and Individual) 3 4 No. of Ind.Pols & Group Certifs. Amount No. of Policies POLICY EXHIBIT 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21,777,489 . . . . . . . . . . 21,884,341 . . . . . . . . . . . . . . . . . . . . . . . Federal Employees Health Benefits Plan Premium (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Credit (Group and Individual) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Collectively Renewable Policies (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Medicare Title XVIII exempt from state taxes or fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Other Individual Policies 25.1 Non-cancelable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.2 Guaranteed renewable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 541,527 . . . . . . . . . . . . . . 541,527 . . . . . . . . . . . . . . . . . . . . . . . 25.3 Non-renewable for stated reasons only (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.4 Other accident only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.5 All other (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28,073 . . . . . . . . . . . . . . . 28,073 . . . . . . . . . . . . . . . . . . . . . . . 25.6 TOTALS (sum of Lines 25.1 to 25.5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 569,600 . . . . . . . . . . . . . . 569,600 . . . . . . . . . . . . . . . . . . . . . . . 26. TOTALS (Lines 24 + 24.1 + 24.2 + 24.3 + 24.4 + 25.6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22,347,089 . . . . . . . . . . 22,453,941 . . . . . . . . . . . . . . . . . . . . . . . (b) For health business on indicated lines report: Number of persons insured under PPO managed care products ...........4,939 and number of persons insured under indemnity only products .............267. Supp31 Kentucky 4 5 Direct Losses Paid Direct Losses Incurred .......... 19,236,924 .......... 19,209,427 ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... . . . . . . . . . . . . . . 574,765 . . . . . . . . . . . . . . 585,676 ....................... ....................... ....................... ....................... 33,238 . . . . . . . . . . . . . . 608,003 . . . . . . . . . . 19,844,927 ............... ............... 26,362 . . . . . . . . . . . . . . 612,038 .......... 19,821,465 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201820620100 DIRECT BUSINESS IN THE STATE OF MAINE NAIC Group Code: 0917 Document Code: 206 DURING THE YEAR 2018 NAIC Company Code: 70670 LIFE INSURANCE 1 Ordinary 2 Credit Life (Group and Individual) ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... .......... XXX ......... ........................... .......... XXX ......... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... 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) . . . . . . . . . . . . . . . . ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... DIRECT PREMIUMS AND ANNUITY CONSIDERATIONS 1. 2. 3. 4. 5. 2018 Life Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Annuity considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Deposit-type contract funds . . . . . . . . . . . . . . . . . . . . . . . . . . . Other considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TOTALS (sum of Lines 1 to 4) . . . . . . . . . . . . . . . . . . . . . . . . 3 4 Group 5 Industrial Total DIRECT DIVIDENDS TO POLICYHOLDERS Life Insurance: 6.1 6.2 6.3 6.4 6.5 Annuities: 8. 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ordinary 1 DIRECT DEATH BENEFITS AND MATURED ENDOWMENTS INCURRED No. of Certificates Industrial 6 7 Total 8 9 10 Amount Number Amount Number Amount ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. 20. In force December 31, prior year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21. Issued during year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22. Other changes to in force (Net) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23. In force December 31 of current year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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. ................. .......... .................. ................. .......... .................. ................. .......... .................. ................. .......... .................. 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) . . . . . . . . . . . . . . . . . . . . . . . . . Amount Group 5 .......... 16. 17. Number 2 Credit Life (Group and Individual) 3 4 No. of Ind.Pols & Group Certifs. Amount No. of Policies POLICY EXHIBIT 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Federal Employees Health Benefits Plan Premium (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Credit (Group and Individual) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Collectively Renewable Policies (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Medicare Title XVIII exempt from state taxes or fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Other Individual Policies 25.1 Non-cancelable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.2 Guaranteed renewable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65,353 . . . . . . . . . . . . . . . 65,353 . . . . . . . . . . . . . . . . . . . . . . . 25.3 Non-renewable for stated reasons only (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.4 Other accident only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.5 All other (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21,770 . . . . . . . . . . . . . . . 21,770 . . . . . . . . . . . . . . . . . . . . . . . 25.6 TOTALS (sum of Lines 25.1 to 25.5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87,123 . . . . . . . . . . . . . . . 87,123 . . . . . . . . . . . . . . . . . . . . . . . 26. TOTALS (Lines 24 + 24.1 + 24.2 + 24.3 + 24.4 + 25.6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87,123 . . . . . . . . . . . . . . . 87,123 . . . . . . . . . . . . . . . . . . . . . . . (b) For health business on indicated lines report: Number of persons insured under PPO managed care products ...............5 and number of persons insured under indemnity only products ..............28. Supp31 Maine 4 5 Direct Losses Paid Direct Losses Incurred ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ............... 82,292 ............... 87,233 ....................... ....................... ....................... ....................... 3,931 86,223 86,223 3,999 91,232 91,232 ................ ................ ............... ............... ............... ............... ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201820621100 DIRECT BUSINESS IN THE STATE OF MARYLAND NAIC Group Code: 0917 Document Code: 206 DURING THE YEAR 2018 NAIC Company Code: 70670 LIFE INSURANCE 1 Ordinary 2 Credit Life (Group and Individual) ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... .......... XXX ......... ........................... .......... XXX ......... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... 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) . . . . . . . . . . . . . . . . ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... DIRECT PREMIUMS AND ANNUITY CONSIDERATIONS 1. 2. 3. 4. 5. 2018 Life Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Annuity considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Deposit-type contract funds . . . . . . . . . . . . . . . . . . . . . . . . . . . Other considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TOTALS (sum of Lines 1 to 4) . . . . . . . . . . . . . . . . . . . . . . . . 3 4 Group 5 Industrial Total DIRECT DIVIDENDS TO POLICYHOLDERS Life Insurance: 6.1 6.2 6.3 6.4 6.5 Annuities: 8. 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ordinary 1 DIRECT DEATH BENEFITS AND MATURED ENDOWMENTS INCURRED No. of Certificates Industrial 6 7 Total 8 9 10 Amount Number Amount Number Amount ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. 20. In force December 31, prior year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21. Issued during year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22. Other changes to in force (Net) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23. In force December 31 of current year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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. ................. .......... .................. ................. .......... .................. ................. .......... .................. ................. .......... .................. 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) . . . . . . . . . . . . . . . . . . . . . . . . . Amount Group 5 .......... 16. 17. Number 2 Credit Life (Group and Individual) 3 4 No. of Ind.Pols & Group Certifs. Amount No. of Policies POLICY EXHIBIT 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10,882,965 . . . . . . . . . . 11,057,364 . . . . . . . . . . . . . . . . . . . . . . . Federal Employees Health Benefits Plan Premium (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Credit (Group and Individual) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Collectively Renewable Policies (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Medicare Title XVIII exempt from state taxes or fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Other Individual Policies 25.1 Non-cancelable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.2 Guaranteed renewable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 326,188 . . . . . . . . . . . . . . 326,188 . . . . . . . . . . . . . . . . . . . . . . . 25.3 Non-renewable for stated reasons only (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.4 Other accident only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.5 All other (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32,804 . . . . . . . . . . . . . . . 32,804 . . . . . . . . . . . . . . . . . . . . . . . 25.6 TOTALS (sum of Lines 25.1 to 25.5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 358,992 . . . . . . . . . . . . . . 358,992 . . . . . . . . . . . . . . . . . . . . . . . 26. TOTALS (Lines 24 + 24.1 + 24.2 + 24.3 + 24.4 + 25.6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11,241,957 . . . . . . . . . . 11,416,356 . . . . . . . . . . . . . . . . . . . . . . . (b) For health business on indicated lines report: Number of persons insured under PPO managed care products ...........1,836 and number of persons insured under indemnity only products .............161. Supp31 Maryland 4 5 Direct Losses Paid Direct Losses Incurred ........... 7,086,871 ........... 7,118,775 ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... . . . . . . . . . . . . . . 349,286 . . . . . . . . . . . . . . 351,640 ....................... ....................... ....................... ....................... 11,731 . . . . . . . . . . . . . . 361,017 . . . . . . . . . . . 7,447,888 ................ ............... 7,626 . . . . . . . . . . . . . . 359,266 ........... 7,478,041 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201820622100 2018 DIRECT BUSINESS IN THE STATE OF MASSACHUSETTS NAIC Group Code: 0917 LIFE INSURANCE 1 DURING THE YEAR 2018 NAIC Company Code: 70670 Ordinary 2 Credit Life (Group and Individual) ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... .......... XXX ......... ........................... .......... XXX ......... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... 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) . . . . . . . . . . . . . . . . ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... DIRECT PREMIUMS AND ANNUITY CONSIDERATIONS 1. 2. 3. 4. 5. Document Code: 206 Life Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Annuity considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Deposit-type contract funds . . . . . . . . . . . . . . . . . . . . . . . . . . . Other considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TOTALS (sum of Lines 1 to 4) . . . . . . . . . . . . . . . . . . . . . . . . 3 4 Group 5 Industrial Total DIRECT DIVIDENDS TO POLICYHOLDERS Life Insurance: 6.1 6.2 6.3 6.4 6.5 Annuities: 8. 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ordinary 1 DIRECT DEATH BENEFITS AND MATURED ENDOWMENTS INCURRED No. of Certificates Industrial 6 7 Total 8 9 10 Amount Number Amount Number Amount ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. 20. In force December 31, prior year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21. Issued during year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22. Other changes to in force (Net) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23. In force December 31 of current year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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. ................. .......... .................. ................. .......... .................. ................. .......... .................. ................. .......... .................. 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) . . . . . . . . . . . . . . . . . . . . . . . . . Amount Group 5 .......... 16. 17. Number 2 Credit Life (Group and Individual) 3 4 No. of Ind.Pols & Group Certifs. Amount No. of Policies POLICY EXHIBIT 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Federal Employees Health Benefits Plan Premium (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Credit (Group and Individual) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Collectively Renewable Policies (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Medicare Title XVIII exempt from state taxes or fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Other Individual Policies 25.1 Non-cancelable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.2 Guaranteed renewable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203,539 . . . . . . . . . . . . . . 203,539 . . . . . . . . . . . . . . . . . . . . . . . 25.3 Non-renewable for stated reasons only (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.4 Other accident only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.5 All other (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94,434 . . . . . . . . . . . . . . . 94,434 . . . . . . . . . . . . . . . . . . . . . . . 25.6 TOTALS (sum of Lines 25.1 to 25.5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297,973 . . . . . . . . . . . . . . 297,973 . . . . . . . . . . . . . . . . . . . . . . . 26. TOTALS (Lines 24 + 24.1 + 24.2 + 24.3 + 24.4 + 25.6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297,973 . . . . . . . . . . . . . . 297,973 . . . . . . . . . . . . . . . . . . . . . . . (b) For health business on indicated lines report: Number of persons insured under PPO managed care products ...............6 and number of persons insured under indemnity only products ..............78. Supp31 Massachusetts 4 5 Direct Losses Paid Direct Losses Incurred ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... . . . . . . . . . . . . . . 239,564 . . . . . . . . . . . . . . 241,374 ....................... ....................... ....................... ....................... 15,970 . . . . . . . . . . . . . . 255,534 . . . . . . . . . . . . . . 255,534 ............... ............... (1,334) . . . . . . . . . . . . . . 240,040 . . . . . . . . . . . . . . 240,040 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201820623100 DIRECT BUSINESS IN THE STATE OF MICHIGAN NAIC Group Code: 0917 Document Code: 206 DURING THE YEAR 2018 NAIC Company Code: 70670 LIFE INSURANCE 1 Ordinary 2 Credit Life (Group and Individual) ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... .......... XXX ......... ........................... .......... XXX ......... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... 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) . . . . . . . . . . . . . . . . ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... DIRECT PREMIUMS AND ANNUITY CONSIDERATIONS 1. 2. 3. 4. 5. 2018 Life Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Annuity considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Deposit-type contract funds . . . . . . . . . . . . . . . . . . . . . . . . . . . Other considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TOTALS (sum of Lines 1 to 4) . . . . . . . . . . . . . . . . . . . . . . . . 3 4 Group 5 Industrial Total DIRECT DIVIDENDS TO POLICYHOLDERS Life Insurance: 6.1 6.2 6.3 6.4 6.5 Annuities: 8. 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ordinary 1 DIRECT DEATH BENEFITS AND MATURED ENDOWMENTS INCURRED No. of Certificates Industrial 6 7 Total 8 9 10 Amount Number Amount Number Amount ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. 20. In force December 31, prior year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21. Issued during year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22. Other changes to in force (Net) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23. In force December 31 of current year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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. ................. .......... .................. ................. .......... .................. ................. .......... .................. ................. .......... .................. 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) . . . . . . . . . . . . . . . . . . . . . . . . . Amount Group 5 .......... 16. 17. Number 2 Credit Life (Group and Individual) 3 4 No. of Ind.Pols & Group Certifs. Amount No. of Policies POLICY EXHIBIT 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Federal Employees Health Benefits Plan Premium (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Credit (Group and Individual) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Collectively Renewable Policies (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Medicare Title XVIII exempt from state taxes or fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Other Individual Policies 25.1 Non-cancelable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.2 Guaranteed renewable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,279,788 . . . . . . . . . . . 1,279,788 . . . . . . . . . . . . . . . . . . . . . . . 25.3 Non-renewable for stated reasons only (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.4 Other accident only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.5 All other (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121,322 . . . . . . . . . . . . . . 121,322 . . . . . . . . . . . . . . . . . . . . . . . 25.6 TOTALS (sum of Lines 25.1 to 25.5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,401,110 . . . . . . . . . . . 1,401,110 . . . . . . . . . . . . . . . . . . . . . . . 26. TOTALS (Lines 24 + 24.1 + 24.2 + 24.3 + 24.4 + 25.6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,401,110 . . . . . . . . . . . 1,401,110 . . . . . . . . . . . . . . . . . . . . . . . (b) For health business on indicated lines report: Number of persons insured under PPO managed care products ..............29 and number of persons insured under indemnity only products .............598. Supp31 Michigan 4 5 Direct Losses Paid Direct Losses Incurred ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ........... 1,251,025 ........... 1,278,772 ....................... ....................... ....................... ....................... . . . . . . . . . . . . . . 220,366 . . . . . . . . . . . . . . 229,294 ........... ........... 1,471,391 1,471,391 ........... ........... 1,508,066 1,508,066 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201820624100 DIRECT BUSINESS IN THE STATE OF MINNESOTA NAIC Group Code: 0917 Document Code: 206 DURING THE YEAR 2018 NAIC Company Code: 70670 LIFE INSURANCE 1 Ordinary 2 Credit Life (Group and Individual) ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... .......... XXX ......... ........................... .......... XXX ......... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... 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) . . . . . . . . . . . . . . . . ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... DIRECT PREMIUMS AND ANNUITY CONSIDERATIONS 1. 2. 3. 4. 5. 2018 Life Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Annuity considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Deposit-type contract funds . . . . . . . . . . . . . . . . . . . . . . . . . . . Other considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TOTALS (sum of Lines 1 to 4) . . . . . . . . . . . . . . . . . . . . . . . . 3 4 Group 5 Industrial Total DIRECT DIVIDENDS TO POLICYHOLDERS Life Insurance: 6.1 6.2 6.3 6.4 6.5 Annuities: 8. 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ordinary 1 DIRECT DEATH BENEFITS AND MATURED ENDOWMENTS INCURRED No. of Certificates Industrial 6 7 Total 8 9 10 Amount Number Amount Number Amount ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. 20. In force December 31, prior year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21. Issued during year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22. Other changes to in force (Net) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23. In force December 31 of current year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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. ................. .......... .................. ................. .......... .................. ................. .......... .................. ................. .......... .................. 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) . . . . . . . . . . . . . . . . . . . . . . . . . Amount Group 5 .......... 16. 17. Number 2 Credit Life (Group and Individual) 3 4 No. of Ind.Pols & Group Certifs. Amount No. of Policies POLICY EXHIBIT 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48,893,016 . . . . . . . . . . 48,887,112 . . . . . . . . . . . . . . . . . . . . . . . Federal Employees Health Benefits Plan Premium (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Credit (Group and Individual) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Collectively Renewable Policies (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Medicare Title XVIII exempt from state taxes or fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Other Individual Policies 25.1 Non-cancelable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.2 Guaranteed renewable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 565,551 . . . . . . . . . . . . . . 565,551 . . . . . . . . . . . . . . . . . . . . . . . 25.3 Non-renewable for stated reasons only (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.4 Other accident only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.5 All other (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63,087 . . . . . . . . . . . . . . . 63,087 . . . . . . . . . . . . . . . . . . . . . . . 25.6 TOTALS (sum of Lines 25.1 to 25.5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 628,638 . . . . . . . . . . . . . . 628,638 . . . . . . . . . . . . . . . . . . . . . . . 26. TOTALS (Lines 24 + 24.1 + 24.2 + 24.3 + 24.4 + 25.6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49,521,654 . . . . . . . . . . 49,515,750 . . . . . . . . . . . . . . . . . . . . . . . (b) For health business on indicated lines report: Number of persons insured under PPO managed care products ...........9,483 and number of persons insured under indemnity only products .............247. Supp31 Minnesota 4 5 Direct Losses Paid Direct Losses Incurred .......... 46,298,326 .......... 46,619,084 ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... . . . . . . . . . . . . . . 506,630 . . . . . . . . . . . . . . 517,518 ....................... ....................... ....................... ....................... 48,121 . . . . . . . . . . . . . . 554,751 . . . . . . . . . . 46,853,077 ............... ............... 27,739 . . . . . . . . . . . . . . 545,257 .......... 47,164,341 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201820626100 DIRECT BUSINESS IN THE STATE OF MISSOURI NAIC Group Code: 0917 Document Code: 206 DURING THE YEAR 2018 NAIC Company Code: 70670 LIFE INSURANCE 1 Ordinary 2 Credit Life (Group and Individual) ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... .......... XXX ......... ........................... .......... XXX ......... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... 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) . . . . . . . . . . . . . . . . ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... DIRECT PREMIUMS AND ANNUITY CONSIDERATIONS 1. 2. 3. 4. 5. 2018 Life Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Annuity considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Deposit-type contract funds . . . . . . . . . . . . . . . . . . . . . . . . . . . Other considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TOTALS (sum of Lines 1 to 4) . . . . . . . . . . . . . . . . . . . . . . . . 3 4 Group 5 Industrial Total DIRECT DIVIDENDS TO POLICYHOLDERS Life Insurance: 6.1 6.2 6.3 6.4 6.5 Annuities: 8. 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ordinary 1 DIRECT DEATH BENEFITS AND MATURED ENDOWMENTS INCURRED No. of Certificates Industrial 6 7 Total 8 9 10 Amount Number Amount Number Amount ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. 20. In force December 31, prior year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21. Issued during year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22. Other changes to in force (Net) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23. In force December 31 of current year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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. ................. .......... .................. ................. .......... .................. ................. .......... .................. ................. .......... .................. 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) . . . . . . . . . . . . . . . . . . . . . . . . . Amount Group 5 .......... 16. 17. Number 2 Credit Life (Group and Individual) 3 4 No. of Ind.Pols & Group Certifs. Amount No. of Policies POLICY EXHIBIT 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Federal Employees Health Benefits Plan Premium (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Credit (Group and Individual) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Collectively Renewable Policies (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Medicare Title XVIII exempt from state taxes or fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Other Individual Policies 25.1 Non-cancelable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.2 Guaranteed renewable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,758,118 . . . . . . . . . . . 1,758,118 . . . . . . . . . . . . . . . . . . . . . . . 25.3 Non-renewable for stated reasons only (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.4 Other accident only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.5 All other (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113,570 . . . . . . . . . . . . . . 113,570 . . . . . . . . . . . . . . . . . . . . . . . 25.6 TOTALS (sum of Lines 25.1 to 25.5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,871,688 . . . . . . . . . . . 1,871,688 . . . . . . . . . . . . . . . . . . . . . . . 26. TOTALS (Lines 24 + 24.1 + 24.2 + 24.3 + 24.4 + 25.6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,871,688 . . . . . . . . . . . 1,871,688 . . . . . . . . . . . . . . . . . . . . . . . (b) For health business on indicated lines report: Number of persons insured under PPO managed care products ..............52 and number of persons insured under indemnity only products .............716. Supp31 Missouri 4 5 Direct Losses Paid Direct Losses Incurred ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ........... 2,119,716 ........... 2,108,799 ....................... ....................... ....................... ....................... . . . . . . . . . . . . . . 632,252 . . . . . . . . . . . . . . 705,083 ........... ........... 2,751,968 2,751,968 ........... ........... 2,813,882 2,813,882 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201820627100 DIRECT BUSINESS IN THE STATE OF MONTANA NAIC Group Code: 0917 Document Code: 206 DURING THE YEAR 2018 NAIC Company Code: 70670 LIFE INSURANCE 1 Ordinary 2 Credit Life (Group and Individual) ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... .......... XXX ......... ........................... .......... XXX ......... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... 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) . . . . . . . . . . . . . . . . ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... DIRECT PREMIUMS AND ANNUITY CONSIDERATIONS 1. 2. 3. 4. 5. 2018 Life Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Annuity considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Deposit-type contract funds . . . . . . . . . . . . . . . . . . . . . . . . . . . Other considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TOTALS (sum of Lines 1 to 4) . . . . . . . . . . . . . . . . . . . . . . . . 3 4 Group 5 Industrial Total DIRECT DIVIDENDS TO POLICYHOLDERS Life Insurance: 6.1 6.2 6.3 6.4 6.5 Annuities: 8. 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ordinary 1 DIRECT DEATH BENEFITS AND MATURED ENDOWMENTS INCURRED No. of Certificates Industrial 6 7 Total 8 9 10 Amount Number Amount Number Amount ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. 20. In force December 31, prior year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21. Issued during year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22. Other changes to in force (Net) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23. In force December 31 of current year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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. ................. .......... .................. ................. .......... .................. ................. .......... .................. ................. .......... .................. 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) . . . . . . . . . . . . . . . . . . . . . . . . . Amount Group 5 .......... 16. 17. Number 2 Credit Life (Group and Individual) 3 4 No. of Ind.Pols & Group Certifs. Amount No. of Policies POLICY EXHIBIT 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289,527,405 . . . . . . . . . 283,484,362 . . . . . . . . . . . . . . . . . . . . . . . Federal Employees Health Benefits Plan Premium (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202,944,156 . . . . . . . . . 204,692,599 . . . . . . . . . . . . . . . . . . . . . . . Credit (Group and Individual) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Collectively Renewable Policies (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Medicare Title XVIII exempt from state taxes or fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187,799,333 . . . . . . . . . 169,847,963 . . . . . . . . . . . . . . . . . . . . . . . Other Individual Policies 25.1 Non-cancelable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.2 Guaranteed renewable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54,934,974 . . . . . . . . . . 53,802,641 . . . . . . . . . . . . . . . . . . . . . . . 25.3 Non-renewable for stated reasons only (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.4 Other accident only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.5 All other (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167,901,951 . . . . . . . . . 153,331,814 . . . . . . . . . . . . . . . . . . . . . . . 25.6 TOTALS (sum of Lines 25.1 to 25.5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 222,836,925 . . . . . . . . . 207,134,455 . . . . . . . . . . . . . . . . . . . . . . . 26. TOTALS (Lines 24 + 24.1 + 24.2 + 24.3 + 24.4 + 25.6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 903,107,819 . . . . . . . . . 865,159,379 . . . . . . . . . . . . . . . . . . . . . . . (b) For health business on indicated lines report: Number of persons insured under PPO managed care products ..........95,125 and number of persons insured under indemnity only products ..........19,909. Supp31 Montana 4 5 Direct Losses Paid Direct Losses Incurred . . . . . . . . . 234,213,938 . . . . . . . . . 233,588,697 . . . . . . . . . 185,124,745 . . . . . . . . . 187,219,917 ....................... ....................... ....................... ....................... . . . . . . . . . 166,096,681 . . . . . . . . . 164,852,696 ....................... .......... 38,163,312 ....................... .......... 38,291,992 ....................... ....................... ....................... ....................... . . . . . . . . . 116,208,301 . . . . . . . . . 114,532,051 . . . . . . . . . 154,371,613 . . . . . . . . . 152,824,043 . . . . . . . . . 739,806,977 . . . . . . . . . 738,485,353 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201820628100 DIRECT BUSINESS IN THE STATE OF NEBRASKA NAIC Group Code: 0917 Document Code: 206 DURING THE YEAR 2018 NAIC Company Code: 70670 LIFE INSURANCE 1 Ordinary 2 Credit Life (Group and Individual) ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... .......... XXX ......... ........................... .......... XXX ......... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... 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) . . . . . . . . . . . . . . . . ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... DIRECT PREMIUMS AND ANNUITY CONSIDERATIONS 1. 2. 3. 4. 5. 2018 Life Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Annuity considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Deposit-type contract funds . . . . . . . . . . . . . . . . . . . . . . . . . . . Other considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TOTALS (sum of Lines 1 to 4) . . . . . . . . . . . . . . . . . . . . . . . . 3 4 Group 5 Industrial Total DIRECT DIVIDENDS TO POLICYHOLDERS Life Insurance: 6.1 6.2 6.3 6.4 6.5 Annuities: 8. 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ordinary 1 DIRECT DEATH BENEFITS AND MATURED ENDOWMENTS INCURRED No. of Certificates Industrial 6 7 Total 8 9 10 Amount Number Amount Number Amount ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. 20. In force December 31, prior year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21. Issued during year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22. Other changes to in force (Net) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23. In force December 31 of current year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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. ................. .......... .................. ................. .......... .................. ................. .......... .................. ................. .......... .................. 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) . . . . . . . . . . . . . . . . . . . . . . . . . Amount Group 5 .......... 16. 17. Number 2 Credit Life (Group and Individual) 3 4 No. of Ind.Pols & Group Certifs. Amount No. of Policies POLICY EXHIBIT 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,721,022 . . . . . . . . . . . 2,753,864 . . . . . . . . . . . . . . . . . . . . . . . Federal Employees Health Benefits Plan Premium (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Credit (Group and Individual) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Collectively Renewable Policies (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Medicare Title XVIII exempt from state taxes or fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Other Individual Policies 25.1 Non-cancelable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.2 Guaranteed renewable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98,465 . . . . . . . . . . . . . . . 98,465 . . . . . . . . . . . . . . . . . . . . . . . 25.3 Non-renewable for stated reasons only (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.4 Other accident only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.5 All other (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.6 TOTALS (sum of Lines 25.1 to 25.5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98,465 . . . . . . . . . . . . . . . 98,465 . . . . . . . . . . . . . . . . . . . . . . . 26. TOTALS (Lines 24 + 24.1 + 24.2 + 24.3 + 24.4 + 25.6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,819,487 . . . . . . . . . . . 2,852,329 . . . . . . . . . . . . . . . . . . . . . . . (b) For health business on indicated lines report: Number of persons insured under PPO managed care products .............561 and number of persons insured under indemnity only products ..............46. Supp31 Nebraska 4 5 Direct Losses Paid Direct Losses Incurred ........... 2,749,286 ........... 2,763,401 ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... . . . . . . . . . . . . . . 114,901 . . . . . . . . . . . . . . 112,010 ....................... ....................... ....................... ....................... 76,798 . . . . . . . . . . . . . . 191,699 . . . . . . . . . . . 2,940,985 ............... ............... 75,907 . . . . . . . . . . . . . . 187,917 ........... 2,951,318 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201820629100 DIRECT BUSINESS IN THE STATE OF NEVADA NAIC Group Code: 0917 Document Code: 206 DURING THE YEAR 2018 NAIC Company Code: 70670 LIFE INSURANCE 1 Ordinary 2 Credit Life (Group and Individual) ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... .......... XXX ......... ........................... .......... XXX ......... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... 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) . . . . . . . . . . . . . . . . ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... DIRECT PREMIUMS AND ANNUITY CONSIDERATIONS 1. 2. 3. 4. 5. 2018 Life Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Annuity considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Deposit-type contract funds . . . . . . . . . . . . . . . . . . . . . . . . . . . Other considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TOTALS (sum of Lines 1 to 4) . . . . . . . . . . . . . . . . . . . . . . . . 3 4 Group 5 Industrial Total DIRECT DIVIDENDS TO POLICYHOLDERS Life Insurance: 6.1 6.2 6.3 6.4 6.5 Annuities: 8. 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ordinary 1 DIRECT DEATH BENEFITS AND MATURED ENDOWMENTS INCURRED No. of Certificates Industrial 6 7 Total 8 9 10 Amount Number Amount Number Amount ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. 20. In force December 31, prior year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21. Issued during year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22. Other changes to in force (Net) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23. In force December 31 of current year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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. ................. .......... .................. ................. .......... .................. ................. .......... .................. ................. .......... .................. 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) . . . . . . . . . . . . . . . . . . . . . . . . . Amount Group 5 .......... 16. 17. Number 2 Credit Life (Group and Individual) 3 4 No. of Ind.Pols & Group Certifs. Amount No. of Policies POLICY EXHIBIT 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25,306,980 . . . . . . . . . . 25,781,285 . . . . . . . . . . . . . . . . . . . . . . . Federal Employees Health Benefits Plan Premium (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Credit (Group and Individual) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Collectively Renewable Policies (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Medicare Title XVIII exempt from state taxes or fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Other Individual Policies 25.1 Non-cancelable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.2 Guaranteed renewable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 786,338 . . . . . . . . . . . . . . 786,338 . . . . . . . . . . . . . . . . . . . . . . . 25.3 Non-renewable for stated reasons only (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.4 Other accident only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.5 All other (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251,649 . . . . . . . . . . . . . . 251,649 . . . . . . . . . . . . . . . . . . . . . . . 25.6 TOTALS (sum of Lines 25.1 to 25.5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,037,987 . . . . . . . . . . . 1,037,987 . . . . . . . . . . . . . . . . . . . . . . . 26. TOTALS (Lines 24 + 24.1 + 24.2 + 24.3 + 24.4 + 25.6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26,344,967 . . . . . . . . . . 26,819,272 . . . . . . . . . . . . . . . . . . . . . . . (b) For health business on indicated lines report: Number of persons insured under PPO managed care products ...........4,679 and number of persons insured under indemnity only products .............431. Supp31 Nevada 4 5 Direct Losses Paid Direct Losses Incurred .......... 18,919,679 .......... 19,182,360 ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ........... 1,557,663 ........... 1,620,710 ....................... ....................... ....................... ....................... . . . . . . . . . . . . . . 291,713 . . . . . . . . . . . . . . 269,828 ........... .......... 1,849,376 20,769,055 ........... .......... 1,890,538 21,072,898 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201820630100 2018 DIRECT BUSINESS IN THE STATE OF NEW HAMPSHIRE NAIC Group Code: 0917 LIFE INSURANCE 1 DURING THE YEAR 2018 NAIC Company Code: 70670 Ordinary 2 Credit Life (Group and Individual) ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... .......... XXX ......... ........................... .......... XXX ......... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... 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) . . . . . . . . . . . . . . . . ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... DIRECT PREMIUMS AND ANNUITY CONSIDERATIONS 1. 2. 3. 4. 5. Document Code: 206 Life Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Annuity considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Deposit-type contract funds . . . . . . . . . . . . . . . . . . . . . . . . . . . Other considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TOTALS (sum of Lines 1 to 4) . . . . . . . . . . . . . . . . . . . . . . . . 3 4 Group 5 Industrial Total DIRECT DIVIDENDS TO POLICYHOLDERS Life Insurance: 6.1 6.2 6.3 6.4 6.5 Annuities: 8. 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ordinary 1 DIRECT DEATH BENEFITS AND MATURED ENDOWMENTS INCURRED No. of Certificates Industrial 6 7 Total 8 9 10 Amount Number Amount Number Amount ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. 20. In force December 31, prior year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21. Issued during year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22. Other changes to in force (Net) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23. In force December 31 of current year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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. ................. .......... .................. ................. .......... .................. ................. .......... .................. ................. .......... .................. 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) . . . . . . . . . . . . . . . . . . . . . . . . . Amount Group 5 .......... 16. 17. Number 2 Credit Life (Group and Individual) 3 4 No. of Ind.Pols & Group Certifs. Amount No. of Policies POLICY EXHIBIT 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,883,200 . . . . . . . . . . . 6,809,666 . . . . . . . . . . . . . . . . . . . . . . . Federal Employees Health Benefits Plan Premium (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Credit (Group and Individual) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Collectively Renewable Policies (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Medicare Title XVIII exempt from state taxes or fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Other Individual Policies 25.1 Non-cancelable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.2 Guaranteed renewable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74,839 . . . . . . . . . . . . . . . 74,839 . . . . . . . . . . . . . . . . . . . . . . . 25.3 Non-renewable for stated reasons only (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.4 Other accident only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.5 All other (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.6 TOTALS (sum of Lines 25.1 to 25.5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74,839 . . . . . . . . . . . . . . . 74,839 . . . . . . . . . . . . . . . . . . . . . . . 26. TOTALS (Lines 24 + 24.1 + 24.2 + 24.3 + 24.4 + 25.6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,958,039 . . . . . . . . . . . 6,884,505 . . . . . . . . . . . . . . . . . . . . . . . (b) For health business on indicated lines report: Number of persons insured under PPO managed care products ...........1,384 and number of persons insured under indemnity only products ..............34. Supp31 New Hampshire 4 5 Direct Losses Paid Direct Losses Incurred ........... 8,861,598 ........... 8,740,520 ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ............... 70,747 ............... 69,416 ....................... ....................... ....................... ....................... 8,177 . . . . . . . . . . . . . . . 78,924 . . . . . . . . . . . 8,940,522 ................ ................ 9,123 78,539 8,819,059 ............... ........... ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201820631100 DIRECT BUSINESS IN THE STATE OF NEW JERSEY NAIC Group Code: 0917 1 Document Code: 206 DURING THE YEAR 2018 NAIC Company Code: 70670 LIFE INSURANCE Ordinary 2 Credit Life (Group and Individual) ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... .......... XXX ......... ........................... .......... XXX ......... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... 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) . . . . . . . . . . . . . . . . ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... DIRECT PREMIUMS AND ANNUITY CONSIDERATIONS 1. 2. 3. 4. 5. 2018 Life Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Annuity considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Deposit-type contract funds . . . . . . . . . . . . . . . . . . . . . . . . . . . Other considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TOTALS (sum of Lines 1 to 4) . . . . . . . . . . . . . . . . . . . . . . . . 3 4 Group 5 Industrial Total DIRECT DIVIDENDS TO POLICYHOLDERS Life Insurance: 6.1 6.2 6.3 6.4 6.5 Annuities: 8. 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ordinary 1 DIRECT DEATH BENEFITS AND MATURED ENDOWMENTS INCURRED No. of Certificates Industrial 6 7 Total 8 9 10 Amount Number Amount Number Amount ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. 20. In force December 31, prior year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21. Issued during year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22. Other changes to in force (Net) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23. In force December 31 of current year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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. ................. .......... .................. ................. .......... .................. ................. .......... .................. ................. .......... .................. 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) . . . . . . . . . . . . . . . . . . . . . . . . . Amount Group 5 .......... 16. 17. Number 2 Credit Life (Group and Individual) 3 4 No. of Ind.Pols & Group Certifs. Amount No. of Policies POLICY EXHIBIT 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Federal Employees Health Benefits Plan Premium (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Credit (Group and Individual) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Collectively Renewable Policies (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Medicare Title XVIII exempt from state taxes or fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Other Individual Policies 25.1 Non-cancelable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.2 Guaranteed renewable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209,623 . . . . . . . . . . . . . . 209,623 . . . . . . . . . . . . . . . . . . . . . . . 25.3 Non-renewable for stated reasons only (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.4 Other accident only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.5 All other (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19,825 . . . . . . . . . . . . . . . 19,825 . . . . . . . . . . . . . . . . . . . . . . . 25.6 TOTALS (sum of Lines 25.1 to 25.5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229,448 . . . . . . . . . . . . . . 229,448 . . . . . . . . . . . . . . . . . . . . . . . 26. TOTALS (Lines 24 + 24.1 + 24.2 + 24.3 + 24.4 + 25.6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229,448 . . . . . . . . . . . . . . 229,448 . . . . . . . . . . . . . . . . . . . . . . . (b) For health business on indicated lines report: Number of persons insured under PPO managed care products ...............6 and number of persons insured under indemnity only products ..............81. Supp31 New Jersey 4 5 Direct Losses Paid Direct Losses Incurred ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... . . . . . . . . . . . . . . 260,455 . . . . . . . . . . . . . . 262,375 ....................... ....................... ....................... ....................... 46,542 . . . . . . . . . . . . . . 306,997 . . . . . . . . . . . . . . 306,997 ............... ............... 36,959 . . . . . . . . . . . . . . 299,334 . . . . . . . . . . . . . . 299,334 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201820632100 DIRECT BUSINESS IN THE STATE OF NEW MEXICO NAIC Group Code: 0917 1 Document Code: 206 DURING THE YEAR 2018 NAIC Company Code: 70670 LIFE INSURANCE Ordinary 2 Credit Life (Group and Individual) ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... .......... XXX ......... ........................... .......... XXX ......... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... 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) . . . . . . . . . . . . . . . . ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... DIRECT PREMIUMS AND ANNUITY CONSIDERATIONS 1. 2. 3. 4. 5. 2018 Life Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Annuity considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Deposit-type contract funds . . . . . . . . . . . . . . . . . . . . . . . . . . . Other considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TOTALS (sum of Lines 1 to 4) . . . . . . . . . . . . . . . . . . . . . . . . 3 4 Group 5 Industrial Total DIRECT DIVIDENDS TO POLICYHOLDERS Life Insurance: 6.1 6.2 6.3 6.4 6.5 Annuities: 8. 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ordinary 1 DIRECT DEATH BENEFITS AND MATURED ENDOWMENTS INCURRED No. of Certificates Industrial 6 7 Total 8 9 10 Amount Number Amount Number Amount ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. 20. In force December 31, prior year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21. Issued during year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22. Other changes to in force (Net) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23. In force December 31 of current year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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. ................. .......... .................. ................. .......... .................. ................. .......... .................. ................. .......... .................. 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) . . . . . . . . . . . . . . . . . . . . . . . . . Amount Group 5 .......... 16. 17. Number 2 Credit Life (Group and Individual) 3 4 No. of Ind.Pols & Group Certifs. Amount No. of Policies POLICY EXHIBIT 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251,140,590 . . . . . . . . . 257,750,205 . . . . . . . . . . . . . . . . . . . . . . . Federal Employees Health Benefits Plan Premium (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 268,992,361 . . . . . . . . . 272,361,531 . . . . . . . . . . . . . . . . . . . . . . . Credit (Group and Individual) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Collectively Renewable Policies (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Medicare Title XVIII exempt from state taxes or fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15,487,482 . . . . . . . . . . 13,454,697 . . . . . . . . . . . . . . . . . . . . . . . Other Individual Policies 25.1 Non-cancelable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.2 Guaranteed renewable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16,679,051 . . . . . . . . . . 16,628,280 . . . . . . . . . . . . . . . . . . . . . . . 25.3 Non-renewable for stated reasons only (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.4 Other accident only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.5 All other (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,004,261 . . . . . . . . . . . 1,855,644 . . . . . . . . . . . . . . . . . . . . . . . 25.6 TOTALS (sum of Lines 25.1 to 25.5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19,683,311 . . . . . . . . . . 18,483,924 . . . . . . . . . . . . . . . . . . . . . . . 26. TOTALS (Lines 24 + 24.1 + 24.2 + 24.3 + 24.4 + 25.6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 555,303,744 . . . . . . . . . 562,050,358 . . . . . . . . . . . . . . . . . . . . . . . (b) For health business on indicated lines report: Number of persons insured under PPO managed care products ..........82,754 and number of persons insured under indemnity only products ...........8,265. Supp31 New Mexico 4 5 Direct Losses Paid Direct Losses Incurred . . . . . . . . . 209,872,682 . . . . . . . . . 208,068,681 . . . . . . . . . 248,700,052 . . . . . . . . . 251,818,411 ....................... ....................... ....................... ....................... .......... 13,701,615 ....................... .......... 12,065,895 .......... 12,920,212 ....................... .......... 12,192,250 ....................... ....................... ....................... ....................... 1,814,182 . . . . . . . . . . 13,880,077 . . . . . . . . . 486,154,426 ........... ........... 1,687,843 13,880,093 . . . . . . . . . 486,687,397 .......... ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201820636100 DIRECT BUSINESS IN THE STATE OF OHIO NAIC Group Code: 0917 Document Code: 206 DURING THE YEAR 2018 NAIC Company Code: 70670 LIFE INSURANCE 1 Ordinary 2 Credit Life (Group and Individual) ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... .......... XXX ......... ........................... .......... XXX ......... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... 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) . . . . . . . . . . . . . . . . ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... DIRECT PREMIUMS AND ANNUITY CONSIDERATIONS 1. 2. 3. 4. 5. 2018 Life Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Annuity considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Deposit-type contract funds . . . . . . . . . . . . . . . . . . . . . . . . . . . Other considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TOTALS (sum of Lines 1 to 4) . . . . . . . . . . . . . . . . . . . . . . . . 3 4 Group 5 Industrial Total DIRECT DIVIDENDS TO POLICYHOLDERS Life Insurance: 6.1 6.2 6.3 6.4 6.5 Annuities: 8. 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ordinary 1 DIRECT DEATH BENEFITS AND MATURED ENDOWMENTS INCURRED No. of Certificates Industrial 6 7 Total 8 9 10 Amount Number Amount Number Amount ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. 20. In force December 31, prior year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21. Issued during year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22. Other changes to in force (Net) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23. In force December 31 of current year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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. ................. .......... .................. ................. .......... .................. ................. .......... .................. ................. .......... .................. 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) . . . . . . . . . . . . . . . . . . . . . . . . . Amount Group 5 .......... 16. 17. Number 2 Credit Life (Group and Individual) 3 4 No. of Ind.Pols & Group Certifs. Amount No. of Policies POLICY EXHIBIT 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Federal Employees Health Benefits Plan Premium (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Credit (Group and Individual) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Collectively Renewable Policies (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Medicare Title XVIII exempt from state taxes or fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Other Individual Policies 25.1 Non-cancelable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.2 Guaranteed renewable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 677,251 . . . . . . . . . . . . . . 677,251 . . . . . . . . . . . . . . . . . . . . . . . 25.3 Non-renewable for stated reasons only (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.4 Other accident only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.5 All other (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62,291 . . . . . . . . . . . . . . . 62,291 . . . . . . . . . . . . . . . . . . . . . . . 25.6 TOTALS (sum of Lines 25.1 to 25.5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 739,542 . . . . . . . . . . . . . . 739,542 . . . . . . . . . . . . . . . . . . . . . . . 26. TOTALS (Lines 24 + 24.1 + 24.2 + 24.3 + 24.4 + 25.6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 739,542 . . . . . . . . . . . . . . 739,542 . . . . . . . . . . . . . . . . . . . . . . . (b) For health business on indicated lines report: Number of persons insured under PPO managed care products ..............13 and number of persons insured under indemnity only products .............278. Supp31 Ohio 4 5 Direct Losses Paid Direct Losses Incurred ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... . . . . . . . . . . . . . . 757,239 . . . . . . . . . . . . . . 770,690 ....................... ....................... ....................... ....................... 59,056 . . . . . . . . . . . . . . 816,295 . . . . . . . . . . . . . . 816,295 ............... ............... 42,562 . . . . . . . . . . . . . . 813,252 . . . . . . . . . . . . . . 813,252 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201820637100 DIRECT BUSINESS IN THE STATE OF OKLAHOMA NAIC Group Code: 0917 Document Code: 206 DURING THE YEAR 2018 NAIC Company Code: 70670 LIFE INSURANCE 1 Ordinary 2 Credit Life (Group and Individual) ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... .......... XXX ......... ........................... .......... XXX ......... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... 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) . . . . . . . . . . . . . . . . ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... DIRECT PREMIUMS AND ANNUITY CONSIDERATIONS 1. 2. 3. 4. 5. 2018 Life Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Annuity considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Deposit-type contract funds . . . . . . . . . . . . . . . . . . . . . . . . . . . Other considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TOTALS (sum of Lines 1 to 4) . . . . . . . . . . . . . . . . . . . . . . . . 3 4 Group 5 Industrial Total DIRECT DIVIDENDS TO POLICYHOLDERS Life Insurance: 6.1 6.2 6.3 6.4 6.5 Annuities: 8. 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ordinary 1 DIRECT DEATH BENEFITS AND MATURED ENDOWMENTS INCURRED No. of Certificates Industrial 6 7 Total 8 9 10 Amount Number Amount Number Amount ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. 20. In force December 31, prior year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21. Issued during year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22. Other changes to in force (Net) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23. In force December 31 of current year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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. ................. .......... .................. ................. .......... .................. ................. .......... .................. ................. .......... .................. 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) . . . . . . . . . . . . . . . . . . . . . . . . . Amount Group 5 .......... 16. 17. Number 2 Credit Life (Group and Individual) 3 4 No. of Ind.Pols & Group Certifs. Amount No. of Policies POLICY EXHIBIT 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,147,412,458 . . . . . . . 1,128,583,446 . . . . . . . . . . . . . . . . . . . . . . . Federal Employees Health Benefits Plan Premium (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 721,186,508 . . . . . . . . . 724,354,315 . . . . . . . . . . . . . . . . . . . . . . . Credit (Group and Individual) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Collectively Renewable Policies (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Medicare Title XVIII exempt from state taxes or fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,765,308 . . . . . . . . . . . . . . 791,560 . . . . . . . . . . . . . . . . . . . . . . . Other Individual Policies 25.1 Non-cancelable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.2 Guaranteed renewable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133,990,048 . . . . . . . . . 134,158,062 . . . . . . . . . . . . . . . . . . . . . . . 25.3 Non-renewable for stated reasons only (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.4 Other accident only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.5 All other (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,115,713,476 . . . . . . . 1,152,835,293 . . . . . . . . . . . . . . . . . . . . . . . 25.6 TOTALS (sum of Lines 25.1 to 25.5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,249,703,524 . . . . . . . 1,286,993,355 . . . . . . . . . . . . . . . . . . . . . . . 26. TOTALS (Lines 24 + 24.1 + 24.2 + 24.3 + 24.4 + 25.6) . . . . . . . . . . . . . . . . . . . . . . . . . . 3,121,067,798 . . . . . . . 3,140,722,675 . . . . . . . . . . . . . . . . . . . . . . . (b) For health business on indicated lines report: Number of persons insured under PPO managed care products .........472,868 and number of persons insured under indemnity only products ..........61,160. Supp31 Oklahoma 4 5 Direct Losses Paid Direct Losses Incurred . . . . . . . . . 816,989,726 . . . . . . . . . 803,677,338 . . . . . . . . . 660,549,376 . . . . . . . . . 666,101,801 ....................... ....................... ....................... ....................... ........... 3,173,460 ....................... .......... (2,570,724) ....................... . . . . . . . . . 105,546,548 . . . . . . . . . 105,890,234 ....................... ....................... ....................... ....................... . . . . . . . . . 778,423,842 . . . . . . . . . 784,876,478 . . . . . . . . . 883,970,390 . . . . . . . . . 890,766,712 . . . . . . . 2,364,682,952 . . . . . . . 2,357,975,127 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201820638100 DIRECT BUSINESS IN THE STATE OF OREGON NAIC Group Code: 0917 Document Code: 206 DURING THE YEAR 2018 NAIC Company Code: 70670 LIFE INSURANCE 1 Ordinary 2 Credit Life (Group and Individual) ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... .......... XXX ......... ........................... .......... XXX ......... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... 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) . . . . . . . . . . . . . . . . ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... DIRECT PREMIUMS AND ANNUITY CONSIDERATIONS 1. 2. 3. 4. 5. 2018 Life Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Annuity considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Deposit-type contract funds . . . . . . . . . . . . . . . . . . . . . . . . . . . Other considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TOTALS (sum of Lines 1 to 4) . . . . . . . . . . . . . . . . . . . . . . . . 3 4 Group 5 Industrial Total DIRECT DIVIDENDS TO POLICYHOLDERS Life Insurance: 6.1 6.2 6.3 6.4 6.5 Annuities: 8. 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ordinary 1 DIRECT DEATH BENEFITS AND MATURED ENDOWMENTS INCURRED No. of Certificates Industrial 6 7 Total 8 9 10 Amount Number Amount Number Amount ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. 20. In force December 31, prior year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21. Issued during year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22. Other changes to in force (Net) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23. In force December 31 of current year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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. ................. .......... .................. ................. .......... .................. ................. .......... .................. ................. .......... .................. 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) . . . . . . . . . . . . . . . . . . . . . . . . . Amount Group 5 .......... 16. 17. Number 2 Credit Life (Group and Individual) 3 4 No. of Ind.Pols & Group Certifs. Amount No. of Policies POLICY EXHIBIT 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Federal Employees Health Benefits Plan Premium (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Credit (Group and Individual) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Collectively Renewable Policies (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Medicare Title XVIII exempt from state taxes or fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Other Individual Policies 25.1 Non-cancelable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.2 Guaranteed renewable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 302,374 . . . . . . . . . . . . . . 302,374 . . . . . . . . . . . . . . . . . . . . . . . 25.3 Non-renewable for stated reasons only (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.4 Other accident only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.5 All other (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14,677 . . . . . . . . . . . . . . . 14,677 . . . . . . . . . . . . . . . . . . . . . . . 25.6 TOTALS (sum of Lines 25.1 to 25.5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 317,051 . . . . . . . . . . . . . . 317,051 . . . . . . . . . . . . . . . . . . . . . . . 26. TOTALS (Lines 24 + 24.1 + 24.2 + 24.3 + 24.4 + 25.6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 317,051 . . . . . . . . . . . . . . 317,051 . . . . . . . . . . . . . . . . . . . . . . . (b) For health business on indicated lines report: Number of persons insured under PPO managed care products ..............13 and number of persons insured under indemnity only products .............210. Supp31 Oregon 4 5 Direct Losses Paid Direct Losses Incurred ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... . . . . . . . . . . . . . . 379,823 . . . . . . . . . . . . . . 380,434 ....................... ....................... ....................... ....................... 48,575 . . . . . . . . . . . . . . 428,398 . . . . . . . . . . . . . . 428,398 ............... ............... 49,311 . . . . . . . . . . . . . . 429,745 . . . . . . . . . . . . . . 429,745 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201820639100 2018 DIRECT BUSINESS IN THE STATE OF PENNSYLVANIA NAIC Group Code: 0917 LIFE INSURANCE 1 DURING THE YEAR 2018 NAIC Company Code: 70670 Ordinary 2 Credit Life (Group and Individual) ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... .......... XXX ......... ........................... .......... XXX ......... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... 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) . . . . . . . . . . . . . . . . ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... DIRECT PREMIUMS AND ANNUITY CONSIDERATIONS 1. 2. 3. 4. 5. Document Code: 206 Life Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Annuity considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Deposit-type contract funds . . . . . . . . . . . . . . . . . . . . . . . . . . . Other considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TOTALS (sum of Lines 1 to 4) . . . . . . . . . . . . . . . . . . . . . . . . 3 4 Group 5 Industrial Total DIRECT DIVIDENDS TO POLICYHOLDERS Life Insurance: 6.1 6.2 6.3 6.4 6.5 Annuities: 8. 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ordinary 1 DIRECT DEATH BENEFITS AND MATURED ENDOWMENTS INCURRED No. of Certificates Industrial 6 7 Total 8 9 10 Amount Number Amount Number Amount ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. 20. In force December 31, prior year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21. Issued during year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22. Other changes to in force (Net) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23. In force December 31 of current year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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. ................. .......... .................. ................. .......... .................. ................. .......... .................. ................. .......... .................. 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) . . . . . . . . . . . . . . . . . . . . . . . . . Amount Group 5 .......... 16. 17. Number 2 Credit Life (Group and Individual) 3 4 No. of Ind.Pols & Group Certifs. Amount No. of Policies POLICY EXHIBIT 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 591,461 . . . . . . . . . . . . . . 591,461 . . . . . . . . . . . . . . . . . . . . . . . Federal Employees Health Benefits Plan Premium (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Credit (Group and Individual) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Collectively Renewable Policies (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Medicare Title XVIII exempt from state taxes or fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Other Individual Policies 25.1 Non-cancelable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.2 Guaranteed renewable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 402,395 . . . . . . . . . . . . . . 402,395 . . . . . . . . . . . . . . . . . . . . . . . 25.3 Non-renewable for stated reasons only (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.4 Other accident only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.5 All other (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42,533 . . . . . . . . . . . . . . . 42,533 . . . . . . . . . . . . . . . . . . . . . . . 25.6 TOTALS (sum of Lines 25.1 to 25.5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 444,928 . . . . . . . . . . . . . . 444,928 . . . . . . . . . . . . . . . . . . . . . . . 26. TOTALS (Lines 24 + 24.1 + 24.2 + 24.3 + 24.4 + 25.6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,036,389 . . . . . . . . . . . 1,036,389 . . . . . . . . . . . . . . . . . . . . . . . (b) For health business on indicated lines report: Number of persons insured under PPO managed care products ..............10 and number of persons insured under indemnity only products .............169. Supp31 Pennsylvania 4 5 Direct Losses Paid Direct Losses Incurred . . . . . . . . . . . . . . 351,699 . . . . . . . . . . . . . . 924,230 ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... . . . . . . . . . . . . . . 477,956 . . . . . . . . . . . . . . 478,633 ....................... ....................... ....................... ....................... 54,765 . . . . . . . . . . . . . . 532,721 . . . . . . . . . . . . . . 884,420 ............... ............... 51,670 . . . . . . . . . . . . . . 530,303 ........... 1,454,533 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201820641100 2018 DIRECT BUSINESS IN THE STATE OF SOUTH CAROLINA NAIC Group Code: 0917 LIFE INSURANCE 1 DURING THE YEAR 2018 NAIC Company Code: 70670 Ordinary 2 Credit Life (Group and Individual) ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... .......... XXX ......... ........................... .......... XXX ......... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... 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) . . . . . . . . . . . . . . . . ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... DIRECT PREMIUMS AND ANNUITY CONSIDERATIONS 1. 2. 3. 4. 5. Document Code: 206 Life Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Annuity considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Deposit-type contract funds . . . . . . . . . . . . . . . . . . . . . . . . . . . Other considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TOTALS (sum of Lines 1 to 4) . . . . . . . . . . . . . . . . . . . . . . . . 3 4 Group 5 Industrial Total DIRECT DIVIDENDS TO POLICYHOLDERS Life Insurance: 6.1 6.2 6.3 6.4 6.5 Annuities: 8. 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ordinary 1 DIRECT DEATH BENEFITS AND MATURED ENDOWMENTS INCURRED No. of Certificates Industrial 6 7 Total 8 9 10 Amount Number Amount Number Amount ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. 20. In force December 31, prior year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21. Issued during year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22. Other changes to in force (Net) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23. In force December 31 of current year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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. ................. .......... .................. ................. .......... .................. ................. .......... .................. ................. .......... .................. 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) . . . . . . . . . . . . . . . . . . . . . . . . . Amount Group 5 .......... 16. 17. Number 2 Credit Life (Group and Individual) 3 4 No. of Ind.Pols & Group Certifs. Amount No. of Policies POLICY EXHIBIT 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Federal Employees Health Benefits Plan Premium (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Credit (Group and Individual) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Collectively Renewable Policies (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Medicare Title XVIII exempt from state taxes or fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Other Individual Policies 25.1 Non-cancelable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.2 Guaranteed renewable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 493,990 . . . . . . . . . . . . . . 493,990 . . . . . . . . . . . . . . . . . . . . . . . 25.3 Non-renewable for stated reasons only (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.4 Other accident only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.5 All other (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188,645 . . . . . . . . . . . . . . 188,645 . . . . . . . . . . . . . . . . . . . . . . . 25.6 TOTALS (sum of Lines 25.1 to 25.5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 682,635 . . . . . . . . . . . . . . 682,635 . . . . . . . . . . . . . . . . . . . . . . . 26. TOTALS (Lines 24 + 24.1 + 24.2 + 24.3 + 24.4 + 25.6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 682,635 . . . . . . . . . . . . . . 682,635 . . . . . . . . . . . . . . . . . . . . . . . (b) For health business on indicated lines report: Number of persons insured under PPO managed care products ..............36 and number of persons insured under indemnity only products .............273. Supp31 South Carolina 4 5 Direct Losses Paid Direct Losses Incurred ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... . . . . . . . . . . . . . . 601,031 . . . . . . . . . . . . . . 617,380 ....................... ....................... ....................... ....................... . . . . . . . . . . . . . . 181,625 . . . . . . . . . . . . . . 145,793 . . . . . . . . . . . . . . 782,656 . . . . . . . . . . . . . . 763,173 . . . . . . . . . . . . . . 782,656 . . . . . . . . . . . . . . 763,173 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201820643100 DIRECT BUSINESS IN THE STATE OF TENNESSEE NAIC Group Code: 0917 Document Code: 206 DURING THE YEAR 2018 NAIC Company Code: 70670 LIFE INSURANCE 1 Ordinary 2 Credit Life (Group and Individual) ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... .......... XXX ......... ........................... .......... XXX ......... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... 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) . . . . . . . . . . . . . . . . ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... DIRECT PREMIUMS AND ANNUITY CONSIDERATIONS 1. 2. 3. 4. 5. 2018 Life Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Annuity considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Deposit-type contract funds . . . . . . . . . . . . . . . . . . . . . . . . . . . Other considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TOTALS (sum of Lines 1 to 4) . . . . . . . . . . . . . . . . . . . . . . . . 3 4 Group 5 Industrial Total DIRECT DIVIDENDS TO POLICYHOLDERS Life Insurance: 6.1 6.2 6.3 6.4 6.5 Annuities: 8. 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ordinary 1 DIRECT DEATH BENEFITS AND MATURED ENDOWMENTS INCURRED No. of Certificates Industrial 6 7 Total 8 9 10 Amount Number Amount Number Amount ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. 20. In force December 31, prior year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21. Issued during year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22. Other changes to in force (Net) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23. In force December 31 of current year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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. ................. .......... .................. ................. .......... .................. ................. .......... .................. ................. .......... .................. 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) . . . . . . . . . . . . . . . . . . . . . . . . . Amount Group 5 .......... 16. 17. Number 2 Credit Life (Group and Individual) 3 4 No. of Ind.Pols & Group Certifs. Amount No. of Policies POLICY EXHIBIT 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41,987,318 . . . . . . . . . . 42,184,172 . . . . . . . . . . . . . . . . . . . . . . . Federal Employees Health Benefits Plan Premium (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Credit (Group and Individual) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Collectively Renewable Policies (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Medicare Title XVIII exempt from state taxes or fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Other Individual Policies 25.1 Non-cancelable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.2 Guaranteed renewable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,034,894 . . . . . . . . . . . 1,034,894 . . . . . . . . . . . . . . . . . . . . . . . 25.3 Non-renewable for stated reasons only (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.4 Other accident only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.5 All other (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159,665 . . . . . . . . . . . . . . 159,665 . . . . . . . . . . . . . . . . . . . . . . . 25.6 TOTALS (sum of Lines 25.1 to 25.5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,194,559 . . . . . . . . . . . 1,194,559 . . . . . . . . . . . . . . . . . . . . . . . 26. TOTALS (Lines 24 + 24.1 + 24.2 + 24.3 + 24.4 + 25.6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43,181,877 . . . . . . . . . . 43,378,731 . . . . . . . . . . . . . . . . . . . . . . . (b) For health business on indicated lines report: Number of persons insured under PPO managed care products ...........8,404 and number of persons insured under indemnity only products .............574. Supp31 Tennessee 4 5 Direct Losses Paid Direct Losses Incurred .......... 33,613,133 .......... 33,764,808 ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ........... 1,078,937 ........... 1,097,146 ....................... ....................... ....................... ....................... . . . . . . . . . . . . . . 106,944 . . . . . . . . . . . . . . 105,618 ........... .......... 1,185,881 34,799,014 ........... .......... 1,202,764 34,967,572 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201820644100 DIRECT BUSINESS IN THE STATE OF TEXAS NAIC Group Code: 0917 Document Code: 206 DURING THE YEAR 2018 NAIC Company Code: 70670 LIFE INSURANCE 1 Ordinary 2 Credit Life (Group and Individual) ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... .......... XXX ......... ........................... .......... XXX ......... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... 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) . . . . . . . . . . . . . . . . ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... DIRECT PREMIUMS AND ANNUITY CONSIDERATIONS 1. 2. 3. 4. 5. 2018 Life Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Annuity considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Deposit-type contract funds . . . . . . . . . . . . . . . . . . . . . . . . . . . Other considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TOTALS (sum of Lines 1 to 4) . . . . . . . . . . . . . . . . . . . . . . . . 3 4 Group 5 Industrial Total DIRECT DIVIDENDS TO POLICYHOLDERS Life Insurance: 6.1 6.2 6.3 6.4 6.5 Annuities: 8. 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ordinary 1 DIRECT DEATH BENEFITS AND MATURED ENDOWMENTS INCURRED No. of Certificates Industrial 6 7 Total 8 9 10 Amount Number Amount Number Amount ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. 20. In force December 31, prior year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21. Issued during year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22. Other changes to in force (Net) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23. In force December 31 of current year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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. ................. .......... .................. ................. .......... .................. ................. .......... .................. ................. .......... .................. 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) . . . . . . . . . . . . . . . . . . . . . . . . . Amount Group 5 .......... 16. 17. Number 2 Credit Life (Group and Individual) 3 4 No. of Ind.Pols & Group Certifs. Amount No. of Policies POLICY EXHIBIT 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,698,987,833 . . . . . . . 6,654,171,263 . . . . . . . . . . . . . . . . . . . . . . . Federal Employees Health Benefits Plan Premium (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,866,710,245 . . . . . . . 2,911,029,282 . . . . . . . . . . . . . . . . . . . . . . . Credit (Group and Individual) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Collectively Renewable Policies (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Medicare Title XVIII exempt from state taxes or fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Other Individual Policies 25.1 Non-cancelable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.2 Guaranteed renewable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 385,988,527 . . . . . . . . . 384,936,802 . . . . . . . . . . . . . . . . . . . . . . . 25.3 Non-renewable for stated reasons only (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.4 Other accident only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.5 All other (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 461,337,813 . . . . . . . . . 433,563,504 . . . . . . . . . . . . . . . . . . . . . . . 25.6 TOTALS (sum of Lines 25.1 to 25.5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 847,326,339 . . . . . . . . . 818,500,306 . . . . . . . . . . . . . . . . . . . . . . . 26. TOTALS (Lines 24 + 24.1 + 24.2 + 24.3 + 24.4 + 25.6) . . . . . . . . . . . . . . . . . . . . . . . . 10,413,024,417 . . . . . 10,383,700,852 . . . . . . . . . . . . . . . . . . . . . . . (b) For health business on indicated lines report: Number of persons insured under PPO managed care products .......1,622,457 and number of persons insured under indemnity only products .........166,934. Supp31 Texas 4 5 Direct Losses Paid Direct Losses Incurred . . . . . . . 5,490,222,112 . . . . . . . 5,518,315,878 . . . . . . . 2,677,379,230 . . . . . . . 2,712,896,712 ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... . . . . . . . . . 288,681,092 . . . . . . . . . 290,131,472 ....................... ....................... ....................... ....................... . . . . . . . . . 306,460,432 . . . . . . . . . 311,728,460 . . . . . . . . . 595,141,524 . . . . . . . . . 601,859,932 . . . . . . . 8,762,742,866 . . . . . . . 8,833,072,522 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201820645100 DIRECT BUSINESS IN THE STATE OF UTAH NAIC Group Code: 0917 Document Code: 206 DURING THE YEAR 2018 NAIC Company Code: 70670 LIFE INSURANCE 1 Ordinary 2 Credit Life (Group and Individual) ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... .......... XXX ......... ........................... .......... XXX ......... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... 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) . . . . . . . . . . . . . . . . ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... DIRECT PREMIUMS AND ANNUITY CONSIDERATIONS 1. 2. 3. 4. 5. 2018 Life Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Annuity considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Deposit-type contract funds . . . . . . . . . . . . . . . . . . . . . . . . . . . Other considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TOTALS (sum of Lines 1 to 4) . . . . . . . . . . . . . . . . . . . . . . . . 3 4 Group 5 Industrial Total DIRECT DIVIDENDS TO POLICYHOLDERS Life Insurance: 6.1 6.2 6.3 6.4 6.5 Annuities: 8. 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ordinary 1 DIRECT DEATH BENEFITS AND MATURED ENDOWMENTS INCURRED No. of Certificates Industrial 6 7 Total 8 9 10 Amount Number Amount Number Amount ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. 20. In force December 31, prior year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21. Issued during year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22. Other changes to in force (Net) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23. In force December 31 of current year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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. ................. .......... .................. ................. .......... .................. ................. .......... .................. ................. .......... .................. 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) . . . . . . . . . . . . . . . . . . . . . . . . . Amount Group 5 .......... 16. 17. Number 2 Credit Life (Group and Individual) 3 4 No. of Ind.Pols & Group Certifs. Amount No. of Policies POLICY EXHIBIT 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16,062,777 . . . . . . . . . . 16,038,076 . . . . . . . . . . . . . . . . . . . . . . . Federal Employees Health Benefits Plan Premium (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Credit (Group and Individual) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Collectively Renewable Policies (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Medicare Title XVIII exempt from state taxes or fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Other Individual Policies 25.1 Non-cancelable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.2 Guaranteed renewable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120,333 . . . . . . . . . . . . . . 120,333 . . . . . . . . . . . . . . . . . . . . . . . 25.3 Non-renewable for stated reasons only (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.4 Other accident only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.5 All other (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18,900 . . . . . . . . . . . . . . . 18,900 . . . . . . . . . . . . . . . . . . . . . . . 25.6 TOTALS (sum of Lines 25.1 to 25.5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139,233 . . . . . . . . . . . . . . 139,233 . . . . . . . . . . . . . . . . . . . . . . . 26. TOTALS (Lines 24 + 24.1 + 24.2 + 24.3 + 24.4 + 25.6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16,202,010 . . . . . . . . . . 16,177,309 . . . . . . . . . . . . . . . . . . . . . . . (b) For health business on indicated lines report: Number of persons insured under PPO managed care products ...........3,604 and number of persons insured under indemnity only products ..............95. Supp31 Utah 4 5 Direct Losses Paid Direct Losses Incurred .......... 12,167,911 .......... 12,089,228 ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... . . . . . . . . . . . . . . 179,761 . . . . . . . . . . . . . . 179,174 ....................... ....................... ....................... ....................... 45,405 . . . . . . . . . . . . . . 225,166 . . . . . . . . . . 12,393,077 ............... ............... 39,780 . . . . . . . . . . . . . . 218,954 .......... 12,308,182 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201820647100 DIRECT BUSINESS IN THE STATE OF VIRGINIA NAIC Group Code: 0917 Document Code: 206 DURING THE YEAR 2018 NAIC Company Code: 70670 LIFE INSURANCE 1 Ordinary 2 Credit Life (Group and Individual) ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... .......... XXX ......... ........................... .......... XXX ......... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... 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) . . . . . . . . . . . . . . . . ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... DIRECT PREMIUMS AND ANNUITY CONSIDERATIONS 1. 2. 3. 4. 5. 2018 Life Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Annuity considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Deposit-type contract funds . . . . . . . . . . . . . . . . . . . . . . . . . . . Other considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TOTALS (sum of Lines 1 to 4) . . . . . . . . . . . . . . . . . . . . . . . . 3 4 Group 5 Industrial Total DIRECT DIVIDENDS TO POLICYHOLDERS Life Insurance: 6.1 6.2 6.3 6.4 6.5 Annuities: 8. 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ordinary 1 DIRECT DEATH BENEFITS AND MATURED ENDOWMENTS INCURRED No. of Certificates Industrial 6 7 Total 8 9 10 Amount Number Amount Number Amount ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. 20. In force December 31, prior year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21. Issued during year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22. Other changes to in force (Net) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23. In force December 31 of current year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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. ................. .......... .................. ................. .......... .................. ................. .......... .................. ................. .......... .................. 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) . . . . . . . . . . . . . . . . . . . . . . . . . Amount Group 5 .......... 16. 17. Number 2 Credit Life (Group and Individual) 3 4 No. of Ind.Pols & Group Certifs. Amount No. of Policies POLICY EXHIBIT 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Federal Employees Health Benefits Plan Premium (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Credit (Group and Individual) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Collectively Renewable Policies (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Medicare Title XVIII exempt from state taxes or fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Other Individual Policies 25.1 Non-cancelable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.2 Guaranteed renewable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 596,091 . . . . . . . . . . . . . . 596,091 . . . . . . . . . . . . . . . . . . . . . . . 25.3 Non-renewable for stated reasons only (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.4 Other accident only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.5 All other (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101,714 . . . . . . . . . . . . . . 101,714 . . . . . . . . . . . . . . . . . . . . . . . 25.6 TOTALS (sum of Lines 25.1 to 25.5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 697,805 . . . . . . . . . . . . . . 697,805 . . . . . . . . . . . . . . . . . . . . . . . 26. TOTALS (Lines 24 + 24.1 + 24.2 + 24.3 + 24.4 + 25.6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 697,805 . . . . . . . . . . . . . . 697,805 . . . . . . . . . . . . . . . . . . . . . . . (b) For health business on indicated lines report: Number of persons insured under PPO managed care products ..............22 and number of persons insured under indemnity only products .............241. Supp31 Virginia 4 5 Direct Losses Paid Direct Losses Incurred ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... . . . . . . . . . . . . . . 589,849 . . . . . . . . . . . . . . 609,004 ....................... ....................... ....................... ....................... . . . . . . . . . . . . . . 149,573 . . . . . . . . . . . . . . 144,456 . . . . . . . . . . . . . . 739,422 . . . . . . . . . . . . . . 753,460 . . . . . . . . . . . . . . 739,422 . . . . . . . . . . . . . . 753,460 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201820649100 2018 DIRECT BUSINESS IN THE STATE OF WEST VIRGINIA NAIC Group Code: 0917 LIFE INSURANCE 1 DURING THE YEAR 2018 NAIC Company Code: 70670 Ordinary 2 Credit Life (Group and Individual) ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... .......... XXX ......... ........................... .......... XXX ......... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... 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) . . . . . . . . . . . . . . . . ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... DIRECT PREMIUMS AND ANNUITY CONSIDERATIONS 1. 2. 3. 4. 5. Document Code: 206 Life Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Annuity considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Deposit-type contract funds . . . . . . . . . . . . . . . . . . . . . . . . . . . Other considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TOTALS (sum of Lines 1 to 4) . . . . . . . . . . . . . . . . . . . . . . . . 3 4 Group 5 Industrial Total DIRECT DIVIDENDS TO POLICYHOLDERS Life Insurance: 6.1 6.2 6.3 6.4 6.5 Annuities: 8. 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ordinary 1 DIRECT DEATH BENEFITS AND MATURED ENDOWMENTS INCURRED No. of Certificates Industrial 6 7 Total 8 9 10 Amount Number Amount Number Amount ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. 20. In force December 31, prior year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21. Issued during year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22. Other changes to in force (Net) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23. In force December 31 of current year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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. ................. .......... .................. ................. .......... .................. ................. .......... .................. ................. .......... .................. 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) . . . . . . . . . . . . . . . . . . . . . . . . . Amount Group 5 .......... 16. 17. Number 2 Credit Life (Group and Individual) 3 4 No. of Ind.Pols & Group Certifs. Amount No. of Policies POLICY EXHIBIT 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Federal Employees Health Benefits Plan Premium (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Credit (Group and Individual) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Collectively Renewable Policies (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Medicare Title XVIII exempt from state taxes or fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Other Individual Policies 25.1 Non-cancelable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.2 Guaranteed renewable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42,451 . . . . . . . . . . . . . . . 42,451 . . . . . . . . . . . . . . . . . . . . . . . 25.3 Non-renewable for stated reasons only (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.4 Other accident only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.5 All other (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22,513 . . . . . . . . . . . . . . . 22,513 . . . . . . . . . . . . . . . . . . . . . . . 25.6 TOTALS (sum of Lines 25.1 to 25.5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64,964 . . . . . . . . . . . . . . . 64,964 . . . . . . . . . . . . . . . . . . . . . . . 26. TOTALS (Lines 24 + 24.1 + 24.2 + 24.3 + 24.4 + 25.6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64,964 . . . . . . . . . . . . . . . 64,964 . . . . . . . . . . . . . . . . . . . . . . . (b) For health business on indicated lines report: Number of persons insured under PPO managed care products ...............7 and number of persons insured under indemnity only products ..............16. Supp31 West Virginia 4 5 Direct Losses Paid Direct Losses Incurred ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ............... 57,736 ............... 58,638 ....................... ....................... ....................... ....................... 6,232 63,968 63,968 6,508 65,146 65,146 ................ ................ ............... ............... ............... ............... ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201820650100 DIRECT BUSINESS IN THE STATE OF WISCONSIN NAIC Group Code: 0917 Document Code: 206 DURING THE YEAR 2018 NAIC Company Code: 70670 LIFE INSURANCE 1 Ordinary 2 Credit Life (Group and Individual) ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... .......... XXX ......... ........................... .......... XXX ......... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... 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) . . . . . . . . . . . . . . . . ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... DIRECT PREMIUMS AND ANNUITY CONSIDERATIONS 1. 2. 3. 4. 5. 2018 Life Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Annuity considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Deposit-type contract funds . . . . . . . . . . . . . . . . . . . . . . . . . . . Other considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TOTALS (sum of Lines 1 to 4) . . . . . . . . . . . . . . . . . . . . . . . . 3 4 Group 5 Industrial Total DIRECT DIVIDENDS TO POLICYHOLDERS Life Insurance: 6.1 6.2 6.3 6.4 6.5 Annuities: 8. 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ordinary 1 DIRECT DEATH BENEFITS AND MATURED ENDOWMENTS INCURRED No. of Certificates Industrial 6 7 Total 8 9 10 Amount Number Amount Number Amount ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. 20. In force December 31, prior year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21. Issued during year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22. Other changes to in force (Net) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23. In force December 31 of current year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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. ................. .......... .................. ................. .......... .................. ................. .......... .................. ................. .......... .................. 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) . . . . . . . . . . . . . . . . . . . . . . . . . Amount Group 5 .......... 16. 17. Number 2 Credit Life (Group and Individual) 3 4 No. of Ind.Pols & Group Certifs. Amount No. of Policies POLICY EXHIBIT 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Federal Employees Health Benefits Plan Premium (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Credit (Group and Individual) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Collectively Renewable Policies (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Medicare Title XVIII exempt from state taxes or fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Other Individual Policies 25.1 Non-cancelable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.2 Guaranteed renewable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,595,928 . . . . . . . . . . . 3,595,928 . . . . . . . . . . . . . . . . . . . . . . . 25.3 Non-renewable for stated reasons only (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.4 Other accident only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.5 All other (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 480,620 . . . . . . . . . . . . . . 480,620 . . . . . . . . . . . . . . . . . . . . . . . 25.6 TOTALS (sum of Lines 25.1 to 25.5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,076,548 . . . . . . . . . . . 4,076,548 . . . . . . . . . . . . . . . . . . . . . . . 26. TOTALS (Lines 24 + 24.1 + 24.2 + 24.3 + 24.4 + 25.6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,076,548 . . . . . . . . . . . 4,076,548 . . . . . . . . . . . . . . . . . . . . . . . (b) For health business on indicated lines report: Number of persons insured under PPO managed care products ..............96 and number of persons insured under indemnity only products ...........1,444. Supp31 Wisconsin 4 5 Direct Losses Paid Direct Losses Incurred ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ........... 3,436,141 ........... 3,508,398 ....................... ....................... ....................... ....................... 1,077,887 4,514,028 4,514,028 . . . . . . . . . . . . . . 870,453 ........... ........... ........... ........... ........... 4,378,851 4,378,851 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201820658100 2018 DIRECT BUSINESS IN THE STATE OF OTHER FOREIGN TOTAL NAIC Group Code: 0917 LIFE INSURANCE 1 DURING THE YEAR 2018 NAIC Company Code: 70670 Ordinary 2 Credit Life (Group and Individual) ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... .......... XXX ......... ........................... .......... XXX ......... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... 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) . . . . . . . . . . . . . . . . ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... DIRECT PREMIUMS AND ANNUITY CONSIDERATIONS 1. 2. 3. 4. 5. Document Code: 206 Life Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Annuity considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Deposit-type contract funds . . . . . . . . . . . . . . . . . . . . . . . . . . . Other considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TOTALS (sum of Lines 1 to 4) . . . . . . . . . . . . . . . . . . . . . . . . 3 4 Group 5 Industrial Total DIRECT DIVIDENDS TO POLICYHOLDERS Life Insurance: 6.1 6.2 6.3 6.4 6.5 Annuities: 8. 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ordinary 1 DIRECT DEATH BENEFITS AND MATURED ENDOWMENTS INCURRED No. of Certificates Industrial 6 7 Total 8 9 10 Amount Number Amount Number Amount ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. 20. In force December 31, prior year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21. Issued during year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22. Other changes to in force (Net) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23. In force December 31 of current year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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. ................. .......... .................. ................. .......... .................. ................. .......... .................. ................. .......... .................. 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) . . . . . . . . . . . . . . . . . . . . . . . . . Amount Group 5 .......... 16. 17. Number 2 Credit Life (Group and Individual) 3 4 No. of Ind.Pols & Group Certifs. Amount No. of Policies POLICY EXHIBIT 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185,242,397 . . . . . . . . . 254,988,383 . . . . . . . . . . . . . . . . . . . . . . . Federal Employees Health Benefits Plan Premium (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Credit (Group and Individual) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Collectively Renewable Policies (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Medicare Title XVIII exempt from state taxes or fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Other Individual Policies 25.1 Non-cancelable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.2 Guaranteed renewable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.3 Non-renewable for stated reasons only (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.4 Other accident only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.5 All other (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 286,884,643 . . . . . . . . . 262,209,439 . . . . . . . . . . . . . . . . . . . . . . . 25.6 TOTALS (sum of Lines 25.1 to 25.5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 286,884,643 . . . . . . . . . 262,209,439 . . . . . . . . . . . . . . . . . . . . . . . 26. TOTALS (Lines 24 + 24.1 + 24.2 + 24.3 + 24.4 + 25.6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 472,127,040 . . . . . . . . . 517,197,822 . . . . . . . . . . . . . . . . . . . . . . . (b) For health business on indicated lines report: Number of persons insured under PPO managed care products ...............0 and number of persons insured under indemnity only products ...............0. Supp31 Other Foreign Total 4 5 Direct Losses Paid Direct Losses Incurred ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ....................... ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 70670201820659100 2018 DIRECT BUSINESS IN THE STATE OF GRAND TOTAL NAIC Group Code: 0917 LIFE INSURANCE 1 DURING THE YEAR 2018 NAIC Company Code: 70670 Ordinary 2 Credit Life (Group and Individual) ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... .......... XXX ......... ........................... .......... XXX ......... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... 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) . . . . . . . . . . . . . . . . ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... DIRECT PREMIUMS AND ANNUITY CONSIDERATIONS 1. 2. 3. 4. 5. Document Code: 206 Life Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Annuity considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Deposit-type contract funds . . . . . . . . . . . . . . . . . . . . . . . . . . . Other considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TOTALS (sum of Lines 1 to 4) . . . . . . . . . . . . . . . . . . . . . . . . 3 4 Group 5 Industrial Total DIRECT DIVIDENDS TO POLICYHOLDERS Life Insurance: 6.1 6.2 6.3 6.4 6.5 Annuities: 8. 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ordinary 1 DIRECT DEATH BENEFITS AND MATURED ENDOWMENTS INCURRED No. of Certificates Industrial 6 7 Total 8 9 10 Amount Number Amount Number Amount ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. .......... ................. .......... .................... .......... ................. .......... ................. .......... .................. 20. In force December 31, prior year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21. Issued during year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22. Other changes to in force (Net) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23. In force December 31 of current year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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. ................. .......... .................. ................. .......... .................. ................. .......... .................. ................. .......... .................. 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) . . . . . . . . . . . . . . . . . . . . . . . . . Amount Group 5 .......... 16. 17. Number 2 Credit Life (Group and Individual) 3 4 No. of Ind.Pols & Group Certifs. Amount No. of Policies POLICY EXHIBIT 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14,827,825,651 . . . . . 14,937,662,418 . . . . . . . . . . . . . . . . . . . . . . . Federal Employees Health Benefits Plan Premium (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,183,316,533 . . . . . . . 5,262,146,770 . . . . . . . . . . . . . . . . . . . . . . . Credit (Group and Individual) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Collectively Renewable Policies (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Medicare Title XVIII exempt from state taxes or fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 471,868,447 . . . . . . . . . 428,364,166 . . . . . . . . . . . . . . . . . . . . . . . Other Individual Policies 25.1 Non-cancelable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.2 Guaranteed renewable (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,613,857,003 . . . . . . . 1,606,625,076 . . . . . . . . . . . . . . . . . . . . . . . 25.3 Non-renewable for stated reasons only (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.4 Other accident only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.5 All other (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,842,735,766 . . . . . . . 3,823,472,811 . . . . . . . . . . . . . . . . . . . . . . . 25.6 TOTALS (sum of Lines 25.1 to 25.5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,456,592,770 . . . . . . . 5,430,097,887 . . . . . . . . . . . . . . . . . . . . . . . 26. TOTALS (Lines 24 + 24.1 + 24.2 + 24.3 + 24.4 + 25.6) . . . . . . . . . . . . . . . . . . . . . . . . 25,939,603,401 . . . . . 26,058,271,240 . . . . . . . . . . . . . . . . . . . . . . . (b) For health business on indicated lines report: Number of persons insured under PPO managed care products .......3,590,125 and number of persons insured under indemnity only products .........644,232. Supp31 Grand Total ..... 4 5 Direct Losses Paid Direct Losses Incurred 12,170,189,541 ..... 12,105,804,304 . . . . . . . 4,816,316,845 . . . . . . . 4,884,028,710 ....................... ....................... ....................... ....................... . . . . . . . . . 423,292,389 . . . . . . . . . 410,726,238 ....................... ....................... . . . . . . . 1,257,205,824 . . . . . . . 1,267,184,385 ....................... ....................... ....................... ....................... . . . . . . . 2,462,250,367 . . . . . . . 2,454,938,103 . . . . . . . 3,719,456,191 . . . . . . . 3,722,122,488 ..... 21,129,254,966 ..... 21,122,681,740 ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 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 2018 OF THE Health Care Service Corporation, a Mutual Legal Reserve Company 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 2 - Verification Between Years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . SI15 Schedule E - Part 3 - Special Deposits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . E28 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