ANNUAL STATEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company *79413201820100100* LIFE AND ACCIDENT AND HEALTH COMPANIES - ASSOCIATION EDITION ANNUAL STATEMENT FOR THE YEAR ENDED DECEMBER 31, 2018 OF THE CONDITION AND AFFAIRS OF THE UnitedHealthcare Insurance Company NAIC Group Code 0707 0707 (Current) (Prior) Organized under the Laws of NAIC Company Code Connecticut 79413 Employer's ID Number 36-2739571 , State of Domicile or Port of Entry Country of Domicile CT United States of America Incorporated/Organized 03/24/1972 Statutory Home Office Commenced Business 185 Asylum Street (Street and Number) , Main Administrative Office Mail Address 185 Asylum Street (Street and Number or P.O. Box) 877-832-7734 (Area Code) (Telephone Number) , Primary Location of Books and Records Hartford, CT, US 06103-3408 (City or Town, State, Country and Zip Code) 185 Asylum Street (Street and Number) , Hartford, CT, US 06103-3408 (City or Town, State, Country and Zip Code) Internet Website Address Statutory Statement Contact Hartford, CT, US 06103-3408 (City or Town, State, Country and Zip Code) 185 Asylum Street (Street and Number) , Hartford, CT, US 06103-3408 (City or Town, State, Country and Zip Code) 04/11/1972 860-702-6201 (Area Code) (Telephone Number) www.unitedhealthgroup.com Peter A Tassinari (Name) peter_a_tassinari@uhc.com (E-mail Address) , 860-702-6201 (Area Code) (Telephone Number) 860-702-5792 (FAX Number) , OFFICERS President William John Golden # Secretary Thomas Joseph McGuire Chief Financial Officer Treasurer James Francis Bedard Peter Marshall Gill # OTHER Steven Marc Burstein, Assistant Secretary Gary Anthony Iannone, Chief Actuary Timothy John Noel, Assistant Treasurer Nyle Brent Cottington, Vice President Heather Anastasia Lang, Assistant Secretary Thomas Edward Roos, Senior Vice President Gavin Guy Galimi #, Assistant Secretary Thomas Shaun McGlinch, Assistant Treasurer Jessica Leigh Zuba, Assistant Secretary DIRECTORS OR TRUSTEES James Francis Bedard William John Golden # Thomas Shaun McGlinch State of County of Brian Douglas Brueckman # Paul Daniel Hansen Timothy John Noel # State of County of Nyle Brent Cottington Gary Anthony Iannone Thomas Edward Roos State of County of The officers of this reporting entity being duly sworn, each depose and say that they are the described officers of said reporting entity, and that on the reporting period stated above, all of the herein described assets were the absolute property of the said reporting entity, free and clear from any liens or claims thereon, except as herein stated, and that this statement, together with related exhibits, schedules and explanations therein contained, annexed or referred to, is a full and true statement of all the assets and liabilities and of the condition and affairs of the said reporting entity as of the reporting period stated above, and of its income and deductions there from 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. William John Golden Thomas Joseph McGuire James Francis Bedard President Secretary Chief Financial Officer Subscribed and sworn to before me this day of Subscribed and sworn to before me this Subscribed and sworn to before me this day of day of a. Is this an original filing?.................................... b. If no, 1. State the amendment number…………….. 2. Date filed………………………………….. Yes [ X ] No [ ] *79413201821000100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company ACCIDENT AND HEALTH POLICY EXPERIENCE EXHIBIT FOR YEAR NAIC Group Code 0707 210-1 A. INDIVIDUAL BUSINESS 1. Comprehensive Major Medical 1.1 With Contract Reserves 1.2 Without Contract Reserves 1.3 Subtotal 2. Short-Term Medical 2.1 With Contract Reserves 2.2 Without Contract Reserves 2.3 Subtotal 3. Other Medical (Non-Comprehensive) 3.1 With Contract Reserves 3.2 Without Contract Reserves 3.3 Subtotal 4. Specified/Named Disease 4.1 With Contract Reserves 4.2 Without Contract Reserves 4.3 Subtotal 5. Limited Benefit 5.1 With Contract Reserves 5.2 Without Contract Reserves 5.3 Subtotal 6. Student 6.1 With Contract Reserves 6.2 Without Contract Reserves 6.3 Subtotal 7. Accident Only or AD&D 7.1 With Contract Reserves 7.2 Without Contract Reserves 7.3 Subtotal 8. Disability Income - Short - Term 8.1 With Contract Reserves 8.2 Without Contract Reserves 8.3 Subtotal United States Policy Forms Direct Business Only For The Year Ended December 31, 2018 (To Be Filed By April 1) 1 2 3 4 Premiums Earned Incurred Claims Amount Change in Contract Reserves Loss Ratio (2+3)/1 5 Number of Policies or Certificates as of Dec. 31 NAIC Company Code 79413 6 7 Number of Covered Lives Member Months as of Dec. 31 0 5,941,246 5,941,246 0 2,643,349 2,643,349 0 0 0 0.0 44.5 44.5 0 5,342 5,342 0 10,158 10,158 0 117,531 117,531 0 0 0 0 0 0 0 0 0 0.0 0.0 0.0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.0 0.0 0.0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.0 0.0 0.0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.0 0.0 0.0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.0 0.0 0.0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.0 0.0 0.0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.0 0.0 0.0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company ACCIDENT AND HEALTH POLICY EXPERIENCE EXHIBIT FOR YEAR 210-2 A. INDIVIDUAL BUSINESS (Continued) 9. Disability Income - Long - Term 9.1 With Contract Reserves 9.2 Without Contract Reserves 9.3 Subtotal 10. Long-Term Care 10.1 With Contract Reserves 10.2 Without Contract Reserves 10.3 Subtotal 11. Medicare Supplement (Medigap) 11.1 With Contract Reserves 11.2 Without Contract Reserves 11.3 Subtotal 12. Dental 12.1 With Contract Reserves 12.2 Without Contract Reserves 12.3 Subtotal 13. State Children’s Health Insurance Program 13.1 With Contract Reserves 13.2 Without Contract Reserves 13.3 Subtotal 14. Medicare 14.1 With Contract Reserves 14.2 Without Contract Reserves 14.3 Subtotal 15. Medicaid 15.1 With Contract Reserves 15.2 Without Contract Reserves 15.3 Subtotal 16. Medicare Part D - Stand-Alone 16.1 With Contract Reserves 16.2 Without Contract Reserves 16.3 Subtotal 17. Other Individual Business 17.1 With Contract Reserves 17.2 Without Contract Reserves 17.3 Subtotal 18. Total Individual Business 18.1 With Contract Reserves 18.2 Without Contract Reserves 19. Grand Total Individual 1 2 3 4 Premiums Earned Incurred Claims Amount Change in Contract Reserves Loss Ratio (2+3)/1 5 Number of Policies or Certificates as of Dec. 31 6 Number of Covered Lives as of Dec. 31 7 Member Months 0 0 0 0 0 0 0 0 0 0.0 0.0 0.0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.0 0.0 0.0 0 0 0 0 0 0 0 0 0 3,337,223,109 0 3,337,223,109 2,639,033,975 0 2,639,033,975 19,229,347 0 19,229,347 79.7 0.0 79.7 1,386,964 0 1,386,964 1,386,964 0 1,386,964 16,557,509 0 16,557,509 0 0 0 0 0 0 0 0 0 0.0 0.0 0.0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.0 0.0 0.0 0 0 0 0 0 0 0 0 0 11,596,021,692 0 11,596,021,692 9,333,519,195 0 9,333,519,195 (2,746,697) 0 (2,746,697) 80.5 0.0 80.5 1,156,374 0 1,156,374 1,156,387 0 1,156,387 13,552,362 0 13,552,362 2,904,057,237 0 2,904,057,237 2,640,433,695 0 2,640,433,695 (5) 0 (5) 90.9 0.0 90.9 273,655 0 273,655 273,655 0 273,655 3,230,161 0 3,230,161 0 3,637,050,890 3,637,050,890 0 2,599,658,786 2,599,658,786 0 0 0 0.0 71.5 71.5 0 3,382,032 3,382,032 0 3,382,032 3,382,032 0 41,203,860 41,203,860 0 0 0 0 0 0 0 0 0 0.0 0.0 0.0 0 0 0 0 0 0 0 0 0 17,837,302,038 3,642,992,136 21,480,294,174 14,612,986,865 2,602,302,135 17,215,289,000 16,482,645 0 16,482,645 82.0 71.4 80.2 2,816,993 3,387,374 6,204,367 2,817,006 3,392,190 6,209,196 33,340,032 41,321,391 74,661,423 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company ACCIDENT AND HEALTH POLICY EXPERIENCE EXHIBIT FOR YEAR 210-3 B. GROUP BUSINESS Comprehensive Major Medical 1. Single Employer 1.1 Small Employer 1.2 Other Employer 1.3 Single Employer Subtotal 2. Multiple Employer Assns and Trusts 3. Other Associations and Discretionary Trusts 4. Other Comprehensive Major Medical 5. Comprehensive/Major Medical Subtotal Other Medical (Non-Comprehensive) 6. Specified/Named Disease 7. Limited Benefit 8. Student 9. Accident Only or AD&D 10. Disability Income - Short-term 11. Disability Income - Long-term 12. Long-Term Care 13. Medicare Supplement (Medigap) 14. Federal Employees Health Benefits Plans 15. Tricare 16. Dental 17. Medicare 18. Medicare Part D - Stand-Alone 19. Other Group Care 20. Grand Total Group Business C. OTHER BUSINESS 1. Credit (Individual and Group) 2. Stop Loss/Excess Loss 3. Administrative Services Only 4. Administrative Services Contracts 5. Grand Total Other Business D. TOTAL BUSINESS 1. Total Non U.S. Policy Forms 2. Grand Total Individual, Group and Other Business 1 2 3 4 Premiums Earned Incurred Claims Amount Change in Contract Reserves Loss Ratio (2+3)/1 5 Number of Policies or Certificates as of Dec. 31 6 Number of Covered Lives as of Dec. 31 7 Member Months 6,601,096,591 15,144,723,618 21,745,820,209 0 0 0 21,745,820,209 4,986,367,129 12,301,431,354 17,287,798,483 0 0 0 17,287,798,483 0 (4,789) (4,789) 0 0 0 (4,789) 75.5 81.2 79.5 0.0 0.0 0.0 79.5 678,545 1,820,789 2,499,334 0 0 0 2,499,334 1,192,393 3,300,976 4,493,369 0 0 0 4,493,369 13,970,965 40,098,493 54,069,458 0 0 0 54,069,458 0 1,341,354,212 691,436,133 20,046,575 33,319,754 48,633,612 0 6,627,853,693 175,447,414 0 911,371,460 0 103,853,330 102,546,354 31,801,682,746 0 1,301,415,405 541,115,897 9,226,881 20,600,837 29,720,162 0 5,241,223,167 157,589,416 0 663,540,580 0 42,061,505 55,096,333 25,349,388,666 0 3,525,770 0 0 0 0 0 38,190,224 0 0 696,537 0 0 (874,837) 41,532,905 0.0 97.3 78.3 46.0 61.8 61.1 0.0 79.7 89.8 0.0 72.9 0.0 40.5 52.9 79.8 0 2,964,664 348,552 30,628 19,389 66,475 0 2,754,567 18,553 0 1,490,859 0 216,259 628,325 11,037,605 0 5,662,304 359,124 30,628 19,389 66,440 0 2,754,565 39,133 0 2,655,285 0 216,259 716,997 17,013,493 0 67,265,738 4,135,606 579,210 1,971,547 2,766,213 0 32,883,852 422,170 0 30,208,155 0 2,561,595 7,366,187 204,229,731 0 689,027,533 0 553,861,457 0.0 80.4 XXX XXX XXX XXX 689,027,533 553,861,457 0 80.4 0 734,467 162,533 0 897,000 0 1,503,455 189,492 0 1,692,947 0 18,118,948 2,266,012 0 20,384,960 0 53,971,004,453 0 43,118,539,123 0 58,015,550 0.0 80.0 0 18,138,972 0 24,915,636 0 299,276,114 0 0 XXX XXX XXX XXX SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company ACCIDENT AND HEALTH POLICY EXPERIENCE EXHIBIT FOR YEAR PART 1 – INDIVIDUAL POLICIES SUMMARY 1 Premiums Earned Description 1. 2. 3. 4. 5. 6. 2 Incurred Claims Amount 21,480,294,174 0 21,480,294,174 1,748,988,604 6,776 23,229,276,002 U.S. Forms Direct Business Other Forms Direct Business Total Direct Business Reinsurance Assumed Less Reinsurance Ceded Total 3 Change in Contract Reserves 17,215,289,000 0 17,215,289,000 1,389,004,640 (149,838) 18,604,443,478 16,482,644 0 16,482,644 0 0 16,482,644 4 Loss Ratio (2+3)/1 80.2 0.0 80.2 79.4 (2,211.3) 80.2 PART 2 – GROUP POLICIES SUMMARY 1 Description 1. 2. 3. 4. 5. 6. 2 Incurred Claims Amount Premiums Earned 32,490,710,278 0 32,490,710,278 632,116,903 2,078,627,843 31,044,199,338 U.S. Forms Direct Business Other Forms Direct Business Total Direct Business Reinsurance Assumed Less Reinsurance Ceded Total 3 Change in Contract Reserves 25,903,250,125 0 25,903,250,125 516,835,796 1,814,213,661 24,605,872,260 4 Loss Ratio (2+3)/1 41,532,906 0 41,532,906 0 0 41,532,906 79.9 0.0 79.9 81.8 87.3 79.4 210-4 PART 3 – CREDIT POLICIES (Individual and Group) SUMMARY 1 Description 1. 2. 3. 4. 5. 6. 2 Incurred Claims Amount Premiums Earned 0 0 0 0 0 0 U.S. Forms Direct Business Other Forms Direct Business Total Direct Business Reinsurance Assumed Less Reinsurance Ceded Total 3 Change in Contract Reserves 0 0 0 0 0 0 4 Loss Ratio (2+3)/1 0 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0 0.0 PART 4 – ALL INDIVIDUAL, GROUP AND CREDIT POLICIES SUMMARY 1 Description 1. 2. 3. 4. 5. 6. U.S. Forms Direct Business Other Forms Direct Business Total Direct Business Reinsurance Assumed Less Reinsurance Ceded Total Premiums Earned 53,971,004,452 0 53,971,004,452 2,381,105,507 2,078,634,619 54,273,475,340 2 Incurred Claims Amount 43,118,539,125 0 43,118,539,125 1,905,840,436 1,814,063,823 43,210,315,738 3 Change in Contract Reserves 58,015,550 0 58,015,550 0 0 58,015,550 4 Loss Ratio (2+3)/1 80.0 0.0 80.0 80.0 87.3 79.7 *79413201821601100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes - See Cautionary Statement at http://www.naic.org/documents/committees_e_app_blanks_related_shce_cautionary_statement.pdf) UnitedHealthcare Insurance Company 2. 185 Asylum Street Hartford, CT 061033408 (LOCATION) BUSINESS IN THE STATE OF Alabama DURING THE YEAR 2018 NAIC Company Code Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 1. 216-1.AL 2. 3. 4. 5. 6. 7. 8. 9. Premium: 1.1 Health premiums earned (From Part 2, Line 1.11) 1.2 Federal high risk pools 1.3 State high risk pools 1.4 Premiums earned including state and federal high risk programs (Lines 1.1 + 1.2 + 1.3) 1.5 Federal taxes and federal assessments 1.6 State insurance, premium and other taxes (Similar local taxes of 26,207 ) $ 1.6a Community Benefit Expenditures (informational only) 1.7 Regulatory authority licenses and fees 1.8 Adjusted Premiums Earned (Lines 1.4 - 1.5 - 1.6 - 1.7) 1.9 Net Assumed less Ceded reinsurance premiums earned 1.10 Other Adjustments due to MLR calculations - Premiums 1.11 Risk Revenue 1.12 Net adjusted premiums earned after reinsurance (Lines 1.8 + 1.9 + 1.10 + 1.11) Claims: 2.1 Incurred claims excluding prescription drugs 2.2 Prescription drugs 2.3 Pharmaceutical rebates 2.4 State stop loss, market stabilization and claim/census based assessments (informational only) Incurred medical incentive pools and bonuses Deductible Fraud and Abuse Detection/Recovery Expenses (for MLR use only) 5.0 Total Incurred Claims (Lines 2.1 + 2.2 - 2.3 + 3) (From Part 2, Line 2.15) 5.1 Net Assumed less Ceded reinsurance claims incurred 5.2 Other Adjustments due to MLR calculations - Claims 5.3 Rebates paid 5.4 Estimated rebates unpaid prior year 5.5 Estimated rebates unpaid current year 5.6 Fee for service and co-pay revenue 5.7 Net incurred claims after reinsurance (Lines 5.0 + 5.1 + 5.2 + 5.3 - 5.4 + 5.5 - 5.6) Improving Health Care Quality Expenses Incurred: 6.1 Improve health outcomes 6.2 Activities to prevent hospital readmissions 6.3 Improve patient safety and reduce medical errors 6.4 Wellness and health promotion activities 6.5 Health Information Technology expenses related to health improvement 6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5) Preliminary Medical Loss Ratio: MLR ((Lines 4 + 5.0 + 6.6 - Footnote 2.0)/Line 1.8 Claims Adjustment Expenses: 8.1 Cost containment expenses not included in quality of care expenses in Line 6.6 8.2 All other claims adjustment expenses 8.3 Total claims adjustment expenses (Lines 8.1 + 8.2) Claims Adjustment Expense Ratio (Line 8.3/Line 1.8) 2 Small Group Employer 3 Large Group Employer 4 5 Small Group Employer Individual Expatriate Plans 6 Large Group Employer 7 11 Government Business (excluded by statute) Other Health Business 9 8 Small Group 10 Student Health Plans Large Group 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 79413 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 58,513 0 (212) 17,088,775 0 (53) 27,654,538 0 (28,076) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 192,211,630 0 41,208 84,131,225 0 0 321,144,682 0 12,866 XXX XXX XXX 58,301 (2,677) 17,088,722 882,289 27,626,462 1,275,205 0 0 0 0 0 0 0 0 0 0 0 0 0 11,937 192,252,838 5,154,270 84,131,225 8,344,961 321,157,548 15,665,984 XXX 16,120 0 90 44,767 1,316 0 0 46,083 311,339 0 (21) 15,895,116 10,610 8,464 0 15,914,190 401,546 0 2,079 25,947,633 (2,839,395) 70,524 0 23,178,762 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (11,937) 59,912 0 0 47,975 3,710,178 0 (17,892) 183,406,282 (54,742) 16,787 0 183,368,327 9,401 0 0 75,776,863 2,987,019 1,391,249 0 80,155,131 4,448,584 0 (15,745) 301,058,725 164,719 1,487,024 0 302,710,468 XXX XXX XXX XXX XXX 4,448,584 0 (15,745) 301,058,022 164,719 1,487,024 0 302,709,766 53,622 9,238 1,101 9,704,419 3,522,924 1,003,349 17,903,888 5,276,517 1,702,231 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 62,655,336 94,057,162 9,580 (1,979,035) 89,594,433 45,983,643 88,338,230 192,460,275 48,699,904 XXX XXX XXX 88,338,230 192,460,275 48,699,904 0 0 0 61,759 0 0 0 0 0 0 61,759 1,984 4,578 510 12,228,572 0 0 0 0 0 0 12,228,572 16,514 14,171 12,939 21,492,345 (2,306,185) 0 0 0 0 0 19,186,160 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 1,152 83 41,632,906 0 0 0 0 0 0 41,632,906 18,499 19,901 13,532 232,118,502 (2,208,971) 0 0 0 0 0 229,909,531 XXX XXX 0 1 0 0 0 156,702,919 97,215 0 XXX XXX XXX 0 156,800,133 18,499 19,901 13,532 232,118,502 (2,208,971) 0 0 0 0 0 229,909,531 468 0 0 0 0 136,710 0 0 0 0 221,236 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 207,949 90,414 68,751 627,773 44,890 468 1.390 136,710 0.778 221,236 0.837 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 1,039,778 XXX 1,019,479 0.563 2,417,671 XXX 833 4,464 5,297 0.118 222,883 348,345 571,228 0.036 339,819 503,630 843,449 0.033 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 96,634 1,377,554 1,474,188 0.008 2,719,155 8,604,605 11,323,760 0.149 3,379,324 10,838,598 14,217,922 XXX XXX XXX XXX XXX 0 0 0 0.000 201,720 39,945 441,143 (30,187) 366,858 321,144,682 0 12,866 702 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 768,084 130,359 509,895 597,586 411,749 0 0 0 0 0 768,084 130,359 509,895 597,586 411,749 0 2,417,671 XXX 0 0 0 3,379,324 10,838,598 14,217,922 XXX XXX XXX 321,157,548 15,666,687 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 (Continued) Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 2 Small Group Employer Individual 10. General and Administrative (G&A) Expenses: 10.1 Direct sales salaries and benefits 10.2 Agents and brokers fees and commissions 10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below) 10.4 Other general and administrative expenses 10.4a Community Benefit Expenditures (informational only) 10.5 Total general and administrative (Lines 10.1 +10.2 + 10.3 + 10.4) 100 316 (1,858) 8,937 0 7,495 3 Large Group Employer 76,439 486,649 77 1,029,287 0 1,592,452 4 5 Small Group Employer Individual 138,968 277,425 44,067 1,128,117 0 1,588,577 0 0 0 0 0 0 Expatriate Plans 6 Large Group Employer 0 0 0 0 0 0 7 8 Small Group 0 0 0 0 0 0 Student Health Plans Large Group 0 0 0 0 0 0 10 11 Government Business (excluded by statute) Other Health Business 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 169,381 3,294,737 212,063 9,665,022 0 13,341,203 106,348 598,160 168,868 6,302,166 0 7,175,541 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 491,236 4,657,287 423,217 18,133,529 0 23,705,269 0 0 0 0 0 0 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) 10,713,025 19,003,445 32,460,075 12. Income from fees of uninsured plans XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 13. Net investment and other gain/(loss) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 14. Federal income taxes (excluding taxes on Line 1.5 above) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 15. Net gain or (loss) (Lines 11 + 12 + 13 - 14) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 16. ICD-10 Implementation Expenses (informational only; already included in general expenses and line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16. 16a ICD-10 Implementation Expenses (informational only; already included in line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (28,936) 1,385,228 1,339,340 0 0 0 0 0 0 47,974 XXX 491,236 4,657,287 423,217 18,133,529 0 23,705,269 32,459,372 3,525 3,525 4,440,901 XXX XXX 257,874 XXX 257,874 XXX 36,643,101 XXX 36,645,924 4,440,901 OTHER INDICATORS: 216-2.AL 1. Number of certificates/policies 19 2,081 3,302 0 0 0 0 0 0 0 65,349 40,091 110,842 0 110,842 2. Number of Covered Lives 21 3,596 6,197 0 0 0 0 0 0 0 90,479 40,091 140,384 0 140,384 3. Number of Groups 376 65 0 0 0 0 0 0 769 0 1,210 0 1,210 4. Member Months 50,535 69,912 0 0 0 0 0 0 1,117,750 493,420 1,731,882 0 1,731,882 XXX 265 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ XXX 0 ] If yes, show the amount of premiums and claims included. Premiums $ 0 Claims $ 0 AFFORDABLE CARE ACT (ACA) RECEIPTS, PAYMENTS, RECEIVABLES and PAYABLES Current Year Prior Year Comprehensive Health Coverage Comprehensive Health Coverage 1 2 3 4 Small Group Small Group Employer Plans Employer Plans Individual Plans Individual Plans ACA Receivables and Payables 1. Permanent ACA Risk Adjustment Program 1.0 Premium adjustments receivable/(payable) 2. Transitional ACA Reinsurance Program 2.0 Total amounts recoverable for claims (paid & unpaid) 0 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 0 0 (57,106) (1,348,515) XXX (12,113) 0 0 0 486,596 XXX 0 0 0 0 ACA Receipts and Payments 4. Permanent ACA Risk Adjustment Program 4.0 Premium adjustments receipts/(payments) 5. Transitional ACA Reinsurance Program 5.0 Amounts received for claims 0 6. Temporary ACA Risk Corridors Program 6.1 Retrospective premium received 6.2 Rate credits or policy experience refunds paid 0 0 (4,181) 742,162 XXX (15,562) 0 0 0 0 0 (35,790) XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF 185 Asylum Street Hartford, CT 061033408 Alabama DURING THE YEAR Comprehensive Health Coverage 1 2 3 Individual Small Group Employer Large Group Employer Small Group Employer Individual Expatriate Plans: 7 8 6 Large Group Employer Small Group 10 11 Government Business (excluded by statute) Other Health Business 9 Student Health Plans Large Group 79413 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.AL Health Premiums Earned: 58,513 17,096,412 1.1 Direct premiums written 0 848 1.2 Unearned premium prior year 0 21 1.3 Unearned premium current year 0 826 1.4 Change in unearned premium (Lines 1.2 - 1.3) (7,723) 0 1.5 Paid rate credits 0 0 1.6 Reserve for rate credits current year 0 0 1.7 Reserve for rate credits prior year 0 0 1.8 Change in reserve for rate credits (Lines 1.6 - 1.7) 0 8,464 1.9 Premium balances written off 0 0 1.10 Group conversion charge 58,513 17,088,775 1.11 Total direct premiums earned (Lines 1.1 + 1.4 - 1.9 + 1.10) 0 0 1.12 Assumed premiums earned from non-affiliates 1,316 10,610 1.13 Net Assumed less Ceded premiums earned from affiliates 0 0 1.14 Ceded premiums earned to non-affiliates 0 8,464 1.15 Other Adjustments due to MLR calculation - Premiums 67,553 17,107,849 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 94,800 12,756,595 2.1 Paid claims during the year 13,268 1,222,568 2.2 Direct claim liability current year 14,184 1,839,826 2.3 Direct claim liability prior year 955 27,404 2.4 Direct claim reserves current year 853 38,498 2.5 Direct claim reserves prior year 97,116 0 2.6 Direct contract reserves current year 121,212 0 2.7 Direct contract reserves prior year (7,723) 0 2.8 Paid rate credits 0 0 2.9 Reserve for rate credits current year 0 0 2.10 Reserve for rate credits prior year 0 4,578 2.11 Incurred medical incentive pools and bonuses (Lines 2.11a + 2.11b - 2.11c) 0 1,367 2.11a Paid medical incentive pools and bonuses current year 0 5,202 2.11b Accrued medical incentive pools and bonuses current year 0 1,990 2.11c Accrued medical incentive pools and bonuses prior year 409 (95,750) 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 409 362,653 2.12a Healthcare receivables current year 0 458,404 2.12b Healthcare receivables prior year 0 0 2.13 Group conversion charge 0 0 2.14 Multi-option coverage blended rate adjustment 2.15 Total incurred claims (Lines 2.1 + 2.2 - 2.3 + 2.4 - 2.5 + 2.6 - 2.7 + 2.8 + 2.9 61,759 12,228,572 2.10 + 2.11 - 2.12 + 2.13 + 2.14) 0 0 2.16 Assumed incurred claims from non-affiliates 0 0 2.17 Net assumed less ceded incurred claims from affiliates 0 0 2.18 Ceded incurred claims to non-affiliates 0 0 2.19 Other adjustments due to MLR calculation - Claims 69,482 12,228,572 2.20 Net Incurred Claims (Lines 2.15 - 2.8 - 2.9 + 2.10 + 2.16 + 2.17 - 2.18 + 2.19) 3. Fraud and Abuse Recoveries that Reduced PAID Claims in Line 2.1 above 0 510 (informational only) 2,484,571 for stand-alone dental and $ (a) Column 13, Line 1.1 includes direct written premium of $ 4 Business Subject to MLR Mini-Med Plans 5 (LOCATION) NAIC Company Code 2018 27,725,063 0 0 0 0 0 0 0 70,524 0 27,654,538 0 1,745 2,841,140 70,524 24,885,668 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 21,541,355 2,662,673 2,978,919 54,572 58,240 0 0 0 0 0 14,171 6,229 15,904 7,963 (256,734) 703,473 960,207 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 21,492,345 0 0 2,306,185 0 19,186,160 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 12,939 0 0 2,722,831 for stand-alone vision policies. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 59,912 0 0 59,912 192,247,802 15,450 34,835 (19,385) (1,907,364) 12,070 0 12,070 16,787 0 192,211,630 0 1,084 55,827 16,787 194,068,969 85,522,474 0 0 0 7,019,467 2,467,764 4,516,119 (2,048,355) 1,391,249 0 84,131,225 0 2,987,019 0 1,391,249 83,538,381 322,650,265 16,298 34,856 (18,558) 5,104,380 2,479,834 4,516,119 (2,036,285) 1,487,024 0 321,144,682 0 3,061,686 2,896,967 1,487,024 319,728,331 (52) 52 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 158,023,535 12,223,393 11,583,252 2,745,062 2,817,020 80,218 71,169 (1,907,364) 12,070 0 0 0 0 0 2,554 12,919 10,365 0 0 38,373,474 955,328 3,509,492 549 549 0 0 7,019,467 2,467,764 4,516,119 1,152 26 1,459 332 (841,332) 22,991,407 23,832,739 0 0 230,789,707 17,077,283 19,925,673 2,828,541 2,915,159 177,335 192,381 5,104,380 2,479,834 4,516,119 19,901 7,622 22,564 10,285 (1,190,853) 24,070,862 25,261,715 0 0 0 0 0 0 0 0 1 0 0 0 0 1 156,702,919 0 0 (97,215) 0 158,695,427 41,632,906 0 0 0 0 36,661,794 232,118,502 0 0 2,208,971 0 226,841,436 0 0 13,829 27,277 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF Alabama DURING THE YEAR All Expenses 1 Individual Comprehensive Coverage Expenses: 5,601 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 158 for affiliated services) 1.3 EDP Equipment and Software (incl $ 15 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 2 for affiliated services) 1.5 Accreditation and Certification (incl $ 3,895 for affiliated services) 1.6 Other Expenses (incl $ 1.7 Subtotal before Reimbursements and Taxes (Lines 1.1 to 1.6) 1.8 Reimbursements by uninsured plans and fiscal intermediaries 1.9 Taxes, Licenses and Fees (in total, for tying purposes) 1.10 Total (1.7 to 1.9) 1.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 2. 216-4.AL 2.7 Subtotal before Reimbursements and Taxes (Lines 2.1 to 2.6) 2.8 Reimbursements by uninsured plans and fiscal intermediaries 2.9 Taxes, Licenses and Fees (in total, for tying purposes) 2.10 Total (2.7 to 2.9) 2.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 3. 0 0 0 0 0 468 468 0 XXX Small Group Comprehensive Coverage Expenses: 508,548 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 36,313 for affiliated services) 2.3 EDP Equipment and Software (incl $ 3,486 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 378 for affiliated services) 2.5 Accreditation and Certification (incl $ 1,158,714 for affiliated services) 2.6 Other Expenses (incl $ 3.7 Subtotal before Reimbursements and Taxes (Lines 3.1 to 3.6) 3.8 Reimbursements by uninsured plans and fiscal intermediaries 3.9 Taxes, Licenses and Fees (in total, for tying purposes) 3.10 Total (3.7 to 3.9) 3.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX Total (1 to 5) 0 0 0 0 0 468 468 0 XXX 0 0 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 0 0 0 0 0 0 0 XXX (LOCATION) NAIC Company Code 2018 XXX 218 98 18 2 0 488 823 0 XXX 2,056 96 67 6 1 2,229 4,455 0 XXX 468 0 0 0 0 0 0 0 0 0 468 0 823 80 4,455 0 0 0 0 0 0 136,710 136,710 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 136,710 136,710 0 60,173 11,653 5,025 482 52 138,373 215,758 0 98,956 11,341 8,263 793 86 221,321 340,759 0 XXX Large Group Comprehensive Coverage Expenses: 725,730 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 49,415 for affiliated services) 3.3 EDP Equipment and Software (incl $ 4,743 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 515 for affiliated services) 3.5 Accreditation and Certification (incl $ 1,614,653 for affiliated services) 3.6 Other Expenses (incl $ Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions Improve Health Outcomes 1. 185 Asylum Street Hartford, CT 061033408 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX XXX XXX 136,710 0 0 0 0 0 0 0 0 0 136,710 0 215,758 61,505 340,759 0 0 0 0 0 0 221,236 221,236 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 221,236 221,236 0 93,234 12,546 7,786 747 81 214,294 328,688 0 143,240 16,416 11,961 1,148 125 320,367 493,257 0 XXX XXX XXX 0 0 0 XXX 221,236 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 221,236 0 XXX 328,688 100,449 493,257 0 79413 9 10 General Administrative Expenses Total Expenses (6 to 9) 3,327 133 73 1 1 5,811 9,346 0 14,379 23,725 0 5,601 326 158 9 2 8,996 15,092 0 14,379 29,471 80 349,420 36,317 23,025 2,210 240 1,175,758 1,586,970 0 331,510 1,918,480 0 508,548 59,310 36,313 3,486 378 1,672,162 2,280,197 0 331,510 2,611,707 61,505 489,255 43,232 29,668 2,848 309 969,887 1,535,199 0 478,507 2,013,706 0 725,730 72,194 49,415 4,743 515 1,725,784 2,578,380 0 478,507 3,056,887 100,449 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 4. 5. 216-5.AL 6. Individual Mini-Med Plans Expenses: 0 for affiliated services) 4.1 Salaries (including $ 4.2 Outsourced Services 0 for affiliated services) 4.3 EDP Equipment and Software (incl $ 0 for affiliated services) 4.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 4.5 Accreditation and Certification (incl $ 0 for affiliated services) 4.6 Other Expenses (incl $ 4.7 Subtotal before Reimbursements and Taxes (Lines 4.1 to 4.6) 4.8 Reimbursements by uninsured plans and fiscal intermediaries 4.9 Taxes, Licenses and Fees (in total, for tying purposes) 4.10 Total (4.7 to 4.9) 4.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Mini-Med Plans Expenses: 0 for affiliated services) 5.1 Salaries (including $ 5.2 Outsourced Services 0 for affiliated services) 5.3 EDP Equipment and Software (incl $ 0 for affiliated services) 5.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 5.5 Accreditation and Certification (incl $ 0 for affiliated services) 5.6 Other Expenses (incl $ 5.7 Subtotal before Reimbursements and Taxes (Lines 5.1 to 5.6) 5.8 Reimbursements by uninsured plans and fiscal intermediaries 5.9 Taxes, Licenses and Fees (in total, for tying purposes) 5.10 Total (5.7 to 5.9) 5.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Mini-Med Plans Expenses: 0 for affiliated services) 6.1 Salaries (including $ 6.2 Outsourced Services 0 for affiliated services) 6.3 EDP Equipment and Software (incl $ 0 for affiliated services) 6.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 6.5 Accreditation and Certification (incl $ 0 for affiliated services) 6.6 Other Expenses (incl $ 6.7 Subtotal before Reimbursements and Taxes (Lines 6.1 to 6.6) 6.8 Reimbursements by uninsured plans and fiscal intermediaries 6.9 Taxes, Licenses and Fees (in total, for tying purposes) 6.10 Total (6.7 to 6.9) 6.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 7. 8. 216-6.AL 9. Small Group Expatriate Plans Expenses: 0 for affiliated services) 7.1 Salaries (including $ 7.2 Outsourced Services 0 for affiliated services) 7.3 EDP Equipment and Software (incl $ 0 for affiliated services) 7.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 7.5 Accreditation and Certification (incl $ 0 for affiliated services) 7.6 Other Expenses (incl $ 7.7 Subtotal before Reimbursements and Taxes (Lines 7.1 to 7.6) 7.8 Reimbursements by uninsured plans and fiscal intermediaries 7.9 Taxes, Licenses and Fees (in total, for tying purposes) 7.10 Total (7.7 to 7.9) 7.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Expatriate Plans Expenses: 0 for affiliated services) 8.1 Salaries (including $ 8.2 Outsourced Services 0 for affiliated services) 8.3 EDP Equipment and Software (incl $ 0 for affiliated services) 8.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 8.5 Accreditation and Certification (incl $ 0 for affiliated services) 8.6 Other Expenses (incl $ 8.7 Subtotal before Reimbursements and Taxes (Lines 8.1 to 8.6) 8.8 Reimbursements by uninsured plans and fiscal intermediaries 8.9 Taxes, Licenses and Fees (in total, for tying purposes) 8.10 Total (8.7 to 8.9) 8.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Student Health Plans Expenses: 0 for affiliated services) 9.1 Salaries (including $ 9.2 Outsourced Services 0 for affiliated services) 9.3 EDP Equipment and Software (incl $ 0 for affiliated services) 9.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 9.5 Accreditation and Certification (incl $ 0 for affiliated services) 9.6 Other Expenses (incl $ 9.7 Subtotal before Reimbursements and Taxes (Lines 9.1 to 9.6) 9.8 Reimbursements by uninsured plans and fiscal intermediaries 9.9 Taxes, Licenses and Fees (in total, for tying purposes) 9.10 Total (9.7 to 9.9) 9.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 *79413201821602100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes - See Cautionary Statement at http://www.naic.org/documents/committees_e_app_blanks_related_shce_cautionary_statement.pdf) UnitedHealthcare Insurance Company 2. 185 Asylum Street Hartford, CT 061033408 (LOCATION) BUSINESS IN THE STATE OF Alaska DURING THE YEAR 2018 NAIC Company Code Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 1. 216-1.AK 2. 3. 4. 5. 6. 7. 8. 9. Premium: 1.1 Health premiums earned (From Part 2, Line 1.11) 1.2 Federal high risk pools 1.3 State high risk pools 1.4 Premiums earned including state and federal high risk programs (Lines 1.1 + 1.2 + 1.3) 1.5 Federal taxes and federal assessments 1.6 State insurance, premium and other taxes (Similar local taxes of 3,820 ) $ 1.6a Community Benefit Expenditures (informational only) 1.7 Regulatory authority licenses and fees 1.8 Adjusted Premiums Earned (Lines 1.4 - 1.5 - 1.6 - 1.7) 1.9 Net Assumed less Ceded reinsurance premiums earned 1.10 Other Adjustments due to MLR calculations - Premiums 1.11 Risk Revenue 1.12 Net adjusted premiums earned after reinsurance (Lines 1.8 + 1.9 + 1.10 + 1.11) Claims: 2.1 Incurred claims excluding prescription drugs 2.2 Prescription drugs 2.3 Pharmaceutical rebates 2.4 State stop loss, market stabilization and claim/census based assessments (informational only) Incurred medical incentive pools and bonuses Deductible Fraud and Abuse Detection/Recovery Expenses (for MLR use only) 5.0 Total Incurred Claims (Lines 2.1 + 2.2 - 2.3 + 3) (From Part 2, Line 2.15) 5.1 Net Assumed less Ceded reinsurance claims incurred 5.2 Other Adjustments due to MLR calculations - Claims 5.3 Rebates paid 5.4 Estimated rebates unpaid prior year 5.5 Estimated rebates unpaid current year 5.6 Fee for service and co-pay revenue 5.7 Net incurred claims after reinsurance (Lines 5.0 + 5.1 + 5.2 + 5.3 - 5.4 + 5.5 - 5.6) Improving Health Care Quality Expenses Incurred: 6.1 Improve health outcomes 6.2 Activities to prevent hospital readmissions 6.3 Improve patient safety and reduce medical errors 6.4 Wellness and health promotion activities 6.5 Health Information Technology expenses related to health improvement 6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5) Preliminary Medical Loss Ratio: MLR ((Lines 4 + 5.0 + 6.6 - Footnote 2.0)/Line 1.8 Claims Adjustment Expenses: 8.1 Cost containment expenses not included in quality of care expenses in Line 6.6 8.2 All other claims adjustment expenses 8.3 Total claims adjustment expenses (Lines 8.1 + 8.2) Claims Adjustment Expense Ratio (Line 8.3/Line 1.8) 2 Small Group Employer 3 Large Group Employer 4 5 Small Group Employer Individual Expatriate Plans 6 Large Group Employer 7 11 Government Business (excluded by statute) Other Health Business 9 8 Small Group 10 Student Health Plans Large Group 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 79413 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 19,971,657 0 (155) 9,068,083 0 0 40,376,129 0 (55,266) XXX XXX XXX 0 (2,204) 19,971,502 140,330 9,068,083 312,246 40,320,863 856,634 XXX 0 0 0 0 0 0 0 0 0 0 0 2,204 0 0 0 2,204 310,763 0 (4,871) 19,525,280 0 26 0 19,525,306 (2,456) 0 0 8,758,294 0 120,932 0 8,879,225 541,712 0 (4,902) 38,927,420 (1,454,683) 122,024 0 37,594,761 XXX XXX XXX XXX XXX 541,712 0 (4,902) 38,927,420 (1,454,683) 122,024 0 37,594,761 0 0 0 0 0 0 0 0 0 15,236,903 30,649 9,022 25,100,715 17,947,651 10,742,308 XXX XXX XXX 25,100,715 17,947,651 10,742,308 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 15,258,530 (13,823) 0 XXX XXX XXX 0 15,244,706 31,068 2,689 78 32,308,747 (1,440,312) 0 0 0 0 0 30,868,435 XXX XXX 31,068 2,689 78 32,308,747 (1,440,312) 0 0 0 0 0 30,868,435 (62,590) 0 (1,530) 3,833,219 0 (52,819) 7,565,759 0 (762) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (64,120) (35,052) 3,780,400 154,493 7,564,998 286,820 0 0 0 0 0 0 0 0 0 0 0 0 1,969 0 (1) (31,037) 0 0 0 (31,037) 81,289 0 (31) 3,544,649 194 0 0 3,544,843 150,148 0 0 7,128,030 (1,454,877) 1,067 0 5,674,219 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 73,906 13,229 5,079 3,001,719 336,643 131,410 6,142,327 1,221,179 347,151 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 82,056 0 0 0 0 0 0 82,056 9,527 165 27 3,207,116 (91,843) 0 0 0 0 0 3,115,274 21,542 2,683 51 7,019,038 (1,334,646) 0 0 0 0 0 5,684,392 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (501) 0 0 0 0 30,666 0 0 0 0 60,526 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (501) (2.628) 30,666 0.913 60,526 0.993 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 546 835 1,381 (0.044) 25,620 27,440 53,060 0.015 74,534 68,552 143,086 0.020 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 XXX XXX XXX 0 0 645,861 16,345,951 10,249,646 0 (159) 0 6,742,007 0 0 0 0 0 0 6,742,007 0 0 0 0 0 104,888 85,977 64,133 174,722 22,434 0 452,155 XXX 84,275 0.779 627,121 XXX 8,974 327,893 336,867 0.017 258,622 771,220 1,029,843 0.118 368,296 1,195,940 1,564,236 XXX XXX 0 0 0 0.000 16,173 4,033 36,548 (5,648) 33,169 40,376,129 0 (55,266) 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 211,752 90,011 100,681 169,074 55,603 0 0 0 0 0 211,752 90,011 100,681 169,074 55,603 0 627,121 XXX 0 0 0 368,296 1,195,940 1,564,236 XXX XXX XXX 40,320,863 856,634 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 (Continued) Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 2 Small Group Employer Individual 10. General and Administrative (G&A) Expenses: 10.1 Direct sales salaries and benefits 10.2 Agents and brokers fees and commissions 10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below) 10.4 Other general and administrative expenses 10.4a Community Benefit Expenditures (informational only) 10.5 Total general and administrative (Lines 10.1 +10.2 + 10.3 + 10.4) 186 5,194 (11) 3,898 0 9,266 3 Large Group Employer 7,300 179,260 1,125 86,870 0 274,556 4 5 Small Group Employer Individual 24,030 31,468 5,994 40,256 0 101,748 0 0 0 0 0 0 Expatriate Plans 6 Large Group Employer 0 0 0 0 0 0 7 8 Small Group 0 0 0 0 0 0 Student Health Plans Large Group 0 0 0 0 0 0 10 11 Government Business (excluded by statute) Other Health Business 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 11,064 0 11,064 30,328 810,646 39,483 2,097,222 0 2,977,680 22,294 24,991 17,569 663,052 0 727,906 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 84,137 1,051,559 64,161 2,902,361 0 4,102,218 0 0 0 0 0 0 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) 12. Income from fees of uninsured plans XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 13. Net investment and other gain/(loss) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 14. Federal income taxes (excluding taxes on Line 1.5 above) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 15. Net gain or (loss) (Lines 11 + 12 + 13 - 14) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 16. ICD-10 Implementation Expenses (informational only; already included in general expenses and line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16. 16a ICD-10 Implementation Expenses (informational only; already included in line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (123,240) 71,289 (315,532) 0 0 0 0 0 0 (8,859) 513,898 295,195 432,751 XXX 84,137 1,051,559 64,161 2,902,361 0 4,102,218 XXX 432,751 0 0 495,551 XXX XXX 28,817 XXX 28,817 XXX 899,485 XXX 899,485 495,551 OTHER INDICATORS: 216-2.AK 1. Number of certificates/policies 1 168 536 0 0 0 0 0 0 0 11,167 9,796 21,668 0 21,668 2. Number of Covered Lives 1 247 849 0 0 0 0 0 0 0 11,452 9,796 22,345 0 22,345 3. Number of Groups 39 17 0 0 0 0 0 0 43 0 99 0 99 4. Member Months 4,085 11,098 0 0 0 0 0 0 139,201 118,259 272,747 0 272,747 XXX 104 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ XXX 0 ] If yes, show the amount of premiums and claims included. Premiums $ 0 Claims $ 0 AFFORDABLE CARE ACT (ACA) RECEIPTS, PAYMENTS, RECEIVABLES and PAYABLES Current Year Prior Year Comprehensive Health Coverage Comprehensive Health Coverage 1 2 3 4 Small Group Small Group Employer Plans Employer Plans Individual Plans Individual Plans ACA Receivables and Payables 1. Permanent ACA Risk Adjustment Program 1.0 Premium adjustments receivable/(payable) 2. Transitional ACA Reinsurance Program 2.0 Total amounts recoverable for claims (paid & unpaid) 0 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 0 0 (107,460) 193,029 XXX (182,462) 0 0 0 (764,167) XXX 0 0 0 0 ACA Receipts and Payments 4. Permanent ACA Risk Adjustment Program 4.0 Premium adjustments receipts/(payments) 5. Transitional ACA Reinsurance Program 5.0 Amounts received for claims 0 6. Temporary ACA Risk Corridors Program 6.1 Retrospective premium received 6.2 Rate credits or policy experience refunds paid 0 0 (241,206) (700,321) XXX (75,636) 0 0 0 0 0 (727,519) XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF 185 Asylum Street Hartford, CT 061033408 DURING THE YEAR Alaska Comprehensive Health Coverage 1 2 3 Individual Small Group Employer Large Group Employer Small Group Employer Individual Expatriate Plans: 7 8 6 Large Group Employer Small Group 10 11 Government Business (excluded by statute) Other Health Business 9 Student Health Plans Large Group 79413 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.AK Health Premiums Earned: (62,590) 3,833,408 1.1 Direct premiums written 0 0 1.2 Unearned premium prior year 0 189 1.3 Unearned premium current year 0 (189) 1.4 Change in unearned premium (Lines 1.2 - 1.3) 892 0 1.5 Paid rate credits 0 0 1.6 Reserve for rate credits current year 0 0 1.7 Reserve for rate credits prior year 0 0 1.8 Change in reserve for rate credits (Lines 1.6 - 1.7) 0 0 1.9 Premium balances written off 0 0 1.10 Group conversion charge (62,590) 3,833,219 1.11 Total direct premiums earned (Lines 1.1 + 1.4 - 1.9 + 1.10) 0 0 1.12 Assumed premiums earned from non-affiliates 0 194 1.13 Net Assumed less Ceded premiums earned from affiliates 0 0 1.14 Ceded premiums earned to non-affiliates 0 0 1.15 Other Adjustments due to MLR calculation - Premiums (63,482) 3,833,413 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 81,164 3,163,252 2.1 Paid claims during the year 0 356,821 2.2 Direct claim liability current year 0 350,174 2.3 Direct claim liability prior year 0 18,794 2.4 Direct claim reserves current year 0 18,216 2.5 Direct claim reserves prior year 0 0 2.6 Direct contract reserves current year 0 0 2.7 Direct contract reserves prior year 892 0 2.8 Paid rate credits 0 0 2.9 Reserve for rate credits current year 0 0 2.10 Reserve for rate credits prior year 0 165 2.11 Incurred medical incentive pools and bonuses (Lines 2.11a + 2.11b - 2.11c) 0 87 2.11a Paid medical incentive pools and bonuses current year 0 88 2.11b Accrued medical incentive pools and bonuses current year 0 10 2.11c Accrued medical incentive pools and bonuses prior year 0 (36,474) 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 0 41,895 2.12a Healthcare receivables current year 0 78,370 2.12b Healthcare receivables prior year 0 0 2.13 Group conversion charge 0 0 2.14 Multi-option coverage blended rate adjustment 2.15 Total incurred claims (Lines 2.1 + 2.2 - 2.3 + 2.4 - 2.5 + 2.6 - 2.7 + 2.8 + 2.9 82,056 3,207,116 2.10 + 2.11 - 2.12 + 2.13 + 2.14) 0 0 2.16 Assumed incurred claims from non-affiliates 0 (91,843) 2.17 Net assumed less ceded incurred claims from affiliates 0 0 2.18 Ceded incurred claims to non-affiliates 0 0 2.19 Other adjustments due to MLR calculation - Claims 81,164 3,115,274 2.20 Net Incurred Claims (Lines 2.15 - 2.8 - 2.9 + 2.10 + 2.16 + 2.17 - 2.18 + 2.19) 3. Fraud and Abuse Recoveries that Reduced PAID Claims in Line 2.1 above 0 27 (informational only) 385,286 for stand-alone dental and $ (a) Column 13, Line 1.1 includes direct written premium of $ 4 Business Subject to MLR Mini-Med Plans 5 (LOCATION) NAIC Company Code 2018 7,566,826 0 0 0 (892) 0 0 0 1,067 0 7,565,759 0 67 1,454,944 1,067 6,112,841 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 19,971,683 12 13 (1) (935,967) 40 1,567 (1,527) 26 0 19,971,657 0 0 0 26 20,909,177 9,189,015 0 0 0 603,682 565,080 521,981 43,098 120,932 0 9,068,083 0 0 0 120,932 8,542,235 40,498,342 12 202 (189) (332,285) 565,119 523,548 41,571 122,024 0 40,376,129 0 261 1,454,944 122,024 39,334,184 8,245,747 555,380 1,859,747 3,926 27,815 0 0 (892) 0 0 2,683 1,149 6,217 4,683 (99,757) 117,625 217,382 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16,079,235 2,361,109 2,201,504 782,109 758,426 5,937 69,764 (935,967) 40 1,567 0 0 0 0 2,674 2,674 0 0 0 6,685,192 202,275 660,874 0 0 0 0 603,682 565,080 521,981 (159) (159) 187,867 187,867 131,208 3,669,995 3,538,787 0 0 34,254,591 3,475,585 5,072,300 804,829 804,456 5,937 69,764 (332,285) 565,119 523,548 2,689 1,076 194,172 192,559 (2,350) 3,832,188 3,834,538 0 0 7,019,038 0 50,344 1,384,990 0 5,685,284 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 15,258,530 0 0 13,823 0 16,182,200 6,742,007 0 0 0 0 6,095,227 32,308,747 0 (41,499) 1,398,813 0 31,159,149 51 0 0 14,392 for stand-alone vision policies. 0 0 0 0 0 0 0 78 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF DURING THE YEAR Alaska All Expenses 1 Individual Comprehensive Coverage Expenses: 1,383 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 101 for affiliated services) 1.3 EDP Equipment and Software (incl $ 10 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 1 for affiliated services) 1.5 Accreditation and Certification (incl $ 3,187 for affiliated services) 1.6 Other Expenses (incl $ 1.7 Subtotal before Reimbursements and Taxes (Lines 1.1 to 1.6) 1.8 Reimbursements by uninsured plans and fiscal intermediaries 1.9 Taxes, Licenses and Fees (in total, for tying purposes) 1.10 Total (1.7 to 1.9) 1.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 2. 216-4.AK 2.7 Subtotal before Reimbursements and Taxes (Lines 2.1 to 2.6) 2.8 Reimbursements by uninsured plans and fiscal intermediaries 2.9 Taxes, Licenses and Fees (in total, for tying purposes) 2.10 Total (2.7 to 2.9) 2.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 3. 0 0 0 0 0 (501) (501) 0 XXX XXX XXX 0 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 30,666 30,666 0 Large Group Comprehensive Coverage Expenses: 103,817 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 6,819 for affiliated services) 3.3 EDP Equipment and Software (incl $ 655 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 71 for affiliated services) 3.5 Accreditation and Certification (incl $ 248,285 for affiliated services) 3.6 Other Expenses (incl $ 3.7 Subtotal before Reimbursements and Taxes (Lines 3.1 to 3.6) 3.8 Reimbursements by uninsured plans and fiscal intermediaries 3.9 Taxes, Licenses and Fees (in total, for tying purposes) 3.10 Total (3.7 to 3.9) 3.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 0 0 0 0 (501) 0 Small Group Comprehensive Coverage Expenses: 52,058 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 3,675 for affiliated services) 2.3 EDP Equipment and Software (incl $ 353 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 38 for affiliated services) 2.5 Accreditation and Certification (incl $ 104,506 for affiliated services) 2.6 Other Expenses (incl $ Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions Improve Health Outcomes 1. 185 Asylum Street Hartford, CT 061033408 0 0 0 0 XXX 0 0 0 XXX Total (1 to 5) XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 0 0 (501) (501) 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 30,666 30,666 0 0 0 0 XXX 153 18 13 1 0 343 528 0 (501) 0 XXX 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 0 0 0 0 (LOCATION) NAIC Company Code 2018 XXX 237 27 20 2 0 530 817 0 XXX 528 150 817 0 6,829 4,722 570 55 6 12,757 24,940 0 8,892 1,019 743 71 8 15,982 26,715 0 XXX XXX 30,666 0 0 0 0 0 0 0 0 0 30,666 0 24,940 5,897 26,715 0 0 0 0 0 0 60,526 60,526 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 60,526 60,526 0 14,097 21,996 1,177 113 12 35,441 72,837 0 18,376 2,106 1,534 147 16 45,004 67,184 0 XXX XXX XXX 0 0 0 XXX 60,526 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 60,526 0 XXX 72,837 16,016 67,184 0 79413 9 10 General Administrative Expenses Total Expenses (6 to 9) 992 93 68 7 1 8,104 9,264 0 2,006 11,270 0 1,383 138 101 10 1 8,477 10,108 0 2,006 12,114 150 36,336 3,820 2,363 227 25 230,144 272,914 0 84,304 357,218 0 52,058 9,561 3,675 353 38 289,550 355,235 0 84,304 439,539 5,897 71,345 12,145 4,107 394 43 6,173 94,208 0 160,754 254,961 0 103,817 36,247 6,819 655 71 147,145 294,754 0 160,754 455,507 16,016 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 4. 5. 216-5.AK 6. Individual Mini-Med Plans Expenses: 0 for affiliated services) 4.1 Salaries (including $ 4.2 Outsourced Services 0 for affiliated services) 4.3 EDP Equipment and Software (incl $ 0 for affiliated services) 4.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 4.5 Accreditation and Certification (incl $ 0 for affiliated services) 4.6 Other Expenses (incl $ 4.7 Subtotal before Reimbursements and Taxes (Lines 4.1 to 4.6) 4.8 Reimbursements by uninsured plans and fiscal intermediaries 4.9 Taxes, Licenses and Fees (in total, for tying purposes) 4.10 Total (4.7 to 4.9) 4.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Mini-Med Plans Expenses: 0 for affiliated services) 5.1 Salaries (including $ 5.2 Outsourced Services 0 for affiliated services) 5.3 EDP Equipment and Software (incl $ 0 for affiliated services) 5.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 5.5 Accreditation and Certification (incl $ 0 for affiliated services) 5.6 Other Expenses (incl $ 5.7 Subtotal before Reimbursements and Taxes (Lines 5.1 to 5.6) 5.8 Reimbursements by uninsured plans and fiscal intermediaries 5.9 Taxes, Licenses and Fees (in total, for tying purposes) 5.10 Total (5.7 to 5.9) 5.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Mini-Med Plans Expenses: 0 for affiliated services) 6.1 Salaries (including $ 6.2 Outsourced Services 0 for affiliated services) 6.3 EDP Equipment and Software (incl $ 0 for affiliated services) 6.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 6.5 Accreditation and Certification (incl $ 0 for affiliated services) 6.6 Other Expenses (incl $ 6.7 Subtotal before Reimbursements and Taxes (Lines 6.1 to 6.6) 6.8 Reimbursements by uninsured plans and fiscal intermediaries 6.9 Taxes, Licenses and Fees (in total, for tying purposes) 6.10 Total (6.7 to 6.9) 6.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 7. 8. 216-6.AK 9. Small Group Expatriate Plans Expenses: 0 for affiliated services) 7.1 Salaries (including $ 7.2 Outsourced Services 0 for affiliated services) 7.3 EDP Equipment and Software (incl $ 0 for affiliated services) 7.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 7.5 Accreditation and Certification (incl $ 0 for affiliated services) 7.6 Other Expenses (incl $ 7.7 Subtotal before Reimbursements and Taxes (Lines 7.1 to 7.6) 7.8 Reimbursements by uninsured plans and fiscal intermediaries 7.9 Taxes, Licenses and Fees (in total, for tying purposes) 7.10 Total (7.7 to 7.9) 7.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Expatriate Plans Expenses: 0 for affiliated services) 8.1 Salaries (including $ 8.2 Outsourced Services 0 for affiliated services) 8.3 EDP Equipment and Software (incl $ 0 for affiliated services) 8.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 8.5 Accreditation and Certification (incl $ 0 for affiliated services) 8.6 Other Expenses (incl $ 8.7 Subtotal before Reimbursements and Taxes (Lines 8.1 to 8.6) 8.8 Reimbursements by uninsured plans and fiscal intermediaries 8.9 Taxes, Licenses and Fees (in total, for tying purposes) 8.10 Total (8.7 to 8.9) 8.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Student Health Plans Expenses: 0 for affiliated services) 9.1 Salaries (including $ 9.2 Outsourced Services 0 for affiliated services) 9.3 EDP Equipment and Software (incl $ 0 for affiliated services) 9.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 9.5 Accreditation and Certification (incl $ 0 for affiliated services) 9.6 Other Expenses (incl $ 9.7 Subtotal before Reimbursements and Taxes (Lines 9.1 to 9.6) 9.8 Reimbursements by uninsured plans and fiscal intermediaries 9.9 Taxes, Licenses and Fees (in total, for tying purposes) 9.10 Total (9.7 to 9.9) 9.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 *79413201821603100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes - See Cautionary Statement at http://www.naic.org/documents/committees_e_app_blanks_related_shce_cautionary_statement.pdf) UnitedHealthcare Insurance Company 2. 185 Asylum Street Hartford, CT 061033408 (LOCATION) BUSINESS IN THE STATE OF Arizona DURING THE YEAR 2018 NAIC Company Code Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 1. 216-1.AZ 2. 3. 4. 5. 6. 7. 8. 9. Premium: 1.1 Health premiums earned (From Part 2, Line 1.11) 1.2 Federal high risk pools 1.3 State high risk pools 1.4 Premiums earned including state and federal high risk programs (Lines 1.1 + 1.2 + 1.3) 1.5 Federal taxes and federal assessments 1.6 State insurance, premium and other taxes (Similar local taxes of 185,493 ) $ 1.6a Community Benefit Expenditures (informational only) 1.7 Regulatory authority licenses and fees 1.8 Adjusted Premiums Earned (Lines 1.4 - 1.5 - 1.6 - 1.7) 1.9 Net Assumed less Ceded reinsurance premiums earned 1.10 Other Adjustments due to MLR calculations - Premiums 1.11 Risk Revenue 1.12 Net adjusted premiums earned after reinsurance (Lines 1.8 + 1.9 + 1.10 + 1.11) Claims: 2.1 Incurred claims excluding prescription drugs 2.2 Prescription drugs 2.3 Pharmaceutical rebates 2.4 State stop loss, market stabilization and claim/census based assessments (informational only) Incurred medical incentive pools and bonuses Deductible Fraud and Abuse Detection/Recovery Expenses (for MLR use only) 5.0 Total Incurred Claims (Lines 2.1 + 2.2 - 2.3 + 3) (From Part 2, Line 2.15) 5.1 Net Assumed less Ceded reinsurance claims incurred 5.2 Other Adjustments due to MLR calculations - Claims 5.3 Rebates paid 5.4 Estimated rebates unpaid prior year 5.5 Estimated rebates unpaid current year 5.6 Fee for service and co-pay revenue 5.7 Net incurred claims after reinsurance (Lines 5.0 + 5.1 + 5.2 + 5.3 - 5.4 + 5.5 - 5.6) Improving Health Care Quality Expenses Incurred: 6.1 Improve health outcomes 6.2 Activities to prevent hospital readmissions 6.3 Improve patient safety and reduce medical errors 6.4 Wellness and health promotion activities 6.5 Health Information Technology expenses related to health improvement 6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5) Preliminary Medical Loss Ratio: MLR ((Lines 4 + 5.0 + 6.6 - Footnote 2.0)/Line 1.8 Claims Adjustment Expenses: 8.1 Cost containment expenses not included in quality of care expenses in Line 6.6 8.2 All other claims adjustment expenses 8.3 Total claims adjustment expenses (Lines 8.1 + 8.2) Claims Adjustment Expense Ratio (Line 8.3/Line 1.8) 2 Small Group Employer 3 Large Group Employer 4 5 Small Group Employer Individual Expatriate Plans 6 Large Group Employer 7 11 Government Business (excluded by statute) Other Health Business 9 8 Small Group 10 Student Health Plans Large Group 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 79413 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 5,673,845 0 (3,380) 428,413,380 0 (15,393) 536,901,485 0 (75,706) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 476,217,958 0 188,514 167,831,505 0 0 1,615,038,173 0 94,034 XXX XXX XXX 5,670,464 (64,452) 428,397,987 14,266,650 536,825,779 12,762,447 0 0 0 0 0 0 0 0 0 0 0 0 0 0 476,406,472 7,207,830 167,831,505 7,320,401 1,615,132,206 41,492,876 XXX 104,727 0 1,405 5,628,784 70 0 0 5,628,853 (333,014) 0 4,094 414,460,257 19,371 132,476 0 414,612,104 4,742,808 0 12,213 519,308,311 (58,341,161) 28,436 0 460,995,585 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,898,252 0 (79,432) 466,379,822 (855,827) 5,189 0 465,529,184 19,970 0 22 160,491,112 2,372,088 528,336 0 163,391,535 7,432,743 0 (61,698) 1,566,268,285 (56,805,460) 694,437 0 1,510,157,262 XXX XXX XXX XXX XXX 7,432,743 0 (61,698) 1,566,268,286 (56,805,460) 694,437 0 1,510,157,262 4,863,066 1,065,962 291,243 286,713,392 71,363,688 21,230,946 396,616,161 90,751,045 28,131,765 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 340,184,240 43,413,846 221,032 45,806,769 177,282,354 93,218,502 1,074,183,627 383,876,895 143,093,488 XXX XXX XXX 1,074,183,627 383,876,895 143,093,488 11 174 2 5,637,958 0 0 0 0 0 0 5,637,958 233,298 (42,952) 263,030 336,803,184 0 0 0 0 0 0 336,803,184 388,144 (368,003) 271,870 458,867,437 (49,257,927) 0 0 0 0 0 409,609,510 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (448,651) 2,717 129,421,969 0 0 0 0 0 0 129,421,969 622,105 (860,810) 537,619 1,314,106,224 (49,740,338) 0 0 0 0 0 1,264,365,886 XXX XXX 0 0 651 (1,378) 0 383,375,676 (482,412) 0 XXX XXX XXX 0 382,893,264 622,105 (860,810) 537,619 1,314,106,224 (49,740,338) 0 0 0 0 0 1,264,365,886 45,391 0 0 0 0 3,427,307 0 0 0 0 4,295,212 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,569,492 625,667 464,136 3,157,121 373,976 45,391 1.010 3,427,307 0.822 4,295,212 0.892 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 6,190,392 XXX 1,356,905 0.815 15,315,207 XXX 51,857 98,739 150,596 0.027 5,563,036 7,735,044 13,298,080 0.032 6,875,124 9,054,103 15,929,227 0.031 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 848,121 6,265,645 7,113,766 0.015 1,452,059 6,159,538 7,611,598 0.047 14,790,198 29,313,069 44,103,267 XXX XXX XXX XXX XXX 0 0 0 0.000 407,385 138,136 363,472 (40,152) 488,063 1,615,038,173 0 94,034 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 9,744,787 763,803 827,609 3,116,969 862,039 0 0 0 0 0 9,744,787 763,803 827,609 3,116,969 862,039 0 15,315,207 XXX 0 0 0 14,790,198 29,313,069 44,103,267 XXX XXX XXX 1,615,132,206 41,492,876 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 (Continued) Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 2 Small Group Employer Individual 10. General and Administrative (G&A) Expenses: 10.1 Direct sales salaries and benefits 10.2 Agents and brokers fees and commissions 10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below) 10.4 Other general and administrative expenses 10.4a Community Benefit Expenditures (informational only) 10.5 Total general and administrative (Lines 10.1 +10.2 + 10.3 + 10.4) 16,425 162,910 4,517 329,632 0 513,484 3 Large Group Employer 1,820,251 17,679,546 555,205 23,331,212 0 43,386,213 4 5 Small Group Employer Individual 2,654,643 11,813,723 816,849 20,663,845 0 35,949,060 0 0 0 0 0 0 Expatriate Plans 6 Large Group Employer 0 0 0 0 0 0 7 8 Small Group 0 0 0 0 0 0 Student Health Plans Large Group 0 0 0 0 0 0 10 11 Government Business (excluded by statute) Other Health Business 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 993,191 16,034,833 681,295 35,614,610 0 53,323,929 343,057 1,864,283 306,967 9,282,506 0 11,796,812 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 5,827,566 47,555,295 2,364,833 89,221,805 0 144,969,498 0 0 0 0 0 0 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) 17,697,321 (4,787,425) 16,007,833 13,204,251 41,403,404 12. Income from fees of uninsured plans XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 13. Net investment and other gain/(loss) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 25,115,090 XXX 14. Federal income taxes (excluding taxes on Line 1.5 above) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 1,309,849 XXX 1,309,849 15. Net gain or (loss) (Lines 11 + 12 + 13 - 14) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 65,208,645 XXX 65,208,645 16. ICD-10 Implementation Expenses (informational only; already included in general expenses and line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16. 16a ICD-10 Implementation Expenses (informational only; already included in line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (718,575) 0 0 0 0 0 0 0 XXX 5,827,566 47,555,295 2,364,833 89,221,805 0 144,969,499 41,403,404 0 0 25,115,090 OTHER INDICATORS: 216-2.AZ 1. Number of certificates/policies 604 49,433 68,786 0 0 0 0 0 0 0 374,868 126,420 620,111 0 620,111 2. Number of Covered Lives 965 87,165 116,170 0 0 0 0 0 0 0 472,524 126,420 803,244 0 803,244 3. Number of Groups 9,982 1,778 0 0 0 0 0 0 5,575 3 17,338 0 17,338 4. Member Months 1,019,276 1,371,616 0 0 0 0 0 0 5,712,524 1,510,157 9,625,137 0 9,625,137 XXX 11,564 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ XXX 0 ] If yes, show the amount of premiums and claims included. Premiums $ 0 Claims $ 0 AFFORDABLE CARE ACT (ACA) RECEIPTS, PAYMENTS, RECEIVABLES and PAYABLES Current Year Prior Year Comprehensive Health Coverage Comprehensive Health Coverage 1 2 3 4 Small Group Small Group Employer Plans Employer Plans Individual Plans Individual Plans ACA Receivables and Payables 1. Permanent ACA Risk Adjustment Program 1.0 Premium adjustments receivable/(payable) 2. Transitional ACA Reinsurance Program 2.0 Total amounts recoverable for claims (paid & unpaid) 0 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 0 0 0 0 72,777 13,976,507 105,637 11,945,913 XXX 109,793 0 13,306,059 XXX 0 0 0 0 ACA Receipts and Payments 4. Permanent ACA Risk Adjustment Program 4.0 Premium adjustments receipts/(payments) 5. Transitional ACA Reinsurance Program 5.0 Amounts received for claims 0 6. Temporary ACA Risk Corridors Program 6.1 Retrospective premium received 6.2 Rate credits or policy experience refunds paid 0 0 XXX (81,792) 0 0 0 0 0 5,439,249 XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF 185 Asylum Street Hartford, CT 061033408 Arizona DURING THE YEAR Comprehensive Health Coverage 1 2 3 Individual Small Group Employer Large Group Employer Small Group Employer Individual Expatriate Plans: 7 8 6 Large Group Employer Small Group 10 11 Government Business (excluded by statute) Other Health Business 9 Student Health Plans Large Group 79413 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.AZ Health Premiums Earned: 5,673,845 428,552,420 1.1 Direct premiums written 0 15,149 1.2 Unearned premium prior year 0 21,712 1.3 Unearned premium current year 0 (6,564) 1.4 Change in unearned premium (Lines 1.2 - 1.3) (1,416,172) 0 1.5 Paid rate credits 0 0 1.6 Reserve for rate credits current year 0 0 1.7 Reserve for rate credits prior year 0 0 1.8 Change in reserve for rate credits (Lines 1.6 - 1.7) 0 132,476 1.9 Premium balances written off 0 0 1.10 Group conversion charge 5,673,845 428,413,380 1.11 Total direct premiums earned (Lines 1.1 + 1.4 - 1.9 + 1.10) 0 0 1.12 Assumed premiums earned from non-affiliates 70 19,371 1.13 Net Assumed less Ceded premiums earned from affiliates 0 0 1.14 Ceded premiums earned to non-affiliates 0 132,476 1.15 Other Adjustments due to MLR calculation - Premiums 7,090,086 428,565,227 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 7,499,457 336,898,626 2.1 Paid claims during the year 202,121 40,169,696 2.2 Direct claim liability current year 346,777 39,928,741 2.3 Direct claim liability prior year 24,766 1,091,807 2.4 Direct claim reserves current year 35,842 920,378 2.5 Direct claim reserves prior year 1,109,170 0 2.6 Direct contract reserves current year 1,392,760 0 2.7 Direct contract reserves prior year (1,416,172) 0 2.8 Paid rate credits 0 0 2.9 Reserve for rate credits current year 0 0 2.10 Reserve for rate credits prior year 174 (42,952) 2.11 Incurred medical incentive pools and bonuses (Lines 2.11a + 2.11b - 2.11c) 0 42,166 2.11a Paid medical incentive pools and bonuses current year 174 365,876 2.11b Accrued medical incentive pools and bonuses current year 0 450,993 2.11c Accrued medical incentive pools and bonuses prior year 6,179 464,875 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 6,501 9,219,057 2.12a Healthcare receivables current year 322 8,754,182 2.12b Healthcare receivables prior year 0 0 2.13 Group conversion charge 0 0 2.14 Multi-option coverage blended rate adjustment 2.15 Total incurred claims (Lines 2.1 + 2.2 - 2.3 + 2.4 - 2.5 + 2.6 - 2.7 + 2.8 + 2.9 5,637,958 336,803,184 2.10 + 2.11 - 2.12 + 2.13 + 2.14) 0 0 2.16 Assumed incurred claims from non-affiliates 0 0 2.17 Net assumed less ceded incurred claims from affiliates 0 0 2.18 Ceded incurred claims to non-affiliates 0 0 2.19 Other adjustments due to MLR calculation - Claims 7,054,130 336,803,184 2.20 Net Incurred Claims (Lines 2.15 - 2.8 - 2.9 + 2.10 + 2.16 + 2.17 - 2.18 + 2.19) 3. Fraud and Abuse Recoveries that Reduced PAID Claims in Line 2.1 above 2 263,030 (informational only) 22,421,652 for stand-alone dental and $ (a) Column 13, Line 1.1 includes direct written premium of $ 4 Business Subject to MLR Mini-Med Plans 5 (LOCATION) NAIC Company Code 2018 536,960,644 (40,251) (9,528) (30,723) 1,869,951 1,161,617 2,058,055 (896,438) 28,436 0 536,901,485 0 26,473 58,367,634 28,436 477,615,247 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 454,111,777 56,507,921 53,947,309 1,425,192 1,240,640 0 0 1,869,951 1,161,617 2,058,055 (368,003) 135,161 950,158 1,453,323 (1,404,988) 10,251,585 11,656,573 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 458,867,437 0 0 49,257,927 0 408,635,998 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 271,870 0 0 6,629,854 for stand-alone vision policies. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 476,217,526 13,195 7,573 5,622 (2,875,145) 4,969,531 654,184 4,315,347 5,189 0 476,217,958 169,676 89,229 1,114,732 5,189 473,927,118 168,359,840 0 0 0 6,044,187 1,629,496 6,038,065 (4,408,569) 528,336 0 167,831,505 0 2,372,088 0 528,336 169,096,310 1,615,764,274 (11,908) 19,757 (31,665) 3,622,821 7,760,644 8,750,304 (989,660) 694,437 0 1,615,038,173 169,676 2,507,230 59,482,366 694,437 1,556,293,988 373,246,436 44,912,591 37,723,048 14,190,713 12,727,242 287,160 242,259 (2,875,145) 4,969,531 654,184 (1,378) (1,541) 206 43 7,500 135,302 127,803 0 0 133,521,725 6,782,008 9,374,088 6,368 3,101 0 0 6,044,187 1,629,496 6,038,065 (448,651) 4,913 319,318 772,881 2,697,909 33,989,197 31,291,288 0 0 1,304,098,921 145,663,686 137,230,213 16,738,845 14,927,202 1,396,330 1,635,019 3,622,821 7,760,644 8,750,304 (860,810) 180,698 1,635,732 2,677,240 1,771,475 53,601,642 51,830,167 0 0 0 0 0 0 0 0 383,375,676 175,394 0 657,805 0 381,453,062 129,421,969 0 0 0 0 127,786,351 1,314,106,224 175,394 0 49,915,732 0 1,261,732,725 0 0 2,717 537,619 (1,179,100) (2,910,651) (4,089,751) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF Arizona DURING THE YEAR All Expenses 1 Improve Health Outcomes 1. Individual Comprehensive Coverage Expenses: 166,398 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 9,142 for affiliated services) 1.3 EDP Equipment and Software (incl $ 878 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 95 for affiliated services) 1.5 Accreditation and Certification (incl $ 277,159 for affiliated services) 1.6 Other Expenses (incl $ 1.7 Subtotal before Reimbursements and Taxes (Lines 1.1 to 1.6) 1.8 Reimbursements by uninsured plans and fiscal intermediaries 1.9 Taxes, Licenses and Fees (in total, for tying purposes) 1.10 Total (1.7 to 1.9) 1.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 2. 216-4.AZ Small Group Comprehensive Coverage Expenses: 11,517,790 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 815,256 for affiliated services) 2.3 EDP Equipment and Software (incl $ 78,255 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 8,497 for affiliated services) 2.5 Accreditation and Certification (incl $ 26,246,656 for affiliated services) 2.6 Other Expenses (incl $ 2.7 Subtotal before Reimbursements and Taxes (Lines 2.1 to 2.6) 2.8 Reimbursements by uninsured plans and fiscal intermediaries 2.9 Taxes, Licenses and Fees (in total, for tying purposes) 2.10 Total (2.7 to 2.9) 2.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 3. Large Group Comprehensive Coverage Expenses: 13,439,760 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 908,579 for affiliated services) 3.3 EDP Equipment and Software (incl $ 87,213 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 9,470 for affiliated services) 3.5 Accreditation and Certification (incl $ 30,662,177 for affiliated services) 3.6 Other Expenses (incl $ 3.7 Subtotal before Reimbursements and Taxes (Lines 3.1 to 3.6) 3.8 Reimbursements by uninsured plans and fiscal intermediaries 3.9 Taxes, Licenses and Fees (in total, for tying purposes) 3.10 Total (3.7 to 3.9) 3.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 185 Asylum Street Hartford, CT 061033408 0 0 0 0 0 45,391 45,391 0 XXX Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX Total (1 to 5) 0 0 0 0 0 45,391 45,391 0 XXX 0 0 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 0 0 0 0 0 0 0 XXX (LOCATION) NAIC Company Code 2018 XXX 14,495 2,053 1,210 116 13 32,439 50,327 0 XXX 36,871 2,635 1,884 181 20 55,520 97,110 0 XXX 45,391 0 0 0 0 0 0 0 0 0 45,391 0 50,327 13,194 97,110 0 0 0 0 0 0 3,427,307 3,427,307 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3,427,307 3,427,307 0 1,424,676 551,389 118,967 11,419 1,240 3,285,452 5,393,143 0 2,193,705 251,403 183,185 17,584 1,909 4,906,366 7,554,150 0 XXX 5,393,143 1,467,054 XXX 7,554,150 0 XXX 3,427,307 0 0 0 0 0 0 4,295,212 4,295,212 0 XXX 4,295,212 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 3,427,307 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4,295,212 4,295,212 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 4,295,212 0 1,801,795 545,683 150,458 14,442 1,568 4,144,343 6,658,290 (11) XXX 6,658,279 1,970,333 2,572,118 294,770 214,784 20,617 2,239 5,752,712 8,857,239 2 XXX 8,857,241 0 79413 9 10 General Administrative Expenses Total Expenses (6 to 9) 115,032 8,456 6,048 515 63 377,691 507,805 0 114,970 622,775 0 166,398 13,144 9,142 811 95 511,041 700,632 0 114,970 815,602 13,194 7,899,409 914,427 513,104 49,252 5,348 33,320,740 42,702,281 0 705,798 43,408,078 0 11,517,790 1,717,218 815,256 78,255 8,497 44,939,865 59,076,882 0 705,798 59,782,679 1,467,054 9,065,847 948,643 543,337 52,154 5,663 24,336,529 34,952,172 8 6,165,608 41,117,788 0 13,439,760 1,789,095 908,579 87,213 9,470 38,528,796 54,762,913 0 6,165,608 60,928,520 1,970,333 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 4. 5. 216-5.AZ 6. Individual Mini-Med Plans Expenses: 0 for affiliated services) 4.1 Salaries (including $ 4.2 Outsourced Services 0 for affiliated services) 4.3 EDP Equipment and Software (incl $ 0 for affiliated services) 4.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 4.5 Accreditation and Certification (incl $ 0 for affiliated services) 4.6 Other Expenses (incl $ 4.7 Subtotal before Reimbursements and Taxes (Lines 4.1 to 4.6) 4.8 Reimbursements by uninsured plans and fiscal intermediaries 4.9 Taxes, Licenses and Fees (in total, for tying purposes) 4.10 Total (4.7 to 4.9) 4.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Mini-Med Plans Expenses: 0 for affiliated services) 5.1 Salaries (including $ 5.2 Outsourced Services 0 for affiliated services) 5.3 EDP Equipment and Software (incl $ 0 for affiliated services) 5.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 5.5 Accreditation and Certification (incl $ 0 for affiliated services) 5.6 Other Expenses (incl $ 5.7 Subtotal before Reimbursements and Taxes (Lines 5.1 to 5.6) 5.8 Reimbursements by uninsured plans and fiscal intermediaries 5.9 Taxes, Licenses and Fees (in total, for tying purposes) 5.10 Total (5.7 to 5.9) 5.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Mini-Med Plans Expenses: 0 for affiliated services) 6.1 Salaries (including $ 6.2 Outsourced Services 0 for affiliated services) 6.3 EDP Equipment and Software (incl $ 0 for affiliated services) 6.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 6.5 Accreditation and Certification (incl $ 0 for affiliated services) 6.6 Other Expenses (incl $ 6.7 Subtotal before Reimbursements and Taxes (Lines 6.1 to 6.6) 6.8 Reimbursements by uninsured plans and fiscal intermediaries 6.9 Taxes, Licenses and Fees (in total, for tying purposes) 6.10 Total (6.7 to 6.9) 6.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 7. 8. 216-6.AZ 9. Small Group Expatriate Plans Expenses: 0 for affiliated services) 7.1 Salaries (including $ 7.2 Outsourced Services 0 for affiliated services) 7.3 EDP Equipment and Software (incl $ 0 for affiliated services) 7.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 7.5 Accreditation and Certification (incl $ 0 for affiliated services) 7.6 Other Expenses (incl $ 7.7 Subtotal before Reimbursements and Taxes (Lines 7.1 to 7.6) 7.8 Reimbursements by uninsured plans and fiscal intermediaries 7.9 Taxes, Licenses and Fees (in total, for tying purposes) 7.10 Total (7.7 to 7.9) 7.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Expatriate Plans Expenses: 0 for affiliated services) 8.1 Salaries (including $ 8.2 Outsourced Services 0 for affiliated services) 8.3 EDP Equipment and Software (incl $ 0 for affiliated services) 8.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 8.5 Accreditation and Certification (incl $ 0 for affiliated services) 8.6 Other Expenses (incl $ 8.7 Subtotal before Reimbursements and Taxes (Lines 8.1 to 8.6) 8.8 Reimbursements by uninsured plans and fiscal intermediaries 8.9 Taxes, Licenses and Fees (in total, for tying purposes) 8.10 Total (8.7 to 8.9) 8.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Student Health Plans Expenses: 0 for affiliated services) 9.1 Salaries (including $ 9.2 Outsourced Services 0 for affiliated services) 9.3 EDP Equipment and Software (incl $ 0 for affiliated services) 9.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 9.5 Accreditation and Certification (incl $ 0 for affiliated services) 9.6 Other Expenses (incl $ 9.7 Subtotal before Reimbursements and Taxes (Lines 9.1 to 9.6) 9.8 Reimbursements by uninsured plans and fiscal intermediaries 9.9 Taxes, Licenses and Fees (in total, for tying purposes) 9.10 Total (9.7 to 9.9) 9.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 *79413201821604100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes - See Cautionary Statement at http://www.naic.org/documents/committees_e_app_blanks_related_shce_cautionary_statement.pdf) UnitedHealthcare Insurance Company 2. 185 Asylum Street Hartford, CT 061033408 (LOCATION) BUSINESS IN THE STATE OF Arkansas DURING THE YEAR 2018 NAIC Company Code Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 1. 216-1.AR 2. 3. 4. 5. 6. 7. 8. 9. Premium: 1.1 Health premiums earned (From Part 2, Line 1.11) 1.2 Federal high risk pools 1.3 State high risk pools 1.4 Premiums earned including state and federal high risk programs (Lines 1.1 + 1.2 + 1.3) 1.5 Federal taxes and federal assessments 1.6 State insurance, premium and other taxes (Similar local taxes of 23,997 ) $ 1.6a Community Benefit Expenditures (informational only) 1.7 Regulatory authority licenses and fees 1.8 Adjusted Premiums Earned (Lines 1.4 - 1.5 - 1.6 - 1.7) 1.9 Net Assumed less Ceded reinsurance premiums earned 1.10 Other Adjustments due to MLR calculations - Premiums 1.11 Risk Revenue 1.12 Net adjusted premiums earned after reinsurance (Lines 1.8 + 1.9 + 1.10 + 1.11) Claims: 2.1 Incurred claims excluding prescription drugs 2.2 Prescription drugs 2.3 Pharmaceutical rebates 2.4 State stop loss, market stabilization and claim/census based assessments (informational only) Incurred medical incentive pools and bonuses Deductible Fraud and Abuse Detection/Recovery Expenses (for MLR use only) 5.0 Total Incurred Claims (Lines 2.1 + 2.2 - 2.3 + 3) (From Part 2, Line 2.15) 5.1 Net Assumed less Ceded reinsurance claims incurred 5.2 Other Adjustments due to MLR calculations - Claims 5.3 Rebates paid 5.4 Estimated rebates unpaid prior year 5.5 Estimated rebates unpaid current year 5.6 Fee for service and co-pay revenue 5.7 Net incurred claims after reinsurance (Lines 5.0 + 5.1 + 5.2 + 5.3 - 5.4 + 5.5 - 5.6) Improving Health Care Quality Expenses Incurred: 6.1 Improve health outcomes 6.2 Activities to prevent hospital readmissions 6.3 Improve patient safety and reduce medical errors 6.4 Wellness and health promotion activities 6.5 Health Information Technology expenses related to health improvement 6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5) Preliminary Medical Loss Ratio: MLR ((Lines 4 + 5.0 + 6.6 - Footnote 2.0)/Line 1.8 Claims Adjustment Expenses: 8.1 Cost containment expenses not included in quality of care expenses in Line 6.6 8.2 All other claims adjustment expenses 8.3 Total claims adjustment expenses (Lines 8.1 + 8.2) Claims Adjustment Expense Ratio (Line 8.3/Line 1.8) 2 Small Group Employer 3 Large Group Employer 4 5 Small Group Employer Individual Expatriate Plans 6 Large Group Employer 7 11 Government Business (excluded by statute) Other Health Business 9 8 Small Group 10 Student Health Plans Large Group 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 79413 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 242,446 0 (506) 28,048,548 0 (2,391) 90,464,258 0 (8,062) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 53,951,664 0 23,924 22,849,672 0 0 195,556,588 0 12,966 XXX XXX XXX 241,940 12,517 28,046,157 1,447,016 90,456,196 4,022,634 0 0 0 0 0 0 0 0 0 0 0 0 0 0 53,975,588 195,949 22,849,672 1,167,224 195,569,554 6,845,339 XXX 16,602 0 212 212,610 80 0 0 212,690 643,265 0 (949) 25,956,826 19,707 38 0 25,976,571 2,011,740 0 34 84,421,788 (12,803,181) 1,527,022 0 73,145,629 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 951,787 0 (10,410) 52,838,262 (67,117) 589 0 52,771,733 2,909 0 0 21,679,539 92,494 461,119 0 22,233,152 3,626,303 0 (11,113) 185,109,024 (12,758,017) 1,988,767 0 174,339,774 XXX XXX XXX XXX XXX 3,626,303 0 (11,113) 185,109,024 (12,758,017) 1,988,767 0 174,339,774 150,417 15,871 2,566 15,234,398 6,321,722 1,976,162 55,646,585 16,971,555 5,435,467 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 42,116,290 1,187,057 5,712 488,690 33,699,365 18,382,020 113,636,380 58,195,570 25,801,928 XXX XXX XXX 113,636,380 58,195,570 25,801,928 7 0 0 163,721 0 0 0 0 0 0 163,721 7,253 103,466 6,027 19,683,423 0 (76,209) 76,209 0 0 0 19,683,423 (128,137) 108,677 9,225 67,291,351 (9,540,336) (21,003) 21,003 (54) (54) 0 57,751,014 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 14 0 0 43,297,636 (9,019) 0 XXX XXX XXX 0 43,288,617 0 (3,735) 0 15,802,300 0 0 0 0 0 0 15,802,300 (120,863) 208,408 15,253 146,238,431 (9,549,355) (97,212) 97,212 (54) (54) 0 136,689,076 XXX XXX (120,863) 208,408 15,253 146,238,431 (9,549,355) (97,212) 97,212 (54) (54) 0 136,689,076 1,940 0 0 0 0 224,388 0 0 0 0 723,714 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,940 0.779 224,388 0.767 723,714 0.806 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 1,365 5,161 6,526 0.031 350,088 538,596 888,684 0.034 1,173,057 1,647,267 2,820,324 0.033 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 XXX XXX XXX 0 0 0 0 0 0 0 184,330 135,920 102,400 333,398 37,592 0 XXX 0 0 0 0.000 36,298 8,366 84,801 (16,740) 74,667 1,170,670 144,286 187,201 316,658 112,259 793,639 XXX 187,392 0.738 1,931,074 XXX 49,060 751,925 800,985 0.015 359,699 1,745,817 2,105,516 0.097 1,933,270 4,688,766 6,622,036 XXX 195,556,588 0 12,966 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 1,170,670 144,286 187,201 316,658 112,259 0 1,931,074 XXX 0 0 0 1,933,270 4,688,766 6,622,036 XXX XXX XXX 195,569,554 6,845,339 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 (Continued) Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 2 Small Group Employer Individual 10. General and Administrative (G&A) Expenses: 10.1 Direct sales salaries and benefits 10.2 Agents and brokers fees and commissions 10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below) 10.4 Other general and administrative expenses 10.4a Community Benefit Expenditures (informational only) 10.5 Total general and administrative (Lines 10.1 +10.2 + 10.3 + 10.4) 82 1,006 (1,221) 19,548 0 19,416 3 Large Group Employer 117,836 910,121 (1,659) 1,675,043 0 2,701,342 4 5 Small Group Employer Individual 472,682 337,896 127,321 4,524,449 0 5,462,348 0 0 0 0 0 0 Expatriate Plans 6 Large Group Employer 0 0 0 0 0 0 7 8 Small Group 0 0 0 0 0 0 Student Health Plans Large Group 0 0 0 0 0 0 10 11 Government Business (excluded by statute) Other Health Business 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 89,525 2,136,626 106,192 5,135,060 0 7,467,403 46,393 162,105 50,630 1,820,457 0 2,079,585 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 726,518 3,547,756 281,263 13,174,557 0 17,730,094 0 0 0 0 0 0 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) 12. Income from fees of uninsured plans XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 13. Net investment and other gain/(loss) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 14. Federal income taxes (excluding taxes on Line 1.5 above) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 15. Net gain or (loss) (Lines 11 + 12 + 13 - 14) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 16. ICD-10 Implementation Expenses (informational only; already included in general expenses and line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16. 16a ICD-10 Implementation Expenses (informational only; already included in line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 21,087 2,478,733 6,388,229 0 0 0 0 0 0 0 421,088 2,058,358 11,367,495 XXX 726,518 3,547,756 281,263 13,174,557 0 17,730,094 XXX 11,367,495 0 0 2,672,353 XXX XXX 137,722 XXX 137,722 XXX 13,902,127 XXX 13,902,127 2,672,353 OTHER INDICATORS: 216-2.AR 1. Number of certificates/policies 33 5,297 13,741 0 0 0 0 0 0 0 38,782 20,118 77,971 0 77,971 2. Number of Covered Lives 33 9,096 21,279 0 0 0 0 0 0 0 51,979 20,118 102,505 0 102,505 3. Number of Groups 586 190 0 0 0 0 0 0 520 0 1,296 0 1,296 4. Member Months 508 90,829 231,635 0 0 0 0 0 0 652,357 246,404 1,221,733 0 1,221,733 XXX Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ XXX 0 ] If yes, show the amount of premiums and claims included. Premiums $ 0 Claims $ 0 AFFORDABLE CARE ACT (ACA) RECEIPTS, PAYMENTS, RECEIVABLES and PAYABLES Current Year Prior Year Comprehensive Health Coverage Comprehensive Health Coverage 1 2 3 4 Small Group Small Group Employer Plans Employer Plans Individual Plans Individual Plans ACA Receivables and Payables 1. Permanent ACA Risk Adjustment Program 1.0 Premium adjustments receivable/(payable) 2. Transitional ACA Reinsurance Program 2.0 Total amounts recoverable for claims (paid & unpaid) 0 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 0 0 (3,219) (54,537) XXX (42,809) 0 0 0 (336,339) XXX 0 0 0 0 ACA Receipts and Payments 4. Permanent ACA Risk Adjustment Program 4.0 Premium adjustments receipts/(payments) 5. Transitional ACA Reinsurance Program 5.0 Amounts received for claims 0 6. Temporary ACA Risk Corridors Program 6.1 Retrospective premium received 6.2 Rate credits or policy experience refunds paid 0 0 (45,271) (215,474) XXX 19,548 0 0 0 0 0 (653,299) XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF 185 Asylum Street Hartford, CT 061033408 DURING THE YEAR Arkansas Comprehensive Health Coverage 1 2 3 Individual Small Group Employer Large Group Employer Small Group Employer Individual Expatriate Plans: 7 8 6 Large Group Employer Small Group 10 11 Government Business (excluded by statute) Other Health Business 9 Student Health Plans Large Group 79413 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.AR Health Premiums Earned: 242,446 28,049,616 1.1 Direct premiums written 0 31,427 1.2 Unearned premium prior year 0 32,458 1.3 Unearned premium current year 0 (1,030) 1.4 Change in unearned premium (Lines 1.2 - 1.3) 105,921 76,209 1.5 Paid rate credits 0 0 1.6 Reserve for rate credits current year 0 0 1.7 Reserve for rate credits prior year 0 0 1.8 Change in reserve for rate credits (Lines 1.6 - 1.7) 0 38 1.9 Premium balances written off 0 0 1.10 Group conversion charge 242,446 28,048,548 1.11 Total direct premiums earned (Lines 1.1 + 1.4 - 1.9 + 1.10) 0 0 1.12 Assumed premiums earned from non-affiliates 80 19,707 1.13 Net Assumed less Ceded premiums earned from affiliates 0 0 1.14 Ceded premiums earned to non-affiliates 0 38 1.15 Other Adjustments due to MLR calculation - Premiums 136,604 27,992,084 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 80,552 20,248,123 2.1 Paid claims during the year 24,870 2,936,333 2.2 Direct claim liability current year 9,538 3,950,383 2.3 Direct claim liability prior year 2,872 162,771 2.4 Direct claim reserves current year 4,699 143,790 2.5 Direct claim reserves prior year 203,021 0 2.6 Direct contract reserves current year 238,698 0 2.7 Direct contract reserves prior year 105,921 76,209 2.8 Paid rate credits 0 0 2.9 Reserve for rate credits current year 0 0 2.10 Reserve for rate credits prior year 0 103,466 2.11 Incurred medical incentive pools and bonuses (Lines 2.11a + 2.11b - 2.11c) 0 17,900 2.11a Paid medical incentive pools and bonuses current year 0 137,124 2.11b Accrued medical incentive pools and bonuses current year 0 51,558 2.11c Accrued medical incentive pools and bonuses prior year 580 (250,694) 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 580 776,432 2.12a Healthcare receivables current year 0 1,027,126 2.12b Healthcare receivables prior year 0 0 2.13 Group conversion charge 0 0 2.14 Multi-option coverage blended rate adjustment 2.15 Total incurred claims (Lines 2.1 + 2.2 - 2.3 + 2.4 - 2.5 + 2.6 - 2.7 + 2.8 + 2.9 163,721 19,683,423 2.10 + 2.11 - 2.12 + 2.13 + 2.14) 0 0 2.16 Assumed incurred claims from non-affiliates 0 0 2.17 Net assumed less ceded incurred claims from affiliates 0 0 2.18 Ceded incurred claims to non-affiliates 0 0 2.19 Other adjustments due to MLR calculation - Claims 57,800 19,607,214 2.20 Net Incurred Claims (Lines 2.15 - 2.8 - 2.9 + 2.10 + 2.16 + 2.17 - 2.18 + 2.19) 3. Fraud and Abuse Recoveries that Reduced PAID Claims in Line 2.1 above 0 6,027 (informational only) 2,260,554 for stand-alone dental and $ (a) Column 13, Line 1.1 includes direct written premium of $ 4 Business Subject to MLR Mini-Med Plans 5 (LOCATION) NAIC Company Code 2018 91,983,622 6,153 (1,504) 7,657 18,862 (54) (54) 0 1,527,022 0 90,464,258 59,090 3,118 12,865,389 1,527,022 79,169,237 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 53,951,244 12,701 11,692 1,008 452,891 189,504 324,552 (135,047) 589 0 53,951,664 0 0 67,117 589 53,567,292 23,310,791 0 0 0 1,274,502 524,474 1,290,992 (766,518) 461,119 0 22,849,672 0 92,494 0 461,119 22,895,301 197,537,720 50,281 42,646 7,635 1,928,385 713,925 1,615,491 (901,566) 1,988,767 0 195,556,588 59,090 115,399 12,932,506 1,988,767 183,760,519 67,045,731 8,241,469 7,963,304 67,405 137,781 0 0 18,862 (54) (54) 108,677 35,345 208,440 135,108 89,709 2,202,393 2,112,685 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 43,659,265 5,125,727 5,331,414 2,042,827 2,506,662 21,145 29,251 452,891 189,504 324,552 0 0 0 0 1,844 1,844 0 0 0 14,861,132 586,211 1,395,295 0 0 0 0 1,274,502 524,474 1,290,992 (3,735) (3,735) 13,065 13,065 (1,246,003) 6,068,835 7,314,839 0 0 145,894,803 16,914,610 18,649,933 2,275,875 2,792,933 224,166 267,950 1,928,385 713,925 1,615,491 208,408 49,510 358,629 199,730 (1,404,565) 9,050,085 10,454,650 0 0 67,291,351 8,030 0 9,548,367 0 57,732,152 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 43,297,636 0 0 9,019 0 42,970,773 15,802,300 0 0 0 0 15,294,316 146,238,431 8,030 0 9,557,386 0 135,662,256 9,225 0 0 724,576 for stand-alone vision policies. 0 0 0 0 0 0 0 15,253 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF DURING THE YEAR Arkansas All Expenses 1 Improve Health Outcomes 1. Individual Comprehensive Coverage Expenses: 10,929 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 239 for affiliated services) 1.3 EDP Equipment and Software (incl $ 23 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 3 for affiliated services) 1.5 Accreditation and Certification (incl $ 5,451 for affiliated services) 1.6 Other Expenses (incl $ 1.7 Subtotal before Reimbursements and Taxes (Lines 1.1 to 1.6) 1.8 Reimbursements by uninsured plans and fiscal intermediaries 1.9 Taxes, Licenses and Fees (in total, for tying purposes) 1.10 Total (1.7 to 1.9) 1.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 2. 216-4.AR 3. 0 0 0 0 0 1,940 1,940 0 XXX Small Group Comprehensive Coverage Expenses: 1,384,971 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 98,080 for affiliated services) 2.3 EDP Equipment and Software (incl $ 9,415 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 1,022 for affiliated services) 2.5 Accreditation and Certification (incl $ 1,133,969 for affiliated services) 2.6 Other Expenses (incl $ 2.7 Subtotal before Reimbursements and Taxes (Lines 2.1 to 2.6) 2.8 Reimbursements by uninsured plans and fiscal intermediaries 2.9 Taxes, Licenses and Fees (in total, for tying purposes) 2.10 Total (2.7 to 2.9) 2.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX Total (1 to 5) 0 0 0 0 0 1,940 1,940 0 XXX 0 0 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 0 0 0 0 0 0 0 XXX (LOCATION) NAIC Company Code 2018 XXX 373 116 31 3 0 834 1,357 0 XXX 3,182 56 33 3 0 1,879 5,153 0 XXX 1,940 0 0 0 0 0 0 0 0 0 1,940 0 1,357 66 5,153 0 0 0 0 0 0 224,388 224,388 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 224,388 224,388 0 169,157 34,303 14,125 1,356 147 120,015 339,103 0 277,601 31,814 23,181 2,225 242 191,840 526,901 0 XXX Large Group Comprehensive Coverage Expenses: 1,761,962 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 117,166 for affiliated services) 3.3 EDP Equipment and Software (incl $ 11,247 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 1,221 for affiliated services) 3.5 Accreditation and Certification (incl $ 5,845,471 for affiliated services) 3.6 Other Expenses (incl $ 3.7 Subtotal before Reimbursements and Taxes (Lines 3.1 to 3.6) 3.8 Reimbursements by uninsured plans and fiscal intermediaries 3.9 Taxes, Licenses and Fees (in total, for tying purposes) 3.10 Total (3.7 to 3.9) 3.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 185 Asylum Street Hartford, CT 061033408 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX XXX XXX 224,388 0 0 0 0 0 0 0 0 0 224,388 0 339,103 94,815 526,901 0 0 0 0 0 0 723,714 723,714 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 723,714 723,714 0 226,766 97,107 18,936 1,818 197 792,125 1,136,949 0 344,480 39,478 28,766 2,761 300 1,199,484 1,615,268 0 723,714 0 XXX 1,136,949 330,717 XXX 1,615,268 0 XXX XXX XXX 0 0 0 XXX 723,714 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 79413 9 10 General Administrative Expenses Total Expenses (6 to 9) 7,374 262 175 4 2 12,814 20,631 0 15,615 36,245 0 10,929 433 239 10 3 17,467 29,080 0 15,615 44,695 66 938,213 98,244 60,774 5,834 633 1,590,969 2,694,667 0 671,670 3,366,337 0 1,384,971 164,361 98,080 9,415 1,022 2,127,212 3,785,060 0 671,670 4,456,730 94,815 1,190,716 131,166 69,464 6,668 724 3,905,114 5,303,851 0 2,238,378 7,542,229 0 1,761,962 267,750 117,166 11,247 1,221 6,620,437 8,779,783 0 2,238,378 11,018,161 330,717 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 4. 5. 216-5.AR 6. Individual Mini-Med Plans Expenses: 0 for affiliated services) 4.1 Salaries (including $ 4.2 Outsourced Services 0 for affiliated services) 4.3 EDP Equipment and Software (incl $ 0 for affiliated services) 4.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 4.5 Accreditation and Certification (incl $ 0 for affiliated services) 4.6 Other Expenses (incl $ 4.7 Subtotal before Reimbursements and Taxes (Lines 4.1 to 4.6) 4.8 Reimbursements by uninsured plans and fiscal intermediaries 4.9 Taxes, Licenses and Fees (in total, for tying purposes) 4.10 Total (4.7 to 4.9) 4.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Mini-Med Plans Expenses: 0 for affiliated services) 5.1 Salaries (including $ 5.2 Outsourced Services 0 for affiliated services) 5.3 EDP Equipment and Software (incl $ 0 for affiliated services) 5.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 5.5 Accreditation and Certification (incl $ 0 for affiliated services) 5.6 Other Expenses (incl $ 5.7 Subtotal before Reimbursements and Taxes (Lines 5.1 to 5.6) 5.8 Reimbursements by uninsured plans and fiscal intermediaries 5.9 Taxes, Licenses and Fees (in total, for tying purposes) 5.10 Total (5.7 to 5.9) 5.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Mini-Med Plans Expenses: 0 for affiliated services) 6.1 Salaries (including $ 6.2 Outsourced Services 0 for affiliated services) 6.3 EDP Equipment and Software (incl $ 0 for affiliated services) 6.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 6.5 Accreditation and Certification (incl $ 0 for affiliated services) 6.6 Other Expenses (incl $ 6.7 Subtotal before Reimbursements and Taxes (Lines 6.1 to 6.6) 6.8 Reimbursements by uninsured plans and fiscal intermediaries 6.9 Taxes, Licenses and Fees (in total, for tying purposes) 6.10 Total (6.7 to 6.9) 6.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 7. 8. 216-6.AR 9. Small Group Expatriate Plans Expenses: 0 for affiliated services) 7.1 Salaries (including $ 7.2 Outsourced Services 0 for affiliated services) 7.3 EDP Equipment and Software (incl $ 0 for affiliated services) 7.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 7.5 Accreditation and Certification (incl $ 0 for affiliated services) 7.6 Other Expenses (incl $ 7.7 Subtotal before Reimbursements and Taxes (Lines 7.1 to 7.6) 7.8 Reimbursements by uninsured plans and fiscal intermediaries 7.9 Taxes, Licenses and Fees (in total, for tying purposes) 7.10 Total (7.7 to 7.9) 7.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Expatriate Plans Expenses: 0 for affiliated services) 8.1 Salaries (including $ 8.2 Outsourced Services 0 for affiliated services) 8.3 EDP Equipment and Software (incl $ 0 for affiliated services) 8.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 8.5 Accreditation and Certification (incl $ 0 for affiliated services) 8.6 Other Expenses (incl $ 8.7 Subtotal before Reimbursements and Taxes (Lines 8.1 to 8.6) 8.8 Reimbursements by uninsured plans and fiscal intermediaries 8.9 Taxes, Licenses and Fees (in total, for tying purposes) 8.10 Total (8.7 to 8.9) 8.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Student Health Plans Expenses: 0 for affiliated services) 9.1 Salaries (including $ 9.2 Outsourced Services 0 for affiliated services) 9.3 EDP Equipment and Software (incl $ 0 for affiliated services) 9.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 9.5 Accreditation and Certification (incl $ 0 for affiliated services) 9.6 Other Expenses (incl $ 9.7 Subtotal before Reimbursements and Taxes (Lines 9.1 to 9.6) 9.8 Reimbursements by uninsured plans and fiscal intermediaries 9.9 Taxes, Licenses and Fees (in total, for tying purposes) 9.10 Total (9.7 to 9.9) 9.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 *79413201821605100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes - See Cautionary Statement at http://www.naic.org/documents/committees_e_app_blanks_related_shce_cautionary_statement.pdf) UnitedHealthcare Insurance Company 2. 185 Asylum Street Hartford, CT 061033408 (LOCATION) BUSINESS IN THE STATE OF California DURING THE YEAR 2018 NAIC Company Code Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 1. 216-1.CA 2. 3. 4. 5. 6. 7. 8. 9. Premium: 1.1 Health premiums earned (From Part 2, Line 1.11) 1.2 Federal high risk pools 1.3 State high risk pools 1.4 Premiums earned including state and federal high risk programs (Lines 1.1 + 1.2 + 1.3) 1.5 Federal taxes and federal assessments 1.6 State insurance, premium and other taxes (Similar local taxes of 353,812 ) $ 1.6a Community Benefit Expenditures (informational only) 1.7 Regulatory authority licenses and fees 1.8 Adjusted Premiums Earned (Lines 1.4 - 1.5 - 1.6 - 1.7) 1.9 Net Assumed less Ceded reinsurance premiums earned 1.10 Other Adjustments due to MLR calculations - Premiums 1.11 Risk Revenue 1.12 Net adjusted premiums earned after reinsurance (Lines 1.8 + 1.9 + 1.10 + 1.11) Claims: 2.1 Incurred claims excluding prescription drugs 2.2 Prescription drugs 2.3 Pharmaceutical rebates 2.4 State stop loss, market stabilization and claim/census based assessments (informational only) Incurred medical incentive pools and bonuses Deductible Fraud and Abuse Detection/Recovery Expenses (for MLR use only) 5.0 Total Incurred Claims (Lines 2.1 + 2.2 - 2.3 + 3) (From Part 2, Line 2.15) 5.1 Net Assumed less Ceded reinsurance claims incurred 5.2 Other Adjustments due to MLR calculations - Claims 5.3 Rebates paid 5.4 Estimated rebates unpaid prior year 5.5 Estimated rebates unpaid current year 5.6 Fee for service and co-pay revenue 5.7 Net incurred claims after reinsurance (Lines 5.0 + 5.1 + 5.2 + 5.3 - 5.4 + 5.5 - 5.6) Improving Health Care Quality Expenses Incurred: 6.1 Improve health outcomes 6.2 Activities to prevent hospital readmissions 6.3 Improve patient safety and reduce medical errors 6.4 Wellness and health promotion activities 6.5 Health Information Technology expenses related to health improvement 6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5) Preliminary Medical Loss Ratio: MLR ((Lines 4 + 5.0 + 6.6 - Footnote 2.0)/Line 1.8 Claims Adjustment Expenses: 8.1 Cost containment expenses not included in quality of care expenses in Line 6.6 8.2 All other claims adjustment expenses 8.3 Total claims adjustment expenses (Lines 8.1 + 8.2) Claims Adjustment Expense Ratio (Line 8.3/Line 1.8) 2 Small Group Employer 3 Large Group Employer 4 5 Small Group Employer Individual Expatriate Plans 6 Large Group Employer 7 11 Government Business (excluded by statute) Other Health Business 9 8 Small Group 10 Student Health Plans Large Group 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 79413 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 6,715,609 0 (417) 684,658,463 0 (48,719) 1,438,511,947 0 (171,391) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,176,187,854 0 502,067 397,249,771 0 0 3,703,323,644 0 281,539 XXX XXX XXX 3,703,323,644 0 281,539 6,715,192 321,537 684,609,744 20,593,216 1,438,340,556 47,923,809 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,176,689,921 10,615,786 397,249,771 16,998,952 3,703,605,183 96,453,301 XXX (4,377) 3,703,605,183 96,448,924 (397) 0 607 6,393,444 0 0 0 6,393,444 1,934,084 0 59,687 662,022,757 979 358,551 0 662,382,288 8,237,598 0 111,833 1,382,067,316 (280,165,008) 12,418 0 1,101,914,726 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 12,111,314 0 (185,860) 1,154,148,680 2,054,566 1,720 0 1,156,204,966 55,536 0 0 380,195,283 0 2,778,829 0 382,974,112 22,338,134 0 (13,732) 3,584,827,480 (278,109,463) 3,151,518 0 3,309,869,536 XXX XXX XXX XXX XXX 22,338,137 0 (13,732) 3,584,831,855 (278,109,463) 3,151,518 0 3,309,873,911 4,048,593 814,502 223,170 463,628,822 92,348,869 25,514,997 1,029,744,247 207,843,618 57,202,898 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 784,907,083 186,344,554 625,187 59,712,995 555,760,430 304,923,468 2,342,041,739 1,043,111,974 388,489,719 XXX XXX XXX 2,342,041,739 1,043,111,974 388,489,719 12 0 2 4,639,925 0 0 0 0 0 0 4,639,925 504,686 509,272 360,648 530,971,967 (11,060) 0 0 0 0 0 530,960,907 1,695,716 515,497 396,544 1,180,900,465 (231,442,126) 0 0 0 0 0 949,458,338 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 92,231 310,549,956 0 (13,543,506) 0 0 13,543,506 0 310,549,956 2,202,697 1,023,884 849,424 2,997,687,878 (230,455,935) (13,543,506) 0 0 13,543,506 0 2,767,231,943 XXX XXX 0 0 2,282 (885) 0 970,625,565 997,251 0 XXX XXX XXX 0 971,622,816 2,202,697 1,023,884 849,424 2,997,687,878 (230,455,935) (13,543,506) 0 0 13,543,506 0 2,767,231,943 0 0 0 0 0 1,720,153 112,132 138,957 7,295,479 407,208 0 53,725 0 0 0 0 5,477,268 0 0 0 0 11,508,096 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 53,725 0.734 5,477,268 0.811 11,508,096 0.863 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 51,611 81,789 133,401 0.021 7,661,369 10,204,053 17,865,421 0.027 15,079,172 16,926,296 32,005,468 0.023 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 XXX XXX XXX XXX 0 0 0 0.000 830,718 219,694 1,219,671 (330,657) 1,283,394 19,589,959 331,825 1,358,628 6,964,822 1,690,602 9,673,928 XXX 3,222,820 0.826 29,935,836 XXX 1,095,958 15,642,551 16,738,509 0.015 8,145,914 25,887,658 34,033,572 0.090 32,034,023 68,742,348 100,776,370 XXX 2 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 597 (6) 1,803 376 1,251 19,590,556 331,819 1,360,431 6,965,198 1,691,853 4,022 XXX 29,939,858 XXX 28,517 40,001 68,518 XXX 32,062,540 68,782,349 100,844,888 XXX SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 (Continued) Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 2 Small Group Employer Individual 10. General and Administrative (G&A) Expenses: 10.1 Direct sales salaries and benefits 10.2 Agents and brokers fees and commissions 10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below) 10.4 Other general and administrative expenses 10.4a Community Benefit Expenditures (informational only) 10.5 Total general and administrative (Lines 10.1 +10.2 + 10.3 + 10.4) 18,338 411,047 (1,109) 224,802 0 653,078 3 Large Group Employer 2,416,139 50,077,721 764,453 31,363,770 0 84,622,083 4 5 Small Group Employer Individual 6,190,504 40,242,029 1,505,084 23,492,594 0 71,430,210 0 0 0 0 0 0 Expatriate Plans 6 Large Group Employer 0 0 0 0 0 0 7 8 Small Group 0 0 0 0 0 0 Student Health Plans Large Group 0 0 0 0 0 0 10 11 Government Business (excluded by statute) Other Health Business 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,788,638 40,340,873 1,915,257 97,189,536 0 141,234,304 893,356 4,452,309 814,930 25,369,236 0 31,529,830 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 11,306,975 135,523,978 4,998,614 177,639,938 0 329,469,506 684 0 (178) (18,726) 0 (18,220) 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) 23,456,609 37,512,614 12. Income from fees of uninsured plans XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 13. Net investment and other gain/(loss) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 51,081,700 XXX 14. Federal income taxes (excluding taxes on Line 1.5 above) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 156,044 XXX 156,044 15. Net gain or (loss) (Lines 11 + 12 + 13 - 14) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 133,381,537 XXX 133,363,946 16. ICD-10 Implementation Expenses (informational only; already included in general expenses and line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16. 16a ICD-10 Implementation Expenses (informational only; already included in line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 913,316 0 0 0 0 0 0 0 16,935,408 3,637,934 82,455,880 XXX 11,307,659 135,523,978 4,998,436 177,621,212 0 329,451,286 82,405,936 32,354 32,354 51,081,700 OTHER INDICATORS: 216-2.CA 1. Number of certificates/policies 447 62,162 131,430 0 0 0 0 0 0 0 705,487 616,122 1,515,648 279 1,515,927 2. Number of Covered Lives 852 112,115 256,232 0 0 0 0 0 0 0 961,497 616,122 1,946,818 279 1,947,097 3. Number of Groups 13,933 1,396 0 0 0 0 0 0 7,066 219 22,614 4 22,618 4. Member Months 10,263 1,352,096 3,283,239 0 0 0 0 0 0 11,038,949 7,461,396 23,145,943 3,660 23,149,603 XXX Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ XXX 0 ] If yes, show the amount of premiums and claims included. Premiums $ 0 Claims $ 0 AFFORDABLE CARE ACT (ACA) RECEIPTS, PAYMENTS, RECEIVABLES and PAYABLES Current Year Prior Year Comprehensive Health Coverage Comprehensive Health Coverage 1 2 3 4 Small Group Small Group Employer Plans Employer Plans Individual Plans Individual Plans ACA Receivables and Payables 1. Permanent ACA Risk Adjustment Program 1.0 Premium adjustments receivable/(payable) 2. Transitional ACA Reinsurance Program 2.0 Total amounts recoverable for claims (paid & unpaid) 0 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 0 0 0 0 427,191 10,245,223 1,336,968 (7,970,464) XXX 612,651 0 6,509,580 XXX 0 0 0 0 ACA Receipts and Payments 4. Permanent ACA Risk Adjustment Program 4.0 Premium adjustments receipts/(payments) 5. Transitional ACA Reinsurance Program 5.0 Amounts received for claims 0 6. Temporary ACA Risk Corridors Program 6.1 Retrospective premium received 6.2 Rate credits or policy experience refunds paid 0 0 XXX (196,151) 0 0 0 0 0 (6,573,711) XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF 185 Asylum Street Hartford, CT 061033408 California DURING THE YEAR Comprehensive Health Coverage 1 2 3 Individual Small Group Employer Small Group Employer Individual Expatriate Plans: 7 8 6 Large Group Employer Small Group 10 11 Government Business (excluded by statute) Other Health Business 9 Student Health Plans Large Group 79413 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.CA Health Premiums Earned: 6,715,609 684,954,373 1.1 Direct premiums written 0 12,415 1.2 Unearned premium prior year 0 (50,226) 1.3 Unearned premium current year 0 62,642 1.4 Change in unearned premium (Lines 1.2 - 1.3) 261 0 1.5 Paid rate credits 0 (41,684) 1.6 Reserve for rate credits current year 0 (41,684) 1.7 Reserve for rate credits prior year 0 0 1.8 Change in reserve for rate credits (Lines 1.6 - 1.7) 0 358,551 1.9 Premium balances written off 0 0 1.10 Group conversion charge 6,715,609 684,658,463 1.11 Total direct premiums earned (Lines 1.1 + 1.4 - 1.9 + 1.10) 0 0 1.12 Assumed premiums earned from non-affiliates 0 979 1.13 Net Assumed less Ceded premiums earned from affiliates 0 0 1.14 Ceded premiums earned to non-affiliates 0 358,551 1.15 Other Adjustments due to MLR calculation - Premiums 6,715,348 685,017,994 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 4,639,671 532,073,122 2.1 Paid claims during the year 76 71,187,436 2.2 Direct claim liability current year 83 72,591,682 2.3 Direct claim liability prior year 0 1,782,861 2.4 Direct claim reserves current year 0 1,535,865 2.5 Direct claim reserves prior year 0 0 2.6 Direct contract reserves current year 0 0 2.7 Direct contract reserves prior year 261 0 2.8 Paid rate credits 0 (41,684) 2.9 Reserve for rate credits current year 0 (41,684) 2.10 Reserve for rate credits prior year 0 509,272 2.11 Incurred medical incentive pools and bonuses (Lines 2.11a + 2.11b - 2.11c) 0 171,633 2.11a Paid medical incentive pools and bonuses current year 0 739,458 2.11b Accrued medical incentive pools and bonuses current year 0 401,819 2.11c Accrued medical incentive pools and bonuses prior year 0 453,177 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 0 10,389,666 2.12a Healthcare receivables current year 0 9,936,489 2.12b Healthcare receivables prior year 0 0 2.13 Group conversion charge 0 0 2.14 Multi-option coverage blended rate adjustment 2.15 Total incurred claims (Lines 2.1 + 2.2 - 2.3 + 2.4 - 2.5 + 2.6 - 2.7 + 2.8 + 2.9 4,639,925 530,971,967 2.10 + 2.11 - 2.12 + 2.13 + 2.14) 0 0 2.16 Assumed incurred claims from non-affiliates 0 (11,060) 2.17 Net assumed less ceded incurred claims from affiliates 0 0 2.18 Ceded incurred claims to non-affiliates 0 0 2.19 Other adjustments due to MLR calculation - Claims 4,639,664 530,960,907 2.20 Net Incurred Claims (Lines 2.15 - 2.8 - 2.9 + 2.10 + 2.16 + 2.17 - 2.18 + 2.19) 3. Fraud and Abuse Recoveries that Reduced PAID Claims in Line 2.1 above 2 360,648 (informational only) 48,947,116 for stand-alone dental and $ (a) Column 13, Line 1.1 includes direct written premium of $ Large Group Employer 4 Business Subject to MLR Mini-Med Plans 5 (LOCATION) NAIC Company Code 2018 1,438,607,670 (105,493) (22,187) (83,306) 492,684 946,034 536,032 410,002 12,418 0 1,438,511,946 617,300 74 280,782,382 12,418 1,157,456,670 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,194,743,721 151,809,312 169,907,950 3,274,153 3,588,132 0 3,807 492,684 946,034 536,032 515,497 658,466 2,471,454 2,614,423 (3,154,986) 23,438,110 26,593,096 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,180,900,465 525,632 (95,171) 231,872,588 0 948,555,653 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 396,544 0 0 13,215,306 for stand-alone vision policies. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,176,498,660 139,373 448,459 (309,086) (22,109,727) 1,460,702 1,047,246 413,456 1,720 0 1,176,187,854 3,643,716 0 1,589,150 1,720 1,199,940,411 400,028,600 0 0 0 17,743,772 16,617,249 18,835,375 (2,218,126) 2,778,829 0 397,249,771 0 0 0 2,778,829 384,502,953 3,706,804,912 46,295 376,046 (329,750) (3,873,010) 18,982,302 20,376,970 (1,394,668) 3,151,518 0 3,703,323,643 4,261,016 1,053 282,371,532 3,151,518 3,433,633,377 983,610,328 95,856,176 92,598,269 36,409,803 30,951,601 445,869 343,682 (22,109,727) 1,460,702 1,047,246 (885) (885) 0 0 105,904 211,101 105,197 0 0 262,367,556 15,945,906 37,158,804 7,592 7,357 0 0 17,743,772 16,617,249 18,835,375 0 0 0 0 (53,869,416) 104,114,058 157,983,474 0 0 2,981,389,334 332,332,364 373,641,799 41,474,410 36,082,955 445,869 347,490 (3,873,010) 18,982,302 20,376,970 1,023,884 829,214 3,210,912 3,016,242 (56,361,939) 138,197,853 194,559,791 0 0 0 0 0 0 0 0 970,625,565 3,016,675 0 2,019,424 0 993,319,088 310,549,956 0 0 0 0 295,024,310 2,997,687,878 3,542,307 (106,230) 233,892,011 0 2,772,499,621 0 0 684,464 3,954,936 (2,466,542) 1,385,011 0 0 0 0 0 0 0 0 0 0 0 103,382 44,917 (58,465) 0 0 1,441,658 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF California DURING THE YEAR All Expenses 1 Improve Health Outcomes 1. Individual Comprehensive Coverage Expenses: 122,264 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 8,733 for affiliated services) 1.3 EDP Equipment and Software (incl $ 838 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 91 for affiliated services) 1.5 Accreditation and Certification (incl $ 276,962 for affiliated services) 1.6 Other Expenses (incl $ 1.7 Subtotal before Reimbursements and Taxes (Lines 1.1 to 1.6) 1.8 Reimbursements by uninsured plans and fiscal intermediaries 1.9 Taxes, Licenses and Fees (in total, for tying purposes) 1.10 Total (1.7 to 1.9) 1.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 2. 216-4.CA Small Group Comprehensive Coverage Expenses: 15,153,156 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 1,070,856 for affiliated services) 2.3 EDP Equipment and Software (incl $ 102,790 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 11,161 for affiliated services) 2.5 Accreditation and Certification (incl $ 34,714,903 for affiliated services) 2.6 Other Expenses (incl $ 2.7 Subtotal before Reimbursements and Taxes (Lines 2.1 to 2.6) 2.8 Reimbursements by uninsured plans and fiscal intermediaries 2.9 Taxes, Licenses and Fees (in total, for tying purposes) 2.10 Total (2.7 to 2.9) 2.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 3. Large Group Comprehensive Coverage Expenses: 26,582,133 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 1,721,378 for affiliated services) 3.3 EDP Equipment and Software (incl $ 165,232 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 17,941 for affiliated services) 3.5 Accreditation and Certification (incl $ 61,262,862 for affiliated services) 3.6 Other Expenses (incl $ 3.7 Subtotal before Reimbursements and Taxes (Lines 3.1 to 3.6) 3.8 Reimbursements by uninsured plans and fiscal intermediaries 3.9 Taxes, Licenses and Fees (in total, for tying purposes) 3.10 Total (3.7 to 3.9) 3.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 185 Asylum Street Hartford, CT 061033408 0 0 0 0 0 53,725 53,725 0 XXX Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX Total (1 to 5) 0 0 0 0 0 53,725 53,725 0 XXX 0 0 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 0 0 0 0 0 0 0 XXX (LOCATION) NAIC Company Code 2018 XXX 14,481 1,696 1,209 116 13 32,387 49,901 0 XXX 23,223 2,661 1,939 186 20 51,940 79,969 0 XXX 53,725 0 0 0 0 0 0 0 0 0 53,725 0 49,901 14,757 79,969 0 0 0 0 0 0 5,477,268 5,477,268 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5,477,268 5,477,268 0 1,889,670 1,023,131 157,796 15,147 1,645 4,349,582 7,436,970 0 2,894,066 331,666 241,668 23,197 2,519 6,472,771 9,965,887 0 XXX 5,477,268 0 0 0 0 0 0 11,508,096 11,508,096 0 XXX 11,508,096 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 5,477,268 0 XXX 7,436,970 1,939,999 XXX 9,965,887 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 11,508,096 11,508,096 0 3,628,418 2,318,322 302,990 29,083 3,158 8,361,167 14,643,139 111 4,814,281 551,717 402,015 38,589 4,190 10,767,457 16,578,249 149 11,508,096 0 XXX 14,643,250 4,099,033 XXX 16,578,398 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 79413 9 10 General Administrative Expenses Total Expenses (6 to 9) 84,560 7,665 5,585 536 58 554,486 652,890 0 3,928 656,818 0 122,264 12,022 8,733 838 91 692,537 836,486 0 3,928 840,414 14,757 10,369,420 1,276,627 671,392 64,446 6,998 71,298,104 83,686,986 0 3,391,432 87,078,418 0 15,153,156 2,631,424 1,070,856 102,790 11,161 87,597,725 106,567,111 0 3,391,432 109,958,543 1,939,999 18,139,434 1,840,302 1,016,373 97,560 10,593 48,419,391 69,523,654 869 11,038,939 80,563,462 0 26,582,133 4,710,342 1,721,378 165,232 17,941 79,056,111 112,253,137 1,129 11,038,939 123,293,205 4,099,033 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 4. 5. 216-5.CA 6. Individual Mini-Med Plans Expenses: 0 for affiliated services) 4.1 Salaries (including $ 4.2 Outsourced Services 0 for affiliated services) 4.3 EDP Equipment and Software (incl $ 0 for affiliated services) 4.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 4.5 Accreditation and Certification (incl $ 0 for affiliated services) 4.6 Other Expenses (incl $ 4.7 Subtotal before Reimbursements and Taxes (Lines 4.1 to 4.6) 4.8 Reimbursements by uninsured plans and fiscal intermediaries 4.9 Taxes, Licenses and Fees (in total, for tying purposes) 4.10 Total (4.7 to 4.9) 4.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Mini-Med Plans Expenses: 0 for affiliated services) 5.1 Salaries (including $ 5.2 Outsourced Services 0 for affiliated services) 5.3 EDP Equipment and Software (incl $ 0 for affiliated services) 5.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 5.5 Accreditation and Certification (incl $ 0 for affiliated services) 5.6 Other Expenses (incl $ 5.7 Subtotal before Reimbursements and Taxes (Lines 5.1 to 5.6) 5.8 Reimbursements by uninsured plans and fiscal intermediaries 5.9 Taxes, Licenses and Fees (in total, for tying purposes) 5.10 Total (5.7 to 5.9) 5.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Mini-Med Plans Expenses: 0 for affiliated services) 6.1 Salaries (including $ 6.2 Outsourced Services 0 for affiliated services) 6.3 EDP Equipment and Software (incl $ 0 for affiliated services) 6.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 6.5 Accreditation and Certification (incl $ 0 for affiliated services) 6.6 Other Expenses (incl $ 6.7 Subtotal before Reimbursements and Taxes (Lines 6.1 to 6.6) 6.8 Reimbursements by uninsured plans and fiscal intermediaries 6.9 Taxes, Licenses and Fees (in total, for tying purposes) 6.10 Total (6.7 to 6.9) 6.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 7. 8. 216-6.CA 9. Small Group Expatriate Plans Expenses: 0 for affiliated services) 7.1 Salaries (including $ 7.2 Outsourced Services 0 for affiliated services) 7.3 EDP Equipment and Software (incl $ 0 for affiliated services) 7.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 7.5 Accreditation and Certification (incl $ 0 for affiliated services) 7.6 Other Expenses (incl $ 7.7 Subtotal before Reimbursements and Taxes (Lines 7.1 to 7.6) 7.8 Reimbursements by uninsured plans and fiscal intermediaries 7.9 Taxes, Licenses and Fees (in total, for tying purposes) 7.10 Total (7.7 to 7.9) 7.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Expatriate Plans Expenses: 0 for affiliated services) 8.1 Salaries (including $ 8.2 Outsourced Services 0 for affiliated services) 8.3 EDP Equipment and Software (incl $ 0 for affiliated services) 8.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 8.5 Accreditation and Certification (incl $ 0 for affiliated services) 8.6 Other Expenses (incl $ 8.7 Subtotal before Reimbursements and Taxes (Lines 8.1 to 8.6) 8.8 Reimbursements by uninsured plans and fiscal intermediaries 8.9 Taxes, Licenses and Fees (in total, for tying purposes) 8.10 Total (8.7 to 8.9) 8.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Student Health Plans Expenses: 0 for affiliated services) 9.1 Salaries (including $ 9.2 Outsourced Services 0 for affiliated services) 9.3 EDP Equipment and Software (incl $ 0 for affiliated services) 9.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 9.5 Accreditation and Certification (incl $ 0 for affiliated services) 9.6 Other Expenses (incl $ 9.7 Subtotal before Reimbursements and Taxes (Lines 9.1 to 9.6) 9.8 Reimbursements by uninsured plans and fiscal intermediaries 9.9 Taxes, Licenses and Fees (in total, for tying purposes) 9.10 Total (9.7 to 9.9) 9.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 *79413201821606100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes - See Cautionary Statement at http://www.naic.org/documents/committees_e_app_blanks_related_shce_cautionary_statement.pdf) UnitedHealthcare Insurance Company 2. 185 Asylum Street Hartford, CT 061033408 (LOCATION) BUSINESS IN THE STATE OF Colorado DURING THE YEAR 2018 NAIC Company Code Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 1. 216-1.CO 2. 3. 4. 5. 6. 7. 8. 9. Premium: 1.1 Health premiums earned (From Part 2, Line 1.11) 1.2 Federal high risk pools 1.3 State high risk pools 1.4 Premiums earned including state and federal high risk programs (Lines 1.1 + 1.2 + 1.3) 1.5 Federal taxes and federal assessments 1.6 State insurance, premium and other taxes (Similar local taxes of 153,996 ) $ 1.6a Community Benefit Expenditures (informational only) 1.7 Regulatory authority licenses and fees 1.8 Adjusted Premiums Earned (Lines 1.4 - 1.5 - 1.6 - 1.7) 1.9 Net Assumed less Ceded reinsurance premiums earned 1.10 Other Adjustments due to MLR calculations - Premiums 1.11 Risk Revenue 1.12 Net adjusted premiums earned after reinsurance (Lines 1.8 + 1.9 + 1.10 + 1.11) Claims: 2.1 Incurred claims excluding prescription drugs 2.2 Prescription drugs 2.3 Pharmaceutical rebates 2.4 State stop loss, market stabilization and claim/census based assessments (informational only) Incurred medical incentive pools and bonuses Deductible Fraud and Abuse Detection/Recovery Expenses (for MLR use only) 5.0 Total Incurred Claims (Lines 2.1 + 2.2 - 2.3 + 3) (From Part 2, Line 2.15) 5.1 Net Assumed less Ceded reinsurance claims incurred 5.2 Other Adjustments due to MLR calculations - Claims 5.3 Rebates paid 5.4 Estimated rebates unpaid prior year 5.5 Estimated rebates unpaid current year 5.6 Fee for service and co-pay revenue 5.7 Net incurred claims after reinsurance (Lines 5.0 + 5.1 + 5.2 + 5.3 - 5.4 + 5.5 - 5.6) Improving Health Care Quality Expenses Incurred: 6.1 Improve health outcomes 6.2 Activities to prevent hospital readmissions 6.3 Improve patient safety and reduce medical errors 6.4 Wellness and health promotion activities 6.5 Health Information Technology expenses related to health improvement 6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5) Preliminary Medical Loss Ratio: MLR ((Lines 4 + 5.0 + 6.6 - Footnote 2.0)/Line 1.8 Claims Adjustment Expenses: 8.1 Cost containment expenses not included in quality of care expenses in Line 6.6 8.2 All other claims adjustment expenses 8.3 Total claims adjustment expenses (Lines 8.1 + 8.2) Claims Adjustment Expense Ratio (Line 8.3/Line 1.8) 2 Small Group Employer 3 Large Group Employer 4 5 Small Group Employer Individual Expatriate Plans 6 Large Group Employer 7 11 Government Business (excluded by statute) Other Health Business 9 8 Small Group 10 Student Health Plans Large Group 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 79413 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 265,241,966 0 113,529 268,223,102 0 0 1,453,091,606 0 2,552 XXX XXX XXX 0 (244) 265,355,495 3,490,769 268,223,102 10,062,971 1,453,094,158 43,894,775 XXX 0 0 0 0 0 0 0 0 0 0 0 244 0 0 0 244 3,945,268 0 (47,722) 257,967,179 (576,692) 1,813 0 257,392,300 27,233 0 0 258,132,898 1,639,197 514,258 0 260,286,353 13,367,497 0 (30,654) 1,395,862,539 (64,765,855) 669,123 0 1,331,765,807 XXX XXX XXX XXX XXX 13,367,497 0 (30,654) 1,395,863,041 (64,765,855) 669,123 0 1,331,766,309 0 0 0 0 0 0 150 0 0 194,452,395 8,355,171 64,335 159,274,472 122,070,998 67,564,112 984,397,934 273,905,241 112,665,810 XXX XXX XXX 984,397,934 273,905,241 112,665,810 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 150 0 0 78 0 0 202,743,231 (644,073) 0 XXX XXX XXX 0 202,099,158 0 300,721 0 214,082,079 0 0 0 0 0 0 214,082,079 323,060 1,539,049 214,906 1,147,176,415 (53,326,529) (4,774,818) 6,905,746 7,395,800 5,264,872 0 1,093,849,886 XXX XXX 323,060 1,539,049 214,906 1,147,176,415 (53,326,529) (4,774,818) 6,905,746 7,395,800 5,264,872 0 1,093,849,886 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 8,074,480 0 (1,825) 533,892,892 0 (43,109) 377,659,167 0 (66,043) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8,072,655 (428,665) 533,849,783 18,447,206 377,593,123 12,322,738 0 0 0 0 0 0 0 0 0 0 0 0 52,809 0 678 8,447,833 (1) 0 0 8,447,832 6,068,822 0 8,567 509,325,188 98,857 135,356 0 509,559,401 3,273,365 0 7,822 361,989,198 (65,927,215) 17,696 0 296,079,679 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8,912,350 1,544,136 478,202 358,959,846 83,254,703 26,507,258 262,798,722 58,680,233 18,051,904 0 0 0 0 0 0 0 0 0 0 0 0 6 0 164 9,978,284 0 (21,423) 0 0 21,423 0 9,978,284 132,601 553,711 79,142 416,261,002 0 (4,753,395) 6,905,746 7,395,800 5,243,449 0 416,261,002 190,376 684,617 135,600 304,111,668 (52,682,456) 0 0 0 0 0 251,429,213 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 64,596 0 0 0 0 4,271,143 0 0 0 0 3,021,273 0 0 0 0 0 0 0 0 0 0 0 0 0 0 64,596 1.189 4,271,143 0.826 3,021,273 0.849 0 0.000 66,138 112,219 178,357 0.021 5,988,837 8,252,202 14,241,039 0.028 4,232,912 5,105,890 9,338,802 0.026 0 0 0 0.000 0 0 0 XXX XXX XXX 0 150 0 0 0 0 0 549,973 186,945 152,555 1,783,566 130,606 894,332 243,732 400,025 21,248 539,047 8,801,317 430,677 552,581 1,804,814 669,653 0 2,803,645 XXX 2,098,385 0.837 12,259,042 XXX 412,022 3,900,598 4,312,621 0.017 2,259,964 6,056,204 8,316,168 0.032 12,959,874 23,427,113 36,386,987 XXX XXX 0 0 0 0.000 1,453,091,606 0 2,552 (502) 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 8,801,317 430,677 552,581 1,804,814 669,653 0 12,259,042 XXX 0 0 0 12,959,874 23,427,113 36,386,987 XXX XXX XXX 1,453,094,158 43,894,274 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 (Continued) Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 2 Small Group Employer Individual 10. General and Administrative (G&A) Expenses: 10.1 Direct sales salaries and benefits 10.2 Agents and brokers fees and commissions 10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below) 10.4 Other general and administrative expenses 10.4a Community Benefit Expenditures (informational only) 10.5 Total general and administrative (Lines 10.1 +10.2 + 10.3 + 10.4) 22,724 222,677 4,510 314,596 0 564,506 3 Large Group Employer 1,948,308 19,754,546 369,237 23,922,975 0 45,995,065 4 5 Small Group Employer Individual 1,779,692 11,126,357 435,900 8,493,738 0 21,835,687 0 0 0 0 0 0 Expatriate Plans 6 Large Group Employer 0 0 0 0 0 0 7 8 Small Group 0 0 0 0 0 0 Student Health Plans Large Group 0 0 0 0 0 0 10 11 Government Business (excluded by statute) Other Health Business 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,072 0 1,072 536,003 11,952,515 506,370 24,038,195 0 37,033,082 558,575 2,964,066 497,678 15,792,986 0 19,813,306 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 4,845,302 46,020,161 1,813,693 72,563,562 0 125,242,717 0 0 0 0 0 0 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) (2,337,911) 28,791,151 10,454,704 11,143,795 15,976,415 64,027,175 12. Income from fees of uninsured plans XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 13. Net investment and other gain/(loss) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 20,921,916 XXX 14. Federal income taxes (excluding taxes on Line 1.5 above) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 250,330 XXX 250,330 15. Net gain or (loss) (Lines 11 + 12 + 13 - 14) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 84,698,761 XXX 84,695,748 16. ICD-10 Implementation Expenses (informational only; already included in general expenses and line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16. 16a ICD-10 Implementation Expenses (informational only; already included in line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (979) XXX 4,845,302 46,020,161 1,813,693 72,563,562 0 125,242,717 64,027,677 (3,515) (3,515) 20,921,916 OTHER INDICATORS: 216-2.CO 1. Number of certificates/policies 2. Number of Covered Lives 3. Number of Groups 4. Member Months 617 55,227 37,937 0 0 0 0 0 0 0 236,721 80,399 410,901 0 410,901 1,177 100,112 72,151 0 0 0 0 0 0 0 359,134 80,399 612,973 0 612,973 10,426 661 0 0 0 0 0 0 7,507 2 18,596 0 18,596 1,091,116 894,299 0 0 0 0 0 0 4,273,017 954,337 7,226,488 0 7,226,488 XXX 13,719 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ XXX 0 ] If yes, show the amount of premiums and claims included. Premiums $ 0 Claims $ 0 AFFORDABLE CARE ACT (ACA) RECEIPTS, PAYMENTS, RECEIVABLES and PAYABLES Current Year Prior Year Comprehensive Health Coverage Comprehensive Health Coverage 1 2 3 4 Small Group Small Group Employer Plans Employer Plans Individual Plans Individual Plans ACA Receivables and Payables 1. Permanent ACA Risk Adjustment Program 1.0 Premium adjustments receivable/(payable) 2. Transitional ACA Reinsurance Program 2.0 Total amounts recoverable for claims (paid & unpaid) 0 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 0 0 0 0 0 0 0 0 1,718,236 25,504,974 1,092,943 16,982,666 1,201,487 32,456,582 XXX 1,442,439 0 21,674,491 XXX ACA Receipts and Payments 4. Permanent ACA Risk Adjustment Program 4.0 Premium adjustments receipts/(payments) 5. Transitional ACA Reinsurance Program 5.0 Amounts received for claims 0 6. Temporary ACA Risk Corridors Program 6.1 Retrospective premium received 6.2 Rate credits or policy experience refunds paid 0 0 XXX 0 0 0 0 0 XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF 185 Asylum Street Hartford, CT 061033408 Colorado DURING THE YEAR Comprehensive Health Coverage 1 2 3 Individual Small Group Employer Large Group Employer Small Group Employer Individual Expatriate Plans: 7 8 6 Large Group Employer Small Group 10 11 Government Business (excluded by statute) Other Health Business 9 Student Health Plans Large Group 79413 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.CO Health Premiums Earned: 8,074,480 534,037,651 1.1 Direct premiums written 0 3,292 1.2 Unearned premium prior year 0 12,695 1.3 Unearned premium current year 0 (9,403) 1.4 Change in unearned premium (Lines 1.2 - 1.3) (217,970) 6,905,746 1.5 Paid rate credits 21,423 5,243,449 1.6 Reserve for rate credits current year 0 7,395,800 1.7 Reserve for rate credits prior year 21,423 (2,152,351) 1.8 Change in reserve for rate credits (Lines 1.6 - 1.7) 0 135,356 1.9 Premium balances written off 0 0 1.10 Group conversion charge 8,074,480 533,892,892 1.11 Total direct premiums earned (Lines 1.1 + 1.4 - 1.9 + 1.10) 0 0 1.12 Assumed premiums earned from non-affiliates (1) 98,857 1.13 Net Assumed less Ceded premiums earned from affiliates 0 0 1.14 Ceded premiums earned to non-affiliates 0 135,356 1.15 Other Adjustments due to MLR calculation - Premiums 8,271,025 529,373,710 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 10,240,253 395,903,935 2.1 Paid claims during the year 181,372 57,601,469 2.2 Direct claim liability current year 121,019 40,499,170 2.3 Direct claim liability prior year 20,773 1,382,921 2.4 Direct claim reserves current year 11,788 958,260 2.5 Direct claim reserves prior year 404,140 0 2.6 Direct contract reserves current year 536,666 0 2.7 Direct contract reserves prior year (217,970) 6,905,746 2.8 Paid rate credits 21,423 5,243,449 2.9 Reserve for rate credits current year 0 7,395,800 2.10 Reserve for rate credits prior year 0 553,711 2.11 Incurred medical incentive pools and bonuses (Lines 2.11a + 2.11b - 2.11c) 0 133,075 2.11a Paid medical incentive pools and bonuses current year 0 1,603,879 2.11b Accrued medical incentive pools and bonuses current year 0 1,183,243 2.11c Accrued medical incentive pools and bonuses prior year 2,235 2,476,997 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 2,235 11,877,566 2.12a Healthcare receivables current year 0 9,400,569 2.12b Healthcare receivables prior year 0 0 2.13 Group conversion charge 0 0 2.14 Multi-option coverage blended rate adjustment 2.15 Total incurred claims (Lines 2.1 + 2.2 - 2.3 + 2.4 - 2.5 + 2.6 - 2.7 + 2.8 + 2.9 9,978,284 416,261,002 2.10 + 2.11 - 2.12 + 2.13 + 2.14) 0 0 2.16 Assumed incurred claims from non-affiliates 0 0 2.17 Net assumed less ceded incurred claims from affiliates 0 0 2.18 Ceded incurred claims to non-affiliates 0 0 2.19 Other adjustments due to MLR calculation - Claims 10,174,831 411,507,607 2.20 Net Incurred Claims (Lines 2.15 - 2.8 - 2.9 + 2.10 + 2.16 + 2.17 - 2.18 + 2.19) 3. Fraud and Abuse Recoveries that Reduced PAID Claims in Line 2.1 above 164 79,142 (informational only) 21,900,319 for stand-alone dental and $ (a) Column 13, Line 1.1 includes direct written premium of $ 4 Business Subject to MLR Mini-Med Plans 5 (LOCATION) NAIC Company Code 2018 377,857,594 (209,555) (28,825) (180,731) 1,433,422 1,421,840 1,079,795 342,044 17,696 0 377,659,167 0 6,018 65,933,233 17,696 309,974,182 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 265,244,028 (1,211) (961) (250) (2,796,217) 832,582 892,674 (60,092) 1,813 0 265,241,966 0 0 576,692 1,813 267,523,395 268,737,361 0 0 0 2,393,976 40,774 1,710,845 (1,670,071) 514,258 0 268,223,102 0 1,639,197 0 514,258 269,652,652 1,453,951,113 (207,475) (17,091) (190,384) 7,718,957 7,560,068 11,079,115 (3,519,047) 669,123 0 1,453,091,607 0 1,744,070 66,509,925 669,123 1,384,794,964 303,799,174 32,413,449 35,077,562 815,954 795,032 0 0 1,433,422 1,421,840 1,079,795 684,617 183,743 2,046,771 1,545,896 (495,602) 6,471,074 6,966,676 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 150 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 202,215,093 19,045,522 16,720,411 12,821,103 11,781,052 364,676 327,099 (2,796,217) 832,582 892,674 0 0 0 0 18,293 18,742 449 0 0 212,106,842 12,729,297 15,345,960 7,771 6,454 0 0 2,393,976 40,774 1,710,845 300,721 164,928 241,839 106,045 (3,565,956) 26,287,233 29,853,190 0 0 1,124,265,448 121,971,109 107,764,122 15,048,521 13,552,586 768,816 863,764 7,718,957 7,560,068 11,079,115 1,539,049 481,745 3,892,488 2,835,184 (1,564,033) 44,656,851 46,220,884 0 0 304,111,668 0 0 52,682,456 0 249,653,747 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 150 0 0 0 0 150 202,743,231 0 0 644,073 0 204,955,467 214,082,079 0 0 0 0 213,358,174 1,147,176,414 0 0 53,326,529 0 1,089,649,976 135,600 0 0 5,167,387 for stand-alone vision policies. 0 0 0 0 0 0 34,958 249,864 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF Colorado DURING THE YEAR All Expenses 1 Improve Health Outcomes 1. Individual Comprehensive Coverage Expenses: 165,863 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 10,574 for affiliated services) 1.3 EDP Equipment and Software (incl $ 1,015 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 110 for affiliated services) 1.5 Accreditation and Certification (incl $ 331,683 for affiliated services) 1.6 Other Expenses (incl $ 1.7 Subtotal before Reimbursements and Taxes (Lines 1.1 to 1.6) 1.8 Reimbursements by uninsured plans and fiscal intermediaries 1.9 Taxes, Licenses and Fees (in total, for tying purposes) 1.10 Total (1.7 to 1.9) 1.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 2. 216-4.CO Small Group Comprehensive Coverage Expenses: 11,898,384 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 836,729 for affiliated services) 2.3 EDP Equipment and Software (incl $ 80,316 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 8,721 for affiliated services) 2.5 Accreditation and Certification (incl $ 27,135,339 for affiliated services) 2.6 Other Expenses (incl $ 2.7 Subtotal before Reimbursements and Taxes (Lines 2.1 to 2.6) 2.8 Reimbursements by uninsured plans and fiscal intermediaries 2.9 Taxes, Licenses and Fees (in total, for tying purposes) 2.10 Total (2.7 to 2.9) 2.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 3. Large Group Comprehensive Coverage Expenses: 7,779,520 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 506,358 for affiliated services) 3.3 EDP Equipment and Software (incl $ 48,604 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 5,277 for affiliated services) 3.5 Accreditation and Certification (incl $ 17,405,693 for affiliated services) 3.6 Other Expenses (incl $ 3.7 Subtotal before Reimbursements and Taxes (Lines 3.1 to 3.6) 3.8 Reimbursements by uninsured plans and fiscal intermediaries 3.9 Taxes, Licenses and Fees (in total, for tying purposes) 3.10 Total (3.7 to 3.9) 3.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 185 Asylum Street Hartford, CT 061033408 0 0 0 0 0 64,596 64,596 0 XXX Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX Total (1 to 5) 0 0 0 0 0 64,596 64,596 0 XXX 0 0 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 0 0 0 0 0 0 0 XXX (LOCATION) NAIC Company Code 2018 XXX 18,591 2,131 1,552 149 16 41,580 64,020 0 XXX 35,592 3,408 2,468 237 26 68,234 109,964 0 XXX 64,596 0 0 0 0 0 0 0 0 0 64,596 0 64,020 18,279 109,964 0 0 0 0 0 0 4,271,143 4,271,143 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4,271,143 4,271,143 0 1,525,980 619,633 127,426 12,231 1,328 3,520,557 5,807,155 0 2,340,257 268,198 195,422 18,758 2,037 5,234,140 8,058,812 0 XXX 4,271,143 0 0 0 0 0 0 3,021,273 3,021,273 0 XXX 3,021,273 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 4,271,143 0 XXX 5,807,155 1,569,036 XXX 8,058,812 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3,021,273 3,021,273 0 1,066,646 489,948 89,070 8,550 928 2,449,730 4,104,872 0 1,451,989 166,401 121,248 11,638 1,264 3,247,469 5,000,008 0 3,021,273 0 XXX 4,104,872 1,195,672 XXX 5,000,008 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 79413 9 10 General Administrative Expenses Total Expenses (6 to 9) 111,681 8,952 6,553 601 68 430,533 558,389 0 63,977 622,366 0 165,863 14,491 10,574 987 110 604,944 796,969 0 63,977 860,945 18,279 8,032,148 919,418 513,880 49,326 5,356 35,967,930 45,488,058 0 6,959,469 52,447,527 0 11,898,384 1,807,249 836,729 80,316 8,721 48,993,770 63,625,168 0 6,959,469 70,584,637 1,569,036 5,260,886 590,706 296,040 28,416 3,085 15,104,874 21,284,007 0 4,066,788 25,350,796 0 7,779,520 1,247,055 506,358 48,604 5,277 23,823,346 33,410,161 0 4,066,788 37,476,949 1,195,672 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 4. 5. 216-5.CO 6. Individual Mini-Med Plans Expenses: 0 for affiliated services) 4.1 Salaries (including $ 4.2 Outsourced Services 0 for affiliated services) 4.3 EDP Equipment and Software (incl $ 0 for affiliated services) 4.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 4.5 Accreditation and Certification (incl $ 0 for affiliated services) 4.6 Other Expenses (incl $ 4.7 Subtotal before Reimbursements and Taxes (Lines 4.1 to 4.6) 4.8 Reimbursements by uninsured plans and fiscal intermediaries 4.9 Taxes, Licenses and Fees (in total, for tying purposes) 4.10 Total (4.7 to 4.9) 4.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Mini-Med Plans Expenses: 0 for affiliated services) 5.1 Salaries (including $ 5.2 Outsourced Services 0 for affiliated services) 5.3 EDP Equipment and Software (incl $ 0 for affiliated services) 5.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 5.5 Accreditation and Certification (incl $ 0 for affiliated services) 5.6 Other Expenses (incl $ 5.7 Subtotal before Reimbursements and Taxes (Lines 5.1 to 5.6) 5.8 Reimbursements by uninsured plans and fiscal intermediaries 5.9 Taxes, Licenses and Fees (in total, for tying purposes) 5.10 Total (5.7 to 5.9) 5.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Mini-Med Plans Expenses: 0 for affiliated services) 6.1 Salaries (including $ 6.2 Outsourced Services 0 for affiliated services) 6.3 EDP Equipment and Software (incl $ 0 for affiliated services) 6.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 6.5 Accreditation and Certification (incl $ 0 for affiliated services) 6.6 Other Expenses (incl $ 6.7 Subtotal before Reimbursements and Taxes (Lines 6.1 to 6.6) 6.8 Reimbursements by uninsured plans and fiscal intermediaries 6.9 Taxes, Licenses and Fees (in total, for tying purposes) 6.10 Total (6.7 to 6.9) 6.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 7. 8. 216-6.CO 9. Small Group Expatriate Plans Expenses: 0 for affiliated services) 7.1 Salaries (including $ 7.2 Outsourced Services 0 for affiliated services) 7.3 EDP Equipment and Software (incl $ 0 for affiliated services) 7.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 7.5 Accreditation and Certification (incl $ 0 for affiliated services) 7.6 Other Expenses (incl $ 7.7 Subtotal before Reimbursements and Taxes (Lines 7.1 to 7.6) 7.8 Reimbursements by uninsured plans and fiscal intermediaries 7.9 Taxes, Licenses and Fees (in total, for tying purposes) 7.10 Total (7.7 to 7.9) 7.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Expatriate Plans Expenses: 0 for affiliated services) 8.1 Salaries (including $ 8.2 Outsourced Services 0 for affiliated services) 8.3 EDP Equipment and Software (incl $ 0 for affiliated services) 8.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 8.5 Accreditation and Certification (incl $ 0 for affiliated services) 8.6 Other Expenses (incl $ 8.7 Subtotal before Reimbursements and Taxes (Lines 8.1 to 8.6) 8.8 Reimbursements by uninsured plans and fiscal intermediaries 8.9 Taxes, Licenses and Fees (in total, for tying purposes) 8.10 Total (8.7 to 8.9) 8.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Student Health Plans Expenses: 0 for affiliated services) 9.1 Salaries (including $ 9.2 Outsourced Services 0 for affiliated services) 9.3 EDP Equipment and Software (incl $ 0 for affiliated services) 9.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 9.5 Accreditation and Certification (incl $ 0 for affiliated services) 9.6 Other Expenses (incl $ 9.7 Subtotal before Reimbursements and Taxes (Lines 9.1 to 9.6) 9.8 Reimbursements by uninsured plans and fiscal intermediaries 9.9 Taxes, Licenses and Fees (in total, for tying purposes) 9.10 Total (9.7 to 9.9) 9.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 *79413201821607100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes - See Cautionary Statement at http://www.naic.org/documents/committees_e_app_blanks_related_shce_cautionary_statement.pdf) UnitedHealthcare Insurance Company 2. 185 Asylum Street Hartford, CT 061033408 (LOCATION) BUSINESS IN THE STATE OF Connecticut DURING THE YEAR 2018 NAIC Company Code Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 1. 216-1.CT 2. 3. 4. 5. 6. 7. 8. 9. Premium: 1.1 Health premiums earned (From Part 2, Line 1.11) 1.2 Federal high risk pools 1.3 State high risk pools 1.4 Premiums earned including state and federal high risk programs (Lines 1.1 + 1.2 + 1.3) 1.5 Federal taxes and federal assessments 1.6 State insurance, premium and other taxes (Similar local taxes of 218,479 ) $ 1.6a Community Benefit Expenditures (informational only) 1.7 Regulatory authority licenses and fees 1.8 Adjusted Premiums Earned (Lines 1.4 - 1.5 - 1.6 - 1.7) 1.9 Net Assumed less Ceded reinsurance premiums earned 1.10 Other Adjustments due to MLR calculations - Premiums 1.11 Risk Revenue 1.12 Net adjusted premiums earned after reinsurance (Lines 1.8 + 1.9 + 1.10 + 1.11) Claims: 2.1 Incurred claims excluding prescription drugs 2.2 Prescription drugs 2.3 Pharmaceutical rebates 2.4 State stop loss, market stabilization and claim/census based assessments (informational only) Incurred medical incentive pools and bonuses Deductible Fraud and Abuse Detection/Recovery Expenses (for MLR use only) 5.0 Total Incurred Claims (Lines 2.1 + 2.2 - 2.3 + 3) (From Part 2, Line 2.15) 5.1 Net Assumed less Ceded reinsurance claims incurred 5.2 Other Adjustments due to MLR calculations - Claims 5.3 Rebates paid 5.4 Estimated rebates unpaid prior year 5.5 Estimated rebates unpaid current year 5.6 Fee for service and co-pay revenue 5.7 Net incurred claims after reinsurance (Lines 5.0 + 5.1 + 5.2 + 5.3 - 5.4 + 5.5 - 5.6) Improving Health Care Quality Expenses Incurred: 6.1 Improve health outcomes 6.2 Activities to prevent hospital readmissions 6.3 Improve patient safety and reduce medical errors 6.4 Wellness and health promotion activities 6.5 Health Information Technology expenses related to health improvement 6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5) Preliminary Medical Loss Ratio: MLR ((Lines 4 + 5.0 + 6.6 - Footnote 2.0)/Line 1.8 Claims Adjustment Expenses: 8.1 Cost containment expenses not included in quality of care expenses in Line 6.6 8.2 All other claims adjustment expenses 8.3 Total claims adjustment expenses (Lines 8.1 + 8.2) Claims Adjustment Expense Ratio (Line 8.3/Line 1.8) 2 Small Group Employer 3 Large Group Employer 4 5 Small Group Employer Individual Expatriate Plans 6 Large Group Employer 7 11 Government Business (excluded by statute) Other Health Business 9 8 Small Group 10 Large Group Student Health Plans 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 79413 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 276,915 0 (2,680) 7,438,577 0 (178) 367,216,910 0 (54,907) 0 0 0 0 0 0 0 0 0 0 0 0 132,159,401 0 (2,401) 692,561,479 0 (44,600) 0 0 0 391,424,215 0 7,769 218,701,856 0 (7) 1,809,779,353 0 (97,003) XXX XXX XXX 1,809,779,353 0 (97,003) 274,236 (16,671) 7,438,398 540,098 367,162,003 9,834,570 0 0 0 0 0 0 0 0 132,157,000 2,385,659 692,516,879 26,990,189 0 (3) 391,431,985 (8,185,029) 218,701,849 12,220,546 1,809,682,350 43,769,358 XXX 40,097 1,809,682,350 43,809,455 (20,089) 0 298,620 12,376 216 86,644 0 99,236 106,064 0 24,307 6,767,929 21,054 10,563 0 6,799,546 4,457,005 0 633,942 352,236,486 (65,336,288) 71,030 0 286,971,228 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 817,898 0 78,291 128,875,152 2,640,920 1,727 0 131,517,799 10,234,442 0 52,967 655,239,281 38,338,525 0 0 693,577,806 8 0 0 (5) 0 0 0 (5) 5,352,172 0 54,289 394,210,553 (279,505) 1,207 0 393,932,255 22,915 0 0 206,458,387 588,578 791,828 0 207,838,793 20,970,415 0 1,142,416 1,743,800,160 (24,026,499) 962,997 0 1,720,736,658 XXX XXX XXX XXX XXX 20,970,411 0 1,142,416 1,743,760,068 (24,026,499) 962,997 0 1,720,696,566 135,561 25,575 17,391 3,096,028 1,433,319 338,365 249,252,322 63,903,777 17,310,937 0 0 0 0 0 0 0 0 0 0 0 0 73,251,490 9,570,049 2,434,518 457,050,573 110,993,103 26,524,436 8 0 0 243,106,190 140,308,323 152,668 120,225,431 128,674,532 73,357,067 1,146,117,602 454,908,679 120,135,382 XXX XXX XXX 1,146,117,602 454,908,679 120,135,382 808 596 24 144,341 26 0 0 0 0 0 144,367 91,566 26,777 783 4,217,759 (328) 0 0 0 0 0 4,217,431 2,862,984 1,163,141 54,311 297,008,303 (52,705,425) 5 0 5 0 0 244,302,878 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 332,239 83,489 0 80,470,510 1,566,985 0 0 0 0 0 82,037,495 722,084 23,051 40 541,542,292 32,521,740 0 0 0 0 0 574,064,032 8 0 0 8 0 0 0 (461,655) 36,762 175,081,240 0 0 0 0 0 0 175,081,240 4,019,549 950,615 91,920 1,481,841,514 (18,952,738) 5 0 5 0 0 1,462,888,776 XXX XXX 0 8 9,860 115,216 0 383,377,061 (335,736) 0 XXX XXX XXX 0 383,041,325 4,019,549 950,615 91,920 1,481,841,514 (18,952,738) 5 0 5 0 0 1,462,888,776 0 0 0 0 0 611,873 184,253 144,366 1,921,077 123,942 1,030,763 228,603 696,356 (20,602) 759,994 11,239,863 412,856 840,722 1,900,475 883,936 0 2,985,511 XXX 2,695,115 0.861 15,277,853 XXX (6,061,564) 12,482,784 6,421,220 0.031 3,287,064 30,798,324 34,085,388 XXX 2,215 0 0 0 0 59,509 0 0 0 0 2,937,735 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,057,275 0 0 0 0 5,540,492 0 0 0 0 2,215 11.217 59,509 0.632 2,937,735 0.852 0 0.000 0 0.000 0 0.000 0 0.000 1,057,275 0.633 5,540,492 0.835 5,670 7,068 12,738 1.029 82,769 94,389 177,158 0.026 3,406,886 4,376,994 7,783,880 0.022 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 (2.000) 43,839 147,337 191,176 0.001 5,522,654 9,827,368 15,350,022 0.023 XXX XXX XXX XXX 0 0 0 0.000 286,810 3,862,384 4,149,193 0.011 (4) 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 11,239,863 412,856 840,722 1,900,475 883,936 0 XXX 15,277,853 XXX (147,934) 0 (147,934) XXX 3,139,130 30,798,324 33,937,454 XXX SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 (Continued) Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 2 Small Group Employer Individual 10. General and Administrative (G&A) Expenses: 10.1 Direct sales salaries and benefits 10.2 Agents and brokers fees and commissions 10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below) 10.4 Other general and administrative expenses 10.4a Community Benefit Expenditures (informational only) 10.5 Total general and administrative (Lines 10.1 +10.2 + 10.3 + 10.4) 264 3,934 (421) 110,493 0 114,270 3 Large Group Employer 25,032 393,562 (16,393) 343,548 0 745,749 4 5 Small Group Employer Individual 1,407,272 13,394,490 390,825 6,120,577 0 21,313,163 0 0 0 0 0 0 Expatriate Plans 6 Large Group Employer 0 0 0 0 0 0 7 8 Small Group 0 0 0 0 0 0 Student Health Plans Large Group 0 0 0 0 0 0 10 11 Government Business (excluded by statute) Other Health Business 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 9 0 8,310,286 1,085,302 29,403,649 0 38,799,236 3,989,247 15,014,453 993,553 34,572,685 0 54,569,938 0 0 0 0 0 0 442,718 10,225,589 514,359 28,116,819 0 39,299,485 (13) 316,283 1,154,091 355,763 11,623,691 0 13,449,828 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 6,180,816 48,496,404 3,322,988 110,291,461 0 168,291,668 0 0 0 0 0 0 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) (35,543,260) 10,191,389 40,192,974 12. Income from fees of uninsured plans XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 13. Net investment and other gain/(loss) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 26,364,061 XXX 14. Federal income taxes (excluding taxes on Line 1.5 above) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 1,531,329 XXX 1,531,329 15. Net gain or (loss) (Lines 11 + 12 + 13 - 14) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 65,025,706 XXX 65,186,853 16. ICD-10 Implementation Expenses (informational only; already included in general expenses and line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16. 16a ICD-10 Implementation Expenses (informational only; already included in line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (174,354) 1,599,700 10,633,572 0 0 0 0 9,432,616 44,053,322 XXX 6,180,816 48,496,404 3,322,988 110,291,461 0 168,291,668 40,300,815 53,306 53,306 26,364,061 OTHER INDICATORS: 216-2.CT 1. Number of certificates/policies 40 747 30,855 0 0 0 0 632 348,552 0 195,361 78,813 655,000 0 655,000 2. Number of Covered Lives 43 1,274 57,243 0 0 0 0 31,944 359,124 0 275,965 78,813 804,406 0 804,406 3. Number of Groups 132 381 0 0 0 632 470 0 1,247 13 2,875 0 2,875 4. Member Months 14,009 675,423 0 0 0 384,695 4,135,606 0 3,312,492 958,790 9,481,627 0 9,481,627 XXX 612 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ XXX 0 ] If yes, show the amount of premiums and claims included. Premiums $ 0 Claims $ 0 AFFORDABLE CARE ACT (ACA) RECEIPTS, PAYMENTS, RECEIVABLES and PAYABLES Current Year Prior Year Comprehensive Health Coverage Comprehensive Health Coverage 1 2 3 4 Small Group Small Group Employer Plans Employer Plans Individual Plans Individual Plans ACA Receivables and Payables 1. Permanent ACA Risk Adjustment Program 1.0 Premium adjustments receivable/(payable) 2. Transitional ACA Reinsurance Program 2.0 Total amounts recoverable for claims (paid & unpaid) 7,755 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 0 0 0 0 0 0 8,746 398,365 2,457,916 14,215 (725,679) XXX 3,305 269,953 465,533 XXX 0 0 ACA Receipts and Payments 4. Permanent ACA Risk Adjustment Program 4.0 Premium adjustments receipts/(payments) 5. Transitional ACA Reinsurance Program 5.0 Amounts received for claims 6. Temporary ACA Risk Corridors Program 6.1 Retrospective premium received 6.2 Rate credits or policy experience refunds paid 262,199 0 0 XXX 1,557,994 99 0 0 0 (125,028) XXX 0 34,243 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF 185 Asylum Street Hartford, CT 061033408 Connecticut DURING THE YEAR Comprehensive Health Coverage 1 2 3 Individual Small Group Employer Large Group Employer Small Group Employer Individual Expatriate Plans: 7 8 6 Large Group Employer Small Group 10 11 Government Business (excluded by statute) Other Health Business 9 Student Health Plans Large Group 79413 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.CT Health Premiums Earned: 363,559 7,448,682 1.1 Direct premiums written 0 457 1.2 Unearned premium prior year 0 0 1.3 Unearned premium current year 0 457 1.4 Change in unearned premium (Lines 1.2 - 1.3) 105,542 (99) 1.5 Paid rate credits 0 0 1.6 Reserve for rate credits current year 0 0 1.7 Reserve for rate credits prior year 0 0 1.8 Change in reserve for rate credits (Lines 1.6 - 1.7) 86,644 10,563 1.9 Premium balances written off 0 0 1.10 Group conversion charge 276,915 7,438,577 1.11 Total direct premiums earned (Lines 1.1 + 1.4 - 1.9 + 1.10) 0 0 1.12 Assumed premiums earned from non-affiliates 216 21,054 1.13 Net Assumed less Ceded premiums earned from affiliates 0 0 1.14 Ceded premiums earned to non-affiliates 86,644 10,563 1.15 Other Adjustments due to MLR calculation - Premiums 258,233 7,470,292 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 329,309 6,069,567 2.1 Paid claims during the year 42,727 (1,078,731) 2.2 Direct claim liability current year 258,774 730,485 2.3 Direct claim liability prior year 2,092 145 2.4 Direct claim reserves current year 14,915 8,383 2.5 Direct claim reserves prior year 194,080 0 2.6 Direct contract reserves current year 259,401 0 2.7 Direct contract reserves prior year 105,542 (99) 2.8 Paid rate credits 0 0 2.9 Reserve for rate credits current year 0 0 2.10 Reserve for rate credits prior year 596 26,777 2.11 Incurred medical incentive pools and bonuses (Lines 2.11a + 2.11b - 2.11c) 1,040 11,955 2.11a Paid medical incentive pools and bonuses current year 491 20,381 2.11b Accrued medical incentive pools and bonuses current year 934 5,559 2.11c Accrued medical incentive pools and bonuses prior year (3,085) 61,032 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 1,032 197,278 2.12a Healthcare receivables current year 4,116 136,246 2.12b Healthcare receivables prior year 0 0 2.13 Group conversion charge 0 0 2.14 Multi-option coverage blended rate adjustment 2.15 Total incurred claims (Lines 2.1 + 2.2 - 2.3 + 2.4 - 2.5 + 2.6 - 2.7 + 2.8 + 2.9 144,341 4,217,759 2.10 + 2.11 - 2.12 + 2.13 + 2.14) 0 0 2.16 Assumed incurred claims from non-affiliates 26 (328) 2.17 Net assumed less ceded incurred claims from affiliates 0 0 2.18 Ceded incurred claims to non-affiliates 0 0 2.19 Other adjustments due to MLR calculation - Claims 38,824 4,217,530 2.20 Net Incurred Claims (Lines 2.15 - 2.8 - 2.9 + 2.10 + 2.16 + 2.17 - 2.18 + 2.19) 3. Fraud and Abuse Recoveries that Reduced PAID Claims in Line 2.1 above 24 783 (informational only) 11,797,464 for stand-alone dental and $ (a) Column 13, Line 1.1 includes direct written premium of $ 4 Business Subject to MLR Mini-Med Plans 5 (LOCATION) NAIC Company Code 2018 367,284,424 0 (3,516) 3,516 52,488 1,073,938 1,036,430 37,508 71,030 0 367,216,910 690,744 41,682 66,068,713 71,030 301,861,656 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 132,161,128 0 0 0 0 0 0 0 1,727 0 132,159,401 0 2,640,920 0 1,727 134,802,048 716,540,489 224,427,367 248,406,377 (23,979,010) 0 2,834,678 0 2,834,678 0 0 692,561,479 12,774,339 23,302,597 (2,261,589) 0 728,065,326 289,069,903 30,411,872 22,582,047 845,881 641,911 0 0 52,488 1,073,938 1,036,430 1,163,141 548,635 928,206 313,700 1,348,532 6,906,873 5,558,341 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 80,266,361 19,623,252 19,365,847 265,678 234,308 0 0 0 0 0 83,489 34,561 147,741 98,813 168,116 866,050 697,935 0 0 535,736,429 99,550,684 95,580,258 11,357 5,055 0 0 0 2,834,678 0 23,051 3,484 24,264 4,697 1,028,594 9,503,359 8,474,765 0 0 297,008,303 308,812 10,792 53,025,029 0 244,212,882 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 80,470,510 0 1,567,389 404 0 82,037,495 541,542,292 9,190,277 21,167,561 (2,163,902) 0 571,229,354 54,311 0 0 4,876,554 for stand-alone vision policies. 0 0 0 40 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 391,415,787 63,132 53,496 9,636 896,398 229,893 130,581 99,311 1,207 0 391,424,215 0 0 279,505 1,207 390,150,208 219,493,683 0 0 0 3,628,841 5,453,159 5,469,863 (16,704) 791,828 0 218,701,855 0 588,578 0 791,828 216,470,125 1,834,707,752 224,490,956 248,456,358 (23,965,402) 4,683,170 9,591,667 6,636,874 2,954,793 962,997 0 1,809,779,353 13,465,083 26,595,047 64,086,628 962,997 1,779,077,888 376,471,590 31,196,647 27,382,470 11,009,858 10,082,154 90,846 32,205 896,398 229,893 130,581 115,216 115,216 0 0 (994,026) (992,697) 1,330 0 0 172,831,924 2,966,568 8,960,964 486 269 0 0 3,628,841 5,453,159 5,469,863 (461,655) 113,708 27,940 603,302 (5,093,014) 29,884,164 34,977,179 0 0 1,460,764,836 182,713,018 174,850,591 12,135,498 10,986,996 284,926 291,606 4,683,170 9,591,667 6,636,874 950,615 828,599 1,149,022 1,027,005 (3,483,852) 46,366,059 49,849,911 0 0 8 0 0 0 0 8 383,377,061 0 0 335,736 0 382,045,616 175,081,240 0 0 0 0 171,469,104 1,481,841,514 9,499,090 22,745,439 51,197,267 0 1,455,250,812 0 0 36,762 91,920 (10,247) 0 (10,254) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF Connecticut DURING THE YEAR All Expenses 1 Improve Health Outcomes 1. Individual Comprehensive Coverage Expenses: 11,920 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 286 for affiliated services) 1.3 EDP Equipment and Software (incl $ 27 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 3 for affiliated services) 1.5 Accreditation and Certification (incl $ 7,352 for affiliated services) 1.6 Other Expenses (incl $ 1.7 Subtotal before Reimbursements and Taxes (Lines 1.1 to 1.6) 1.8 Reimbursements by uninsured plans and fiscal intermediaries 1.9 Taxes, Licenses and Fees (in total, for tying purposes) 1.10 Total (1.7 to 1.9) 1.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 2. 216-4.CT 3. 0 0 0 0 0 2,215 2,215 0 XXX Small Group Comprehensive Coverage Expenses: 160,228 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 11,365 for affiliated services) 2.3 EDP Equipment and Software (incl $ 1,091 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 118 for affiliated services) 2.5 Accreditation and Certification (incl $ 373,921 for affiliated services) 2.6 Other Expenses (incl $ 2.7 Subtotal before Reimbursements and Taxes (Lines 2.1 to 2.6) 2.8 Reimbursements by uninsured plans and fiscal intermediaries 2.9 Taxes, Licenses and Fees (in total, for tying purposes) 2.10 Total (2.7 to 2.9) 2.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Comprehensive Coverage Expenses: 6,642,461 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 441,389 for affiliated services) 3.3 EDP Equipment and Software (incl $ 42,368 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 4,600 for affiliated services) 3.5 Accreditation and Certification (incl $ 14,775,155 for affiliated services) 3.6 Other Expenses (incl $ 3.7 Subtotal before Reimbursements and Taxes (Lines 3.1 to 3.6) 3.8 Reimbursements by uninsured plans and fiscal intermediaries 3.9 Taxes, Licenses and Fees (in total, for tying purposes) 3.10 Total (3.7 to 3.9) 3.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 185 Asylum Street Hartford, CT 061033408 Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX Total (1 to 5) 0 0 0 0 0 2,215 2,215 0 XXX 0 0 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 0 0 0 0 0 0 0 XXX (LOCATION) NAIC Company Code 2018 XXX 566 3,760 47 5 0 1,267 5,646 0 XXX 3,785 115 76 7 1 3,058 7,042 0 XXX 2,215 0 0 0 0 0 0 0 0 0 2,215 0 5,646 213 7,042 0 0 0 0 0 0 59,509 59,509 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 59,509 59,509 0 19,553 13,581 1,633 157 17 45,494 80,435 0 26,689 3,059 2,229 214 23 59,691 91,905 0 XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX XXX XXX 59,509 0 0 0 0 0 0 0 0 0 59,509 0 80,435 20,149 91,905 0 0 0 0 0 0 2,937,735 2,937,735 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,937,735 2,937,735 0 855,346 399,765 71,425 6,856 744 1,970,546 3,304,682 0 1,246,281 142,826 104,070 9,990 1,085 2,787,390 4,291,642 0 2,937,735 0 XXX 3,304,682 951,610 XXX 4,291,642 0 XXX 2,937,735 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 79413 9 10 General Administrative Expenses Total Expenses (6 to 9) 7,569 1,189 162 2 2 105,749 114,673 0 278,179 392,852 0 11,920 5,063 286 14 3 112,289 129,575 0 278,179 407,755 213 113,987 12,459 7,503 720 78 625,624 760,372 0 120,566 880,938 0 160,228 29,099 11,365 1,091 118 790,318 992,220 0 120,566 1,112,786 20,149 4,540,835 520,716 265,893 25,523 2,771 15,475,198 20,830,935 4 5,760,726 26,591,666 0 6,642,461 1,063,307 441,389 42,368 4,600 23,170,870 31,364,995 4 5,760,726 37,125,726 951,610 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 4. 5. 216-5.CT 6. Individual Mini-Med Plans Expenses: 0 for affiliated services) 4.1 Salaries (including $ 4.2 Outsourced Services 0 for affiliated services) 4.3 EDP Equipment and Software (incl $ 0 for affiliated services) 4.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 4.5 Accreditation and Certification (incl $ 0 for affiliated services) 4.6 Other Expenses (incl $ 4.7 Subtotal before Reimbursements and Taxes (Lines 4.1 to 4.6) 4.8 Reimbursements by uninsured plans and fiscal intermediaries 4.9 Taxes, Licenses and Fees (in total, for tying purposes) 4.10 Total (4.7 to 4.9) 4.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Mini-Med Plans Expenses: 0 for affiliated services) 5.1 Salaries (including $ 5.2 Outsourced Services 0 for affiliated services) 5.3 EDP Equipment and Software (incl $ 0 for affiliated services) 5.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 5.5 Accreditation and Certification (incl $ 0 for affiliated services) 5.6 Other Expenses (incl $ 5.7 Subtotal before Reimbursements and Taxes (Lines 5.1 to 5.6) 5.8 Reimbursements by uninsured plans and fiscal intermediaries 5.9 Taxes, Licenses and Fees (in total, for tying purposes) 5.10 Total (5.7 to 5.9) 5.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Mini-Med Plans Expenses: 0 for affiliated services) 6.1 Salaries (including $ 6.2 Outsourced Services 0 for affiliated services) 6.3 EDP Equipment and Software (incl $ 0 for affiliated services) 6.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 6.5 Accreditation and Certification (incl $ 0 for affiliated services) 6.6 Other Expenses (incl $ 6.7 Subtotal before Reimbursements and Taxes (Lines 6.1 to 6.6) 6.8 Reimbursements by uninsured plans and fiscal intermediaries 6.9 Taxes, Licenses and Fees (in total, for tying purposes) 6.10 Total (6.7 to 6.9) 6.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 7. 8. Small Group Expatriate Plans Expenses: 0 for affiliated services) 7.1 Salaries (including $ 7.2 Outsourced Services 0 for affiliated services) 7.3 EDP Equipment and Software (incl $ 0 for affiliated services) 7.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 7.5 Accreditation and Certification (incl $ 0 for affiliated services) 7.6 Other Expenses (incl $ 7.7 Subtotal before Reimbursements and Taxes (Lines 7.1 to 7.6) 7.8 Reimbursements by uninsured plans and fiscal intermediaries 7.9 Taxes, Licenses and Fees (in total, for tying purposes) 7.10 Total (7.7 to 7.9) 7.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Expatriate Plans Expenses: 8,518,248 for affiliated services) 8.1 Salaries (including $ 8.2 Outsourced Services 711,313 for affiliated services) 8.3 EDP Equipment and Software (incl $ 68,278 for affiliated services) 8.4 Other Equipment (excl. EDP) (incl $ 7,414 for affiliated services) 8.5 Accreditation and Certification (incl $ 19,598,134 for affiliated services) 8.6 Other Expenses (incl $ 216-6.CT 8.7 Subtotal before Reimbursements and Taxes (Lines 8.1 to 8.6) 8.8 Reimbursements by uninsured plans and fiscal intermediaries 8.9 Taxes, Licenses and Fees (in total, for tying purposes) 8.10 Total (8.7 to 8.9) 8.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 9. Student Health Plans Expenses: 17,060,918 for affiliated services) 9.1 Salaries (including $ 9.2 Outsourced Services 1,103,525 for affiliated services) 9.3 EDP Equipment and Software (incl $ 105,925 for affiliated services) 9.4 Other Equipment (excl. EDP) (incl $ 11,501 for affiliated services) 9.5 Accreditation and Certification (incl $ 33,113,789 for affiliated services) 9.6 Other Expenses (incl $ 9.7 Subtotal before Reimbursements and Taxes (Lines 9.1 to 9.6) 9.8 Reimbursements by uninsured plans and fiscal intermediaries 9.9 Taxes, Licenses and Fees (in total, for tying purposes) 9.10 Total (9.7 to 9.9) 9.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 12,731 1,459 42,786 4,903 8,462,731 971,050 8,518,248 977,413 0 0 0 1,057,275 1,057,275 0 0 0 0 0 0 0 0 0 0 0 0 1,057,275 1,057,275 0 1,063 102 11 28,473 43,839 0 3,573 343 37 95,694 147,337 0 706,677 67,833 7,365 27,498,278 37,713,934 0 1,981,491 39,695,425 0 711,313 68,278 7,414 28,679,721 38,962,386 0 1,981,491 40,943,877 81 12,736,282 1,020,596 742,398 71,261 7,738 38,799,939 53,378,214 0 11,932,485 65,310,699 0 17,060,918 1,520,099 1,103,525 105,925 11,501 54,013,408 73,815,376 0 11,932,485 85,747,861 103,357 XXX 1,057,275 0 0 0 0 0 0 5,540,492 5,540,492 0 XXX 5,540,492 0 XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 1,057,275 0 43,839 81 147,337 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5,540,492 5,540,492 0 1,548,787 181,385 129,331 12,414 1,348 3,464,607 5,337,872 0 2,775,849 318,118 231,796 22,250 2,416 6,208,370 9,558,798 0 5,540,492 0 XXX 5,337,872 103,357 XXX 9,558,798 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 *79413201821608100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes - See Cautionary Statement at http://www.naic.org/documents/committees_e_app_blanks_related_shce_cautionary_statement.pdf) UnitedHealthcare Insurance Company 2. 185 Asylum Street Hartford, CT 061033408 (LOCATION) BUSINESS IN THE STATE OF Delaware DURING THE YEAR 2018 NAIC Company Code Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 1. 216-1.DE 2. 3. 4. 5. 6. 7. 8. 9. Premium: 1.1 Health premiums earned (From Part 2, Line 1.11) 1.2 Federal high risk pools 1.3 State high risk pools 1.4 Premiums earned including state and federal high risk programs (Lines 1.1 + 1.2 + 1.3) 1.5 Federal taxes and federal assessments 1.6 State insurance, premium and other taxes (Similar local taxes of 14,812 ) $ 1.6a Community Benefit Expenditures (informational only) 1.7 Regulatory authority licenses and fees 1.8 Adjusted Premiums Earned (Lines 1.4 - 1.5 - 1.6 - 1.7) 1.9 Net Assumed less Ceded reinsurance premiums earned 1.10 Other Adjustments due to MLR calculations - Premiums 1.11 Risk Revenue 1.12 Net adjusted premiums earned after reinsurance (Lines 1.8 + 1.9 + 1.10 + 1.11) Claims: 2.1 Incurred claims excluding prescription drugs 2.2 Prescription drugs 2.3 Pharmaceutical rebates 2.4 State stop loss, market stabilization and claim/census based assessments (informational only) Incurred medical incentive pools and bonuses Deductible Fraud and Abuse Detection/Recovery Expenses (for MLR use only) 5.0 Total Incurred Claims (Lines 2.1 + 2.2 - 2.3 + 3) (From Part 2, Line 2.15) 5.1 Net Assumed less Ceded reinsurance claims incurred 5.2 Other Adjustments due to MLR calculations - Claims 5.3 Rebates paid 5.4 Estimated rebates unpaid prior year 5.5 Estimated rebates unpaid current year 5.6 Fee for service and co-pay revenue 5.7 Net incurred claims after reinsurance (Lines 5.0 + 5.1 + 5.2 + 5.3 - 5.4 + 5.5 - 5.6) Improving Health Care Quality Expenses Incurred: 6.1 Improve health outcomes 6.2 Activities to prevent hospital readmissions 6.3 Improve patient safety and reduce medical errors 6.4 Wellness and health promotion activities 6.5 Health Information Technology expenses related to health improvement 6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5) Preliminary Medical Loss Ratio: MLR ((Lines 4 + 5.0 + 6.6 - Footnote 2.0)/Line 1.8 Claims Adjustment Expenses: 8.1 Cost containment expenses not included in quality of care expenses in Line 6.6 8.2 All other claims adjustment expenses 8.3 Total claims adjustment expenses (Lines 8.1 + 8.2) Claims Adjustment Expense Ratio (Line 8.3/Line 1.8) 2 Small Group Employer 3 Large Group Employer 4 5 Small Group Employer Individual Expatriate Plans 6 Large Group Employer 7 11 Government Business (excluded by statute) Other Health Business 9 8 Small Group 10 Student Health Plans Large Group 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 79413 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 156,353 0 (171) 3,334,895 0 (382) 10,943,924 0 (162) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 98,020,068 0 55,099 43,293,407 0 0 155,748,647 0 54,384 XXX XXX XXX 156,183 12,055 3,334,513 213,898 10,943,762 499,556 0 0 0 0 0 0 0 0 0 0 0 0 0 784,538 98,075,168 957,288 43,293,407 1,725,718 155,803,032 4,193,053 XXX 5,016 0 95 139,017 0 0 0 139,017 134,134 0 1,413 2,985,068 1,200 2,571 0 2,988,838 382,203 0 5,109 10,056,894 (441,091) 0 0 9,615,803 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (784,538) 0 0 0 (784,538) 1,225,187 0 (23,203) 95,915,895 (133,967) 142 0 95,782,070 5,232 0 0 41,562,456 0 222,110 0 41,784,567 1,751,772 0 (16,587) 149,874,793 (573,858) 224,822 0 149,525,757 XXX XXX XXX XXX XXX 1,751,772 0 (16,587) 149,874,793 (573,858) 224,822 0 149,525,757 (34,195) 127,413 16,091 1,689,834 334,357 127,497 7,892,671 693,673 301,746 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 75,622,028 1,337,554 223,435 13,760,046 45,828,994 25,258,342 98,930,384 48,321,991 25,927,112 XXX XXX XXX 98,930,384 48,321,991 25,927,112 0 0 0 77,128 0 0 0 0 0 0 77,128 5,363 1,467 428 1,898,160 0 0 0 0 0 0 1,898,160 6,565 3,256 170 8,287,854 (276,976) (432,263) 569,610 174,179 38,920 0 8,012,965 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,289 69 0 76,736,215 (66,398) 190 XXX XXX XXX 0 76,670,007 0 0 0 34,330,698 0 0 0 0 0 0 34,330,698 13,217 4,792 598 121,330,054 (4,280,947) (432,073) 569,610 174,179 38,920 0 117,051,384 XXX XXX 13,217 4,792 598 121,330,054 (4,280,947) (432,073) 569,610 174,179 38,920 0 117,051,384 1,251 0 0 0 0 26,679 0 0 0 0 87,551 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,251 0.564 26,679 0.645 87,551 0.833 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 964 2,514 3,478 0.025 39,565 55,130 94,695 0.032 61,187 73,950 135,138 0.013 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0 0 0 0 (3,937,573) 0 XXX XXX XXX 0 (3,937,573) 0 0 0 0 0 249,001 86,314 65,054 786,551 48,626 0 1,235,546 XXX 158,352 0.830 1,509,379 XXX 39,466 1,425,969 1,465,435 0.015 363,462 520,307 883,769 0.021 504,644 2,077,870 2,582,514 XXX XXX 0 0 0 0.000 59,106 31,784 23,442 (19,376) 63,395 155,748,647 0 54,384 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 423,588 118,098 88,496 767,175 112,021 0 0 0 0 0 423,588 118,098 88,496 767,175 112,021 0 1,509,379 XXX 0 0 0 504,644 2,077,870 2,582,514 XXX XXX XXX 155,803,032 4,193,053 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 (Continued) Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 2 Small Group Employer Individual 10. General and Administrative (G&A) Expenses: 10.1 Direct sales salaries and benefits 10.2 Agents and brokers fees and commissions 10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below) 10.4 Other general and administrative expenses 10.4a Community Benefit Expenditures (informational only) 10.5 Total general and administrative (Lines 10.1 +10.2 + 10.3 + 10.4) 252 1,739 (167) 7,306 0 9,130 3 Large Group Employer 13,459 97,552 (130) 170,270 0 281,151 4 5 Small Group Employer Individual 20,780 347,901 (3,667) 154,497 0 519,511 0 0 0 0 0 0 Expatriate Plans 6 Large Group Employer 0 0 0 0 0 0 7 8 Small Group 0 0 0 0 0 0 Student Health Plans Large Group 0 0 0 0 0 0 10 11 Government Business (excluded by statute) Other Health Business 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 121,115 3,556,009 171,542 9,459,155 0 13,307,821 82,549 97,183 86,257 2,895,007 0 3,160,996 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 238,156 4,100,384 253,836 12,686,234 0 17,278,609 0 0 0 0 0 0 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) 12. Income from fees of uninsured plans XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 13. Net investment and other gain/(loss) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 14. Federal income taxes (excluding taxes on Line 1.5 above) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 15. Net gain or (loss) (Lines 11 + 12 + 13 - 14) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 16. ICD-10 Implementation Expenses (informational only; already included in general expenses and line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16. 16a ICD-10 Implementation Expenses (informational only; already included in line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 48,031 688,153 860,638 0 0 0 0 0 0 3,153,035 3,103,261 3,250,752 11,103,870 XXX 238,156 4,100,384 253,836 12,686,234 0 17,278,609 XXX 11,103,870 0 0 2,310,895 XXX XXX 17,472 XXX 17,472 XXX 13,397,293 XXX 13,397,293 2,310,895 OTHER INDICATORS: 216-2.DE 1. Number of certificates/policies 17 472 596 0 0 0 0 0 0 0 51,693 31,682 84,460 0 84,460 2. Number of Covered Lives 22 828 1,471 0 0 0 0 0 0 0 56,860 31,682 90,863 0 90,863 3. Number of Groups 109 24 0 0 0 0 0 0 200 2 335 0 335 4. Member Months 7,532 21,868 0 0 0 0 0 0 668,667 380,378 1,078,700 0 1,078,700 XXX 255 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ XXX 0 ] If yes, show the amount of premiums and claims included. Premiums $ 0 Claims $ 0 AFFORDABLE CARE ACT (ACA) RECEIPTS, PAYMENTS, RECEIVABLES and PAYABLES Current Year Prior Year Comprehensive Health Coverage Comprehensive Health Coverage 1 2 3 4 Small Group Small Group Employer Plans Employer Plans Individual Plans Individual Plans ACA Receivables and Payables 1. Permanent ACA Risk Adjustment Program 1.0 Premium adjustments receivable/(payable) 2. Transitional ACA Reinsurance Program 2.0 Total amounts recoverable for claims (paid & unpaid) 0 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 0 0 6,704 (833,640) XXX (76,690) 0 0 0 (309,681) XXX 0 0 0 0 ACA Receipts and Payments 4. Permanent ACA Risk Adjustment Program 4.0 Premium adjustments receipts/(payments) 5. Transitional ACA Reinsurance Program 5.0 Amounts received for claims 0 6. Temporary ACA Risk Corridors Program 6.1 Retrospective premium received 6.2 Rate credits or policy experience refunds paid 0 0 (72,692) (372,124) XXX (79,090) 0 0 0 0 0 (156,084) XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF 185 Asylum Street Hartford, CT 061033408 Delaware DURING THE YEAR Comprehensive Health Coverage 1 2 3 Individual Small Group Employer Large Group Employer Small Group Employer Individual Expatriate Plans: 7 8 6 Large Group Employer Small Group 10 11 Government Business (excluded by statute) Other Health Business 9 Student Health Plans Large Group 79413 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.DE Health Premiums Earned: 156,353 3,337,473 1.1 Direct premiums written 0 727 1.2 Unearned premium prior year 0 735 1.3 Unearned premium current year 0 (8) 1.4 Change in unearned premium (Lines 1.2 - 1.3) (536,250) 0 1.5 Paid rate credits 0 0 1.6 Reserve for rate credits current year 0 0 1.7 Reserve for rate credits prior year 0 0 1.8 Change in reserve for rate credits (Lines 1.6 - 1.7) 0 2,571 1.9 Premium balances written off 0 0 1.10 Group conversion charge 156,353 3,334,895 1.11 Total direct premiums earned (Lines 1.1 + 1.4 - 1.9 + 1.10) 0 0 1.12 Assumed premiums earned from non-affiliates 0 1,200 1.13 Net Assumed less Ceded premiums earned from affiliates 0 0 1.14 Ceded premiums earned to non-affiliates 0 2,571 1.15 Other Adjustments due to MLR calculation - Premiums 692,603 3,338,665 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 587,506 1,755,838 2.1 Paid claims during the year 21,428 326,030 2.2 Direct claim liability current year 7,030 125,533 2.3 Direct claim liability prior year 8,445 10,504 2.4 Direct claim reserves current year 1,043 6,111 2.5 Direct claim reserves prior year 47,644 0 2.6 Direct contract reserves current year 38,022 0 2.7 Direct contract reserves prior year (536,250) 0 2.8 Paid rate credits 0 0 2.9 Reserve for rate credits current year 0 0 2.10 Reserve for rate credits prior year 0 1,467 2.11 Incurred medical incentive pools and bonuses (Lines 2.11a + 2.11b - 2.11c) 0 551 2.11a Paid medical incentive pools and bonuses current year 0 1,691 2.11b Accrued medical incentive pools and bonuses current year 0 775 2.11c Accrued medical incentive pools and bonuses prior year 5,552 64,035 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 5,552 73,306 2.12a Healthcare receivables current year 0 9,271 2.12b Healthcare receivables prior year 0 0 2.13 Group conversion charge 0 0 2.14 Multi-option coverage blended rate adjustment 2.15 Total incurred claims (Lines 2.1 + 2.2 - 2.3 + 2.4 - 2.5 + 2.6 - 2.7 + 2.8 + 2.9 77,128 1,898,160 2.10 + 2.11 - 2.12 + 2.13 + 2.14) 0 0 2.16 Assumed incurred claims from non-affiliates 0 0 2.17 Net assumed less ceded incurred claims from affiliates 0 0 2.18 Ceded incurred claims to non-affiliates 0 0 2.19 Other adjustments due to MLR calculation - Claims 613,377 1,898,160 2.20 Net Incurred Claims (Lines 2.15 - 2.8 - 2.9 + 2.10 + 2.16 + 2.17 - 2.18 + 2.19) 3. Fraud and Abuse Recoveries that Reduced PAID Claims in Line 2.1 above 0 428 (informational only) 507,917 for stand-alone dental and $ (a) Column 13, Line 1.1 includes direct written premium of $ 4 Business Subject to MLR Mini-Med Plans 5 (LOCATION) NAIC Company Code 2018 11,193,924 (250,000) 0 (250,000) 566,835 2,580,133 1,129,645 1,450,488 0 0 10,943,924 0 17 441,108 0 8,485,510 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6,017,223 538,441 265,617 8,332 17,727 0 0 566,835 2,580,133 1,129,645 3,256 1,195 6,570 4,509 13,375 116,261 102,886 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8,287,854 0 0 276,976 0 5,993,555 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 170 0 0 299,146 for stand-alone vision policies. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 98,059,951 39,427 79,168 (39,741) (199,912) 37,319 356,482 (319,163) 142 0 98,020,068 0 0 133,967 142 98,405,317 43,515,517 0 0 0 (59,190) (1,514,489) (433,364) (1,081,125) 222,110 0 43,293,407 0 0 0 222,110 44,655,832 156,263,218 (209,846) 79,903 (289,749) (228,516) 1,102,963 1,052,762 50,200 224,822 0 155,748,647 0 1,217 575,075 224,822 155,577,927 (325,101) 1,575,776 1,250,674 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 75,826,816 10,431,243 9,175,917 2,664,339 2,467,449 4,570 19,092 (199,912) 37,319 356,482 69 69 0 0 9,289 96,453 87,164 0 0 35,516,929 1,723,055 1,408,363 47 47 0 0 (59,190) (1,514,489) (433,364) 0 0 0 0 360,608 9,457,644 9,097,036 0 0 119,379,210 14,615,973 12,233,134 2,691,667 2,492,379 52,215 57,114 (228,516) 1,102,963 1,052,762 4,792 1,815 8,261 5,284 452,859 9,749,215 9,296,356 0 0 0 0 (3,937,573) 0 0 (3,937,573) 76,736,215 0 0 66,398 0 77,188,892 34,330,698 0 0 0 0 35,471,013 121,330,054 0 (3,937,573) 343,374 0 117,227,424 0 0 0 598 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF Delaware DURING THE YEAR All Expenses 1 Improve Health Outcomes 1. Individual Comprehensive Coverage Expenses: 4,077 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 156 for affiliated services) 1.3 EDP Equipment and Software (incl $ 15 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 2 for affiliated services) 1.5 Accreditation and Certification (incl $ 4,436 for affiliated services) 1.6 Other Expenses (incl $ 1.7 Subtotal before Reimbursements and Taxes (Lines 1.1 to 1.6) 1.8 Reimbursements by uninsured plans and fiscal intermediaries 1.9 Taxes, Licenses and Fees (in total, for tying purposes) 1.10 Total (1.7 to 1.9) 1.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 2. 216-4.DE 3. 0 0 0 0 0 1,251 1,251 0 XXX Small Group Comprehensive Coverage Expenses: 84,994 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 6,014 for affiliated services) 2.3 EDP Equipment and Software (incl $ 577 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 63 for affiliated services) 2.5 Accreditation and Certification (incl $ 191,278 for affiliated services) 2.6 Other Expenses (incl $ 2.7 Subtotal before Reimbursements and Taxes (Lines 2.1 to 2.6) 2.8 Reimbursements by uninsured plans and fiscal intermediaries 2.9 Taxes, Licenses and Fees (in total, for tying purposes) 2.10 Total (2.7 to 2.9) 2.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX Total (1 to 5) 0 0 0 0 0 1,251 1,251 0 XXX 0 0 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 0 0 0 0 0 0 0 XXX (LOCATION) NAIC Company Code 2018 XXX 273 31 23 2 0 611 940 0 XXX 1,139 54 38 4 0 1,254 2,489 0 XXX 1,251 0 0 0 0 0 0 0 0 0 1,251 0 940 203 2,489 0 0 0 0 0 0 26,679 26,679 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 26,679 26,679 0 10,464 2,796 874 84 9 24,083 38,310 0 15,622 1,790 1,304 125 14 34,939 53,794 0 XXX Large Group Comprehensive Coverage Expenses: 121,751 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 8,494 for affiliated services) 3.3 EDP Equipment and Software (incl $ 815 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 89 for affiliated services) 3.5 Accreditation and Certification (incl $ 269,376 for affiliated services) 3.6 Other Expenses (incl $ 3.7 Subtotal before Reimbursements and Taxes (Lines 3.1 to 3.6) 3.8 Reimbursements by uninsured plans and fiscal intermediaries 3.9 Taxes, Licenses and Fees (in total, for tying purposes) 3.10 Total (3.7 to 3.9) 3.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 185 Asylum Street Hartford, CT 061033408 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX XXX XXX 26,679 0 0 0 0 0 0 0 0 0 26,679 0 38,310 10,833 53,794 0 0 0 0 0 0 87,551 87,551 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 87,551 87,551 0 16,250 4,249 1,357 130 14 37,210 59,211 (8) 20,958 2,402 1,750 168 18 46,874 72,170 1 XXX XXX XXX 0 0 0 XXX 87,551 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 87,551 0 XXX 59,203 18,039 72,172 0 79413 9 10 General Administrative Expenses Total Expenses (6 to 9) 2,665 126 95 6 1 6,386 9,279 0 5,010 14,289 0 4,077 211 156 12 2 9,502 13,959 0 5,010 18,969 203 58,909 5,677 3,836 368 40 211,500 280,329 0 138,959 419,289 0 84,994 10,263 6,014 577 63 297,201 399,113 0 138,959 538,072 10,833 84,543 10,081 5,387 517 56 421,036 521,620 7 388,960 910,586 0 121,751 16,732 8,494 815 89 592,672 740,552 0 388,960 1,129,512 18,039 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 4. 5. 216-5.DE 6. Individual Mini-Med Plans Expenses: 0 for affiliated services) 4.1 Salaries (including $ 4.2 Outsourced Services 0 for affiliated services) 4.3 EDP Equipment and Software (incl $ 0 for affiliated services) 4.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 4.5 Accreditation and Certification (incl $ 0 for affiliated services) 4.6 Other Expenses (incl $ 4.7 Subtotal before Reimbursements and Taxes (Lines 4.1 to 4.6) 4.8 Reimbursements by uninsured plans and fiscal intermediaries 4.9 Taxes, Licenses and Fees (in total, for tying purposes) 4.10 Total (4.7 to 4.9) 4.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Mini-Med Plans Expenses: 0 for affiliated services) 5.1 Salaries (including $ 5.2 Outsourced Services 0 for affiliated services) 5.3 EDP Equipment and Software (incl $ 0 for affiliated services) 5.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 5.5 Accreditation and Certification (incl $ 0 for affiliated services) 5.6 Other Expenses (incl $ 5.7 Subtotal before Reimbursements and Taxes (Lines 5.1 to 5.6) 5.8 Reimbursements by uninsured plans and fiscal intermediaries 5.9 Taxes, Licenses and Fees (in total, for tying purposes) 5.10 Total (5.7 to 5.9) 5.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Mini-Med Plans Expenses: 0 for affiliated services) 6.1 Salaries (including $ 6.2 Outsourced Services 0 for affiliated services) 6.3 EDP Equipment and Software (incl $ 0 for affiliated services) 6.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 6.5 Accreditation and Certification (incl $ 0 for affiliated services) 6.6 Other Expenses (incl $ 6.7 Subtotal before Reimbursements and Taxes (Lines 6.1 to 6.6) 6.8 Reimbursements by uninsured plans and fiscal intermediaries 6.9 Taxes, Licenses and Fees (in total, for tying purposes) 6.10 Total (6.7 to 6.9) 6.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 7. 8. 216-6.DE 9. Small Group Expatriate Plans Expenses: 0 for affiliated services) 7.1 Salaries (including $ 7.2 Outsourced Services 0 for affiliated services) 7.3 EDP Equipment and Software (incl $ 0 for affiliated services) 7.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 7.5 Accreditation and Certification (incl $ 0 for affiliated services) 7.6 Other Expenses (incl $ 7.7 Subtotal before Reimbursements and Taxes (Lines 7.1 to 7.6) 7.8 Reimbursements by uninsured plans and fiscal intermediaries 7.9 Taxes, Licenses and Fees (in total, for tying purposes) 7.10 Total (7.7 to 7.9) 7.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Expatriate Plans Expenses: 0 for affiliated services) 8.1 Salaries (including $ 8.2 Outsourced Services 0 for affiliated services) 8.3 EDP Equipment and Software (incl $ 0 for affiliated services) 8.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 8.5 Accreditation and Certification (incl $ 0 for affiliated services) 8.6 Other Expenses (incl $ 8.7 Subtotal before Reimbursements and Taxes (Lines 8.1 to 8.6) 8.8 Reimbursements by uninsured plans and fiscal intermediaries 8.9 Taxes, Licenses and Fees (in total, for tying purposes) 8.10 Total (8.7 to 8.9) 8.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Student Health Plans Expenses: 0 for affiliated services) 9.1 Salaries (including $ 9.2 Outsourced Services 0 for affiliated services) 9.3 EDP Equipment and Software (incl $ 0 for affiliated services) 9.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 9.5 Accreditation and Certification (incl $ 0 for affiliated services) 9.6 Other Expenses (incl $ 9.7 Subtotal before Reimbursements and Taxes (Lines 9.1 to 9.6) 9.8 Reimbursements by uninsured plans and fiscal intermediaries 9.9 Taxes, Licenses and Fees (in total, for tying purposes) 9.10 Total (9.7 to 9.9) 9.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 *79413201821609100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes - See Cautionary Statement at http://www.naic.org/documents/committees_e_app_blanks_related_shce_cautionary_statement.pdf) UnitedHealthcare Insurance Company 2. 185 Asylum Street Hartford, CT 061033408 (LOCATION) BUSINESS IN THE STATE OF District of Columbia DURING THE YEAR 2018 NAIC Company Code Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 1. 216-1.DC 2. 3. 4. 5. 6. 7. 8. 9. Premium: 1.1 Health premiums earned (From Part 2, Line 1.11) 1.2 Federal high risk pools 1.3 State high risk pools 1.4 Premiums earned including state and federal high risk programs (Lines 1.1 + 1.2 + 1.3) 1.5 Federal taxes and federal assessments 1.6 State insurance, premium and other taxes (Similar local taxes of 84,442 ) $ 1.6a Community Benefit Expenditures (informational only) 1.7 Regulatory authority licenses and fees 1.8 Adjusted Premiums Earned (Lines 1.4 - 1.5 - 1.6 - 1.7) 1.9 Net Assumed less Ceded reinsurance premiums earned 1.10 Other Adjustments due to MLR calculations - Premiums 1.11 Risk Revenue 1.12 Net adjusted premiums earned after reinsurance (Lines 1.8 + 1.9 + 1.10 + 1.11) Claims: 2.1 Incurred claims excluding prescription drugs 2.2 Prescription drugs 2.3 Pharmaceutical rebates 2.4 State stop loss, market stabilization and claim/census based assessments (informational only) Incurred medical incentive pools and bonuses Deductible Fraud and Abuse Detection/Recovery Expenses (for MLR use only) 5.0 Total Incurred Claims (Lines 2.1 + 2.2 - 2.3 + 3) (From Part 2, Line 2.15) 5.1 Net Assumed less Ceded reinsurance claims incurred 5.2 Other Adjustments due to MLR calculations - Claims 5.3 Rebates paid 5.4 Estimated rebates unpaid prior year 5.5 Estimated rebates unpaid current year 5.6 Fee for service and co-pay revenue 5.7 Net incurred claims after reinsurance (Lines 5.0 + 5.1 + 5.2 + 5.3 - 5.4 + 5.5 - 5.6) Improving Health Care Quality Expenses Incurred: 6.1 Improve health outcomes 6.2 Activities to prevent hospital readmissions 6.3 Improve patient safety and reduce medical errors 6.4 Wellness and health promotion activities 6.5 Health Information Technology expenses related to health improvement 6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5) Preliminary Medical Loss Ratio: MLR ((Lines 4 + 5.0 + 6.6 - Footnote 2.0)/Line 1.8 Claims Adjustment Expenses: 8.1 Cost containment expenses not included in quality of care expenses in Line 6.6 8.2 All other claims adjustment expenses 8.3 Total claims adjustment expenses (Lines 8.1 + 8.2) Claims Adjustment Expense Ratio (Line 8.3/Line 1.8) 2 Small Group Employer 3 Large Group Employer 4 5 Small Group Employer Individual Expatriate Plans 6 Large Group Employer 7 Student Health Plans Large Group Government Business (excluded by statute) Other Health Business 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 79413 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 303,030,197 0 (164,305) 138,046,501 0 0 894,179,131 0 (186,705) XXX XXX XXX 894,179,131 0 (186,705) 0 (180) 302,865,892 13,854,156 138,046,501 4,470,507 893,992,425 30,755,649 XXX 135,002 893,992,425 30,890,651 0 0 0 0 0 0 0 0 0 0 0 180 0 0 0 180 4,299,224 0 153,811 284,558,701 (326,737) 3,446 0 284,235,411 14,804 0 0 133,561,190 0 175,719 0 133,736,909 13,519,395 0 496,125 849,221,257 (39,627,784) 199,664 0 809,793,137 1,453 0 0 XXX XXX XXX XXX XXX 13,520,847 0 496,125 849,084,802 (39,627,784) 199,664 0 809,656,682 0 0 0 0 0 0 0 0 0 233,976,469 1,975,963 (575,930) 107,209,821 31,439,418 19,340,977 649,216,927 117,256,266 39,899,909 XXX XXX XXX 649,216,927 117,256,266 39,899,909 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 168,154 60 119,476,416 0 (7,238,524) 4,438,549 0 2,799,975 0 119,476,416 831,918 602,695 14,766 727,175,978 (30,698,543) (6,693,066) 4,476,397 583,457 2,800,126 0 696,477,435 XXX XXX 0 0 124,487 4,401 0 236,532,763 (299,971) 0 XXX XXX XXX 0 236,232,792 831,918 602,695 14,766 727,175,978 (30,698,543) (6,693,066) 4,476,397 583,457 2,800,126 0 696,477,435 0 0 0 0 0 1,114,207 628,860 542,095 567,139 302,301 285,852 74,250 152,513 52,852 272,044 5,024,878 703,110 694,608 619,991 574,345 0 3,154,602 XXX 837,510 0.901 7,616,931 XXX 1,687 XXX 7,618,618 XXX 2,630,369 3,273,581 5,903,950 0.021 1,380,293 2,152,524 3,532,818 0.026 8,999,109 11,626,834 20,625,943 XXX 1,980 24,475 26,455 XXX 9,001,089 11,651,309 20,652,398 XXX 307,493 0 (3) 57,338,733 0 (2,052) 395,456,206 0 (20,346) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 307,490 (56,850) 57,336,681 1,647,196 395,435,860 10,840,820 0 0 0 0 0 0 0 0 0 0 0 0 (488) 0 6,246 358,583 35 0 0 358,618 1,292,113 0 17,093 54,380,279 6,471 15,903 0 54,402,653 7,913,742 0 318,975 376,362,324 (39,307,553) 4,596 0 337,059,366 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 563,251 43,336 (11,009) 36,085,525 11,923,660 2,933,246 271,381,861 71,873,889 18,212,626 0 0 0 0 0 0 0 0 0 0 0 0 6,662 0 0 617,596 0 0 0 173 173 0 617,596 150,491 50,450 1,983 45,126,390 87,874 (37,848) 37,848 (22) (22) 0 45,214,264 550,278 379,689 12,723 325,422,814 (30,486,446) 583,306 0 583,306 0 0 294,936,368 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,460 0 0 0 0 458,710 0 0 0 0 3,163,650 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,460 1.729 458,710 0.838 3,163,650 0.873 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 714,075 1,022,346 1,736,422 0.032 4,274,289 5,178,624 9,452,913 0.025 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 83 (242) (159) 0.000 11 9 8 Small Group 10 0 0 0 XXX XXX XXX XXX 0 0 0 0.000 0 XXX XXX XXX XXX XXX XXX XXX XXX 245 (15) 1,293 (445) 609 5,025,123 703,095 695,900 619,546 574,954 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 (Continued) Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 2 Small Group Employer Individual 10. General and Administrative (G&A) Expenses: 10.1 Direct sales salaries and benefits 10.2 Agents and brokers fees and commissions 10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below) 10.4 Other general and administrative expenses 10.4a Community Benefit Expenditures (informational only) 10.5 Total general and administrative (Lines 10.1 +10.2 + 10.3 + 10.4) 59 334 366 (27,607) 0 (26,848) 3 Large Group Employer 232,439 2,299,479 78,137 2,736,084 0 5,346,138 4 5 Small Group Employer Individual 1,692,998 4,300,195 396,985 10,499,680 0 16,889,857 0 0 0 0 0 0 Expatriate Plans 6 Large Group Employer 0 0 0 0 0 0 7 8 Small Group 0 0 0 0 0 0 Student Health Plans Large Group 0 0 0 0 0 0 10 11 Government Business (excluded by statute) Other Health Business 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 901 0 901 532,014 2,005,199 226,347 9,043,651 0 11,807,212 312,051 2,400,147 209,320 5,806,701 0 8,728,219 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 2,769,561 11,005,354 911,154 28,059,410 0 42,745,479 290 (2) 30,508 816,687 0 847,484 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) 12. Income from fees of uninsured plans XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 13. Net investment and other gain/(loss) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 13,514,242 14. Federal income taxes (excluding taxes on Line 1.5 above) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 15. Net gain or (loss) (Lines 11 + 12 + 13 - 14) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 16. ICD-10 Implementation Expenses (informational only; already included in general expenses and line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16. 16a ICD-10 Implementation Expenses (informational only; already included in line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (234,431) 1,647,121 12,616,579 0 0 0 0 0 0 (722) 27,136,854 1,161,947 42,327,348 XXX 2,769,851 11,005,353 941,663 28,876,098 0 43,592,963 41,315,268 1,554,651 (604,054) 56,445,644 XXX 1,554,651 13,514,242 XXX (604,054) XXX 56,988,214 OTHER INDICATORS: 216-2.DC 1. Number of certificates/policies 38 6,762 34,886 0 0 0 0 0 0 0 334,312 17,035 393,033 0 393,033 2. Number of Covered Lives 77 11,591 73,901 0 0 0 0 0 0 0 685,482 17,035 788,086 0 788,086 3. Number of Groups 1,612 207 0 0 0 0 0 0 791 2 2,612 4 2,616 4. Member Months 768 127,017 845,857 0 0 0 0 0 0 8,183,410 194,385 9,351,437 1,551 9,352,988 XXX Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ XXX 0 ] If yes, show the amount of premiums and claims included. Premiums $ 0 Claims $ 0 AFFORDABLE CARE ACT (ACA) RECEIPTS, PAYMENTS, RECEIVABLES and PAYABLES Current Year Prior Year Comprehensive Health Coverage Comprehensive Health Coverage 1 2 3 4 Small Group Small Group Employer Plans Employer Plans Individual Plans Individual Plans ACA Receivables and Payables 1. Permanent ACA Risk Adjustment Program 1.0 Premium adjustments receivable/(payable) 2. Transitional ACA Reinsurance Program 2.0 Total amounts recoverable for claims (paid & unpaid) 0 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 0 0 (36) 744,341 XXX 30,168 0 0 0 385,791 XXX 0 0 0 0 ACA Receipts and Payments 4. Permanent ACA Risk Adjustment Program 4.0 Premium adjustments receipts/(payments) 5. Transitional ACA Reinsurance Program 5.0 Amounts received for claims 0 6. Temporary ACA Risk Corridors Program 6.1 Retrospective premium received 6.2 Rate credits or policy experience refunds paid 0 0 (5,362) 1,556,892 XXX (35,721) 0 0 0 0 0 (2,131,978) XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF 185 Asylum Street Hartford, CT 061033408 District of Columbia DURING THE YEAR Comprehensive Health Coverage 1 2 3 Individual Small Group Employer Small Group Employer Individual Expatriate Plans: 7 8 6 Large Group Employer Small Group 10 11 Government Business (excluded by statute) Other Health Business 9 Student Health Plans Large Group 79413 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.DC Health Premiums Earned: 307,493 57,354,636 1.1 Direct premiums written 0 0 1.2 Unearned premium prior year 0 0 1.3 Unearned premium current year 0 0 1.4 Change in unearned premium (Lines 1.2 - 1.3) 9,992 37,848 1.5 Paid rate credits 173 (22) 1.6 Reserve for rate credits current year 173 (22) 1.7 Reserve for rate credits prior year 0 0 1.8 Change in reserve for rate credits (Lines 1.6 - 1.7) 0 15,903 1.9 Premium balances written off 0 0 1.10 Group conversion charge 307,493 57,338,733 1.11 Total direct premiums earned (Lines 1.1 + 1.4 - 1.9 + 1.10) 0 0 1.12 Assumed premiums earned from non-affiliates 35 6,471 1.13 Net Assumed less Ceded premiums earned from affiliates 0 0 1.14 Ceded premiums earned to non-affiliates 0 15,903 1.15 Other Adjustments due to MLR calculation - Premiums 297,535 57,323,259 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 535,293 43,991,997 2.1 Paid claims during the year 2,654 6,373,085 2.2 Direct claim liability current year 9,205 5,333,599 2.3 Direct claim liability prior year (1) 104,965 2.4 Direct claim reserves current year (1) 103,866 2.5 Direct claim reserves prior year 0 0 2.6 Direct contract reserves current year 0 0 2.7 Direct contract reserves prior year 9,992 37,848 2.8 Paid rate credits 173 (22) 2.9 Reserve for rate credits current year 173 (22) 2.10 Reserve for rate credits prior year 0 50,450 2.11 Incurred medical incentive pools and bonuses (Lines 2.11a + 2.11b - 2.11c) 0 9,352 2.11a Paid medical incentive pools and bonuses current year 0 59,694 2.11b Accrued medical incentive pools and bonuses current year 0 18,596 2.11c Accrued medical incentive pools and bonuses prior year (78,861) (5,509) 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 0 591,370 2.12a Healthcare receivables current year 78,861 596,880 2.12b Healthcare receivables prior year 0 0 2.13 Group conversion charge 0 0 2.14 Multi-option coverage blended rate adjustment 2.15 Total incurred claims (Lines 2.1 + 2.2 - 2.3 + 2.4 - 2.5 + 2.6 - 2.7 + 2.8 + 2.9 617,596 45,126,390 2.10 + 2.11 - 2.12 + 2.13 + 2.14) 0 0 2.16 Assumed incurred claims from non-affiliates 0 87,874 2.17 Net assumed less ceded incurred claims from affiliates 0 0 2.18 Ceded incurred claims to non-affiliates 0 0 2.19 Other adjustments due to MLR calculation - Claims 607,603 45,176,416 2.20 Net Incurred Claims (Lines 2.15 - 2.8 - 2.9 + 2.10 + 2.16 + 2.17 - 2.18 + 2.19) 3. Fraud and Abuse Recoveries that Reduced PAID Claims in Line 2.1 above 0 1,983 (informational only) 20,385,262 for stand-alone dental and $ (a) Column 13, Line 1.1 includes direct written premium of $ Large Group Employer 4 Business Subject to MLR Mini-Med Plans 5 (LOCATION) NAIC Company Code 2018 395,460,483 (529) (848) 319 19,770 8,848,587 5,596,397 3,252,191 4,596 0 395,456,206 0 295,471 39,603,024 4,596 352,881,289 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 303,372,809 1,673,141 2,012,306 (339,165) 6,549,195 1,673,440,007 1,692,303,403 (18,863,396) 3,446 0 303,030,197 0 0 326,737 3,446 315,021,107 138,222,220 0 0 0 4,586,108 1,659,539 92,378 1,567,161 175,719 0 138,046,501 0 0 0 175,719 132,068,951 894,717,641 1,672,612 2,011,458 (338,846) 11,202,914 1,683,948,285 1,697,992,329 (14,044,045) 199,664 0 894,179,131 0 301,977 39,929,761 199,664 857,592,142 315,658,075 38,621,249 30,773,743 385,814 117,053 0 0 19,770 8,848,587 5,596,397 379,689 61,760 688,068 370,139 2,003,177 7,527,253 5,524,076 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 245,242,709 30,486,994 28,493,165 2,831,247 2,518,541 85,774 79,763 6,549,195 1,673,440,007 1,692,303,403 4,401 4,401 0 0 (1,287,308) 57,650 1,344,958 0 0 114,275,204 1,450,604 1,297,712 149 0 0 0 4,586,108 1,659,539 92,378 168,154 143,005 66,405 41,256 1,273,253 8,680,765 7,407,512 0 0 719,703,278 76,934,586 65,907,425 3,322,175 2,739,459 85,774 79,763 11,202,914 1,683,948,285 1,697,992,329 602,695 218,518 814,167 429,990 1,904,752 16,857,038 14,952,286 0 0 325,422,814 0 (229,573) 30,256,873 0 291,664,408 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 236,532,764 0 0 299,971 0 248,546,993 119,476,416 0 0 0 0 113,323,147 12,723 0 0 39,950,141 for stand-alone vision policies. 0 0 0 0 0 0 2,847 727,175,979 0 (141,699) 30,556,844 0 699,318,567 17,553 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF District of Columbia DURING THE YEAR All Expenses 1 Improve Health Outcomes 1. Individual Comprehensive Coverage Expenses: 231 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 10 for affiliated services) 1.3 EDP Equipment and Software (incl $ 1 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 1.5 Accreditation and Certification (incl $ 546 for affiliated services) 1.6 Other Expenses (incl $ 1.7 Subtotal before Reimbursements and Taxes (Lines 1.1 to 1.6) 1.8 Reimbursements by uninsured plans and fiscal intermediaries 1.9 Taxes, Licenses and Fees (in total, for tying purposes) 1.10 Total (1.7 to 1.9) 1.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 2. 216-4.DC 2.7 Subtotal before Reimbursements and Taxes (Lines 2.1 to 2.6) 2.8 Reimbursements by uninsured plans and fiscal intermediaries 2.9 Taxes, Licenses and Fees (in total, for tying purposes) 2.10 Total (2.7 to 2.9) 2.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 3. 0 0 0 0 0 2,460 2,460 0 XXX Small Group Comprehensive Coverage Expenses: 1,400,586 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 98,244 for affiliated services) 2.3 EDP Equipment and Software (incl $ 9,430 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 1,024 for affiliated services) 2.5 Accreditation and Certification (incl $ 3,285,525 for affiliated services) 2.6 Other Expenses (incl $ Large Group Comprehensive Coverage Expenses: 7,658,378 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 503,220 for affiliated services) 3.3 EDP Equipment and Software (incl $ 48,303 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 5,245 for affiliated services) 3.5 Accreditation and Certification (incl $ 18,134,311 for affiliated services) 3.6 Other Expenses (incl $ 3.7 Subtotal before Reimbursements and Taxes (Lines 3.1 to 3.6) 3.8 Reimbursements by uninsured plans and fiscal intermediaries 3.9 Taxes, Licenses and Fees (in total, for tying purposes) 3.10 Total (3.7 to 3.9) 3.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 185 Asylum Street Hartford, CT 061033408 Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX Total (1 to 5) 0 0 0 0 0 2,460 2,460 0 XXX 0 0 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 0 0 0 0 0 0 0 XXX (LOCATION) NAIC Company Code 2018 XXX 23 3 2 0 0 52 81 0 XXX (60) (9) (7) (1) 0 (169) (246) 0 XXX 2,460 0 0 0 0 0 0 0 0 0 2,460 0 81 0 (246) 0 0 0 0 0 0 458,710 458,710 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 458,710 458,710 0 190,293 47,103 15,890 1,525 166 437,431 692,408 0 290,188 33,256 24,232 2,326 253 649,024 999,278 0 XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX XXX 458,710 0 0 0 0 0 0 0 0 0 458,710 0 0 0 0 0 0 3,163,650 3,163,650 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3,163,650 3,163,650 0 XXX 3,163,650 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 3,163,650 0 XXX 692,408 187,810 1,084,688 472,484 90,577 8,694 944 2,495,205 4,152,591 (2,240) XXX 4,150,351 1,162,582 999,278 0 1,465,288 199,004 122,358 11,745 1,275 3,277,214 5,076,885 394 XXX 5,077,279 0 79413 9 10 General Administrative Expenses Total Expenses (6 to 9) 268 20 15 1 0 (27,521) (27,217) 0 6,133 (21,084) 0 231 14 10 1 0 (25,178) (24,922) 0 6,133 (18,789) 0 920,105 95,768 58,121 5,579 606 4,171,384 5,251,564 0 1,448,515 6,700,079 0 1,400,586 176,127 98,244 9,430 1,024 5,716,549 7,401,960 0 1,448,515 8,850,475 187,810 5,108,401 538,142 290,285 27,864 3,025 10,412,875 16,380,593 1,847 8,965,417 25,347,857 0 7,658,378 1,209,630 503,220 48,303 5,245 19,348,943 28,773,719 0 8,965,417 37,739,137 1,162,582 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 4. 5. 216-5.DC 6. Individual Mini-Med Plans Expenses: 0 for affiliated services) 4.1 Salaries (including $ 4.2 Outsourced Services 0 for affiliated services) 4.3 EDP Equipment and Software (incl $ 0 for affiliated services) 4.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 4.5 Accreditation and Certification (incl $ 0 for affiliated services) 4.6 Other Expenses (incl $ 4.7 Subtotal before Reimbursements and Taxes (Lines 4.1 to 4.6) 4.8 Reimbursements by uninsured plans and fiscal intermediaries 4.9 Taxes, Licenses and Fees (in total, for tying purposes) 4.10 Total (4.7 to 4.9) 4.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Mini-Med Plans Expenses: 0 for affiliated services) 5.1 Salaries (including $ 5.2 Outsourced Services 0 for affiliated services) 5.3 EDP Equipment and Software (incl $ 0 for affiliated services) 5.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 5.5 Accreditation and Certification (incl $ 0 for affiliated services) 5.6 Other Expenses (incl $ 5.7 Subtotal before Reimbursements and Taxes (Lines 5.1 to 5.6) 5.8 Reimbursements by uninsured plans and fiscal intermediaries 5.9 Taxes, Licenses and Fees (in total, for tying purposes) 5.10 Total (5.7 to 5.9) 5.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Mini-Med Plans Expenses: 0 for affiliated services) 6.1 Salaries (including $ 6.2 Outsourced Services 0 for affiliated services) 6.3 EDP Equipment and Software (incl $ 0 for affiliated services) 6.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 6.5 Accreditation and Certification (incl $ 0 for affiliated services) 6.6 Other Expenses (incl $ 6.7 Subtotal before Reimbursements and Taxes (Lines 6.1 to 6.6) 6.8 Reimbursements by uninsured plans and fiscal intermediaries 6.9 Taxes, Licenses and Fees (in total, for tying purposes) 6.10 Total (6.7 to 6.9) 6.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 7. 8. 216-6.DC 9. Small Group Expatriate Plans Expenses: 0 for affiliated services) 7.1 Salaries (including $ 7.2 Outsourced Services 0 for affiliated services) 7.3 EDP Equipment and Software (incl $ 0 for affiliated services) 7.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 7.5 Accreditation and Certification (incl $ 0 for affiliated services) 7.6 Other Expenses (incl $ 7.7 Subtotal before Reimbursements and Taxes (Lines 7.1 to 7.6) 7.8 Reimbursements by uninsured plans and fiscal intermediaries 7.9 Taxes, Licenses and Fees (in total, for tying purposes) 7.10 Total (7.7 to 7.9) 7.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Expatriate Plans Expenses: 0 for affiliated services) 8.1 Salaries (including $ 8.2 Outsourced Services 0 for affiliated services) 8.3 EDP Equipment and Software (incl $ 0 for affiliated services) 8.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 8.5 Accreditation and Certification (incl $ 0 for affiliated services) 8.6 Other Expenses (incl $ 8.7 Subtotal before Reimbursements and Taxes (Lines 8.1 to 8.6) 8.8 Reimbursements by uninsured plans and fiscal intermediaries 8.9 Taxes, Licenses and Fees (in total, for tying purposes) 8.10 Total (8.7 to 8.9) 8.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Student Health Plans Expenses: 0 for affiliated services) 9.1 Salaries (including $ 9.2 Outsourced Services 0 for affiliated services) 9.3 EDP Equipment and Software (incl $ 0 for affiliated services) 9.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 9.5 Accreditation and Certification (incl $ 0 for affiliated services) 9.6 Other Expenses (incl $ 9.7 Subtotal before Reimbursements and Taxes (Lines 9.1 to 9.6) 9.8 Reimbursements by uninsured plans and fiscal intermediaries 9.9 Taxes, Licenses and Fees (in total, for tying purposes) 9.10 Total (9.7 to 9.9) 9.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 *79413201821610100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes - See Cautionary Statement at http://www.naic.org/documents/committees_e_app_blanks_related_shce_cautionary_statement.pdf) UnitedHealthcare Insurance Company 2. 185 Asylum Street Hartford, CT 061033408 (LOCATION) BUSINESS IN THE STATE OF Florida DURING THE YEAR 2018 NAIC Company Code Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 1. 216-1.FL 2. 3. 4. 5. 6. 7. 8. 9. Premium: 1.1 Health premiums earned (From Part 2, Line 1.11) 1.2 Federal high risk pools 1.3 State high risk pools 1.4 Premiums earned including state and federal high risk programs (Lines 1.1 + 1.2 + 1.3) 1.5 Federal taxes and federal assessments 1.6 State insurance, premium and other taxes (Similar local taxes of 24,450,541 ) $ 1.6a Community Benefit Expenditures (informational only) 1.7 Regulatory authority licenses and fees 1.8 Adjusted Premiums Earned (Lines 1.4 - 1.5 - 1.6 - 1.7) 1.9 Net Assumed less Ceded reinsurance premiums earned 1.10 Other Adjustments due to MLR calculations - Premiums 1.11 Risk Revenue 1.12 Net adjusted premiums earned after reinsurance (Lines 1.8 + 1.9 + 1.10 + 1.11) Claims: 2.1 Incurred claims excluding prescription drugs 2.2 Prescription drugs 2.3 Pharmaceutical rebates 2.4 State stop loss, market stabilization and claim/census based assessments (informational only) Incurred medical incentive pools and bonuses Deductible Fraud and Abuse Detection/Recovery Expenses (for MLR use only) 5.0 Total Incurred Claims (Lines 2.1 + 2.2 - 2.3 + 3) (From Part 2, Line 2.15) 5.1 Net Assumed less Ceded reinsurance claims incurred 5.2 Other Adjustments due to MLR calculations - Claims 5.3 Rebates paid 5.4 Estimated rebates unpaid prior year 5.5 Estimated rebates unpaid current year 5.6 Fee for service and co-pay revenue 5.7 Net incurred claims after reinsurance (Lines 5.0 + 5.1 + 5.2 + 5.3 - 5.4 + 5.5 - 5.6) Improving Health Care Quality Expenses Incurred: 6.1 Improve health outcomes 6.2 Activities to prevent hospital readmissions 6.3 Improve patient safety and reduce medical errors 6.4 Wellness and health promotion activities 6.5 Health Information Technology expenses related to health improvement 6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5) Preliminary Medical Loss Ratio: MLR ((Lines 4 + 5.0 + 6.6 - Footnote 2.0)/Line 1.8 Claims Adjustment Expenses: 8.1 Cost containment expenses not included in quality of care expenses in Line 6.6 8.2 All other claims adjustment expenses 8.3 Total claims adjustment expenses (Lines 8.1 + 8.2) Claims Adjustment Expense Ratio (Line 8.3/Line 1.8) 2 Small Group Employer 3 Large Group Employer 4 5 Small Group Employer Individual Expatriate Plans 6 Large Group Employer 7 11 Government Business (excluded by statute) Other Health Business 9 8 Small Group 10 Student Health Plans Large Group 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 79413 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 11,010,789 0 (8,474) 469,460,744 0 (22,109) 1,795,875,714 0 (91,906) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 11,277,135 0 0 1,471,381,809 0 744,862 3,347,204,224 0 0 7,106,210,415 0 622,373 XXX XXX XXX 7,106,210,415 0 622,373 11,002,315 641,417 469,438,635 22,460,979 1,795,783,808 61,089,029 0 0 0 0 0 0 0 0 0 0 0 0 11,277,135 (5,244,659) 1,472,126,671 13,559,118 3,347,204,224 112,788,972 7,106,832,788 205,294,855 XXX (262,864) 7,106,832,788 205,031,991 (1,992,873) 0 51,632 12,302,140 11,325 0 0 12,313,465 8,049,276 0 64,303 438,864,077 427,439 73,870 0 439,365,386 28,205,048 0 135,084 1,706,354,647 (296,050,071) 2,203,671 0 1,412,508,246 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (1,392,700) 0 0 17,914,494 1,851,115 0 0 19,765,609 21,498,151 0 (312,070) 1,437,381,472 (2,270,701) 18,966 0 1,435,129,736 12,686,327 0 0 3,221,728,925 211 2,503,469 0 3,224,232,605 67,053,229 0 (61,051) 6,834,545,754 (296,030,683) 4,799,975 0 6,543,315,047 (44,694) 0 0 XXX XXX XXX XXX XXX 67,008,535 0 (61,051) 6,834,853,312 (296,030,683) 4,799,975 0 6,543,622,605 8,026,725 2,307,956 623,858 293,085,255 82,385,734 24,663,235 1,265,826,140 286,780,265 90,723,614 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 40,960,601 0 0 1,160,037,216 12,191,981 344,548 2,333,570,322 928,098,645 523,665,305 5,101,506,259 1,311,764,581 640,020,561 XXX XXX XXX 5,101,506,259 1,311,764,581 640,020,561 97 0 918 9,710,822 (11,693) 0 0 0 0 0 9,699,128 767,532 320,691 255,523 351,128,445 0 (10,593,599) 10,258,433 11,150,223 11,485,389 0 351,128,445 1,652,650 1,981,931 660,876 1,463,864,722 (237,919,912) 0 0 0 0 0 1,225,944,810 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,265 40,960,601 0 0 XXX XXX XXX 0 40,960,601 (124,375) 0 0 1,171,884,649 (764,555) 0 XXX XXX XXX 0 1,171,120,095 0 10,246,782 692,746 2,748,250,444 0 (553,234) 0 0 553,234 0 2,748,250,444 2,295,903 12,549,404 1,611,329 5,785,799,683 (238,696,160) (11,146,833) 10,258,433 11,150,223 12,038,623 0 5,547,103,523 XXX XXX 2,295,903 12,549,404 1,611,329 5,785,799,683 (238,696,160) (11,146,833) 10,258,433 11,150,223 12,038,623 0 5,547,103,523 0 XXX XXX XXX XXX XXX XXX XXX XXX 88,086 0 0 0 0 3,755,686 0 0 0 0 14,367,006 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 20,195 8,777 10,927 2,385 22,410 2,775,410 806,622 668,969 9,391,793 653,601 13,146,034 3,588,026 4,320,409 2,830,858 7,464,257 34,152,416 4,403,425 5,000,304 12,225,037 8,140,268 125,239 40,894 89,456 43,450 130,351 34,277,655 4,444,319 5,089,761 12,268,487 8,270,619 88,086 0.797 3,755,686 0.809 14,367,006 0.867 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 64,694 XXX 14,296,395 XXX 31,349,584 0.863 63,921,450 XXX 429,391 XXX 64,350,841 XXX 69,098 151,448 220,546 0.018 4,339,589 6,610,641 10,950,230 0.025 19,113,833 25,207,542 44,321,374 0.026 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 100,439 99,954 200,392 0.011 2,201,516 20,525,493 22,727,009 0.016 29,991,876 52,562,951 82,554,827 0.026 55,816,350 105,158,030 160,974,380 XXX 1,060,697 690,092 1,750,790 XXX 56,877,048 105,848,122 162,725,169 XXX SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 (Continued) Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 2 Small Group Employer Individual 10. General and Administrative (G&A) Expenses: 10.1 Direct sales salaries and benefits 10.2 Agents and brokers fees and commissions 10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below) 10.4 Other general and administrative expenses 10.4a Community Benefit Expenditures (informational only) 10.5 Total general and administrative (Lines 10.1 +10.2 + 10.3 + 10.4) 19,625 213,367 (7,178) 550,503 0 776,317 3 Large Group Employer 1,486,105 14,546,138 (1,092,785) 20,291,700 0 35,231,158 4 5 Small Group Employer Individual 8,146,050 11,660,839 1,935,211 38,560,287 0 60,302,388 0 0 0 0 0 0 Expatriate Plans 6 Large Group Employer 0 0 0 0 0 0 7 8 Small Group 0 0 0 0 0 0 Student Health Plans Large Group 0 0 0 0 0 0 10 11 Government Business (excluded by statute) Other Health Business 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 9 0 0 0 0 0 0 0 0 0 0 0 0 33,962 0 13,846 401,037 0 448,844 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 2,739,572 53,519,573 2,401,538 130,327,689 0 188,988,371 7,255,989 63,744,080 5,308,750 168,295,769 0 244,604,588 19,681,303 143,683,997 8,559,382 358,426,984 0 530,351,667 559,742 0 130,764 3,505,487 0 4,195,992 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) 38,299,866 67,572,668 (21,908,923) 37,997,867 117,473,161 240,964,027 12. Income from fees of uninsured plans XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 13. Net investment and other gain/(loss) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 101,445,489 XXX 14. Federal income taxes (excluding taxes on Line 1.5 above) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 3,590,678 XXX 3,590,678 15. Net gain or (loss) (Lines 11 + 12 + 13 - 14) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 338,818,838 XXX 337,791,535 16. ICD-10 Implementation Expenses (informational only; already included in general expenses and line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16. 16a ICD-10 Implementation Expenses (informational only; already included in line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 931 44,539 211,023 0 0 0 0 0 0 0 1,036,428 621,590 1,914,511 0 1,914,511 1,365 76,654 367,989 0 0 0 0 0 0 0 1,384,428 621,590 2,452,026 0 2,452,026 9,066 10,386 0 0 0 0 0 0 17,539 9 37,000 0 37,000 831,836 4,214,048 0 0 0 0 0 0 16,733,708 7,420,372 29,216,410 0 29,216,410 1,529,387 0 0 0 0 0 0 XXX 20,241,045 143,683,997 8,690,146 361,932,471 0 534,547,659 234,895,412 5,041,312 5,041,312 101,445,489 OTHER INDICATORS: 216-2.FL 1. Number of certificates/policies 2. Number of Covered Lives 3. Number of Groups 4. Member Months XXX 16,446 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ XXX 0 ] If yes, show the amount of premiums and claims included. Premiums $ 0 Claims $ 0 AFFORDABLE CARE ACT (ACA) RECEIPTS, PAYMENTS, RECEIVABLES and PAYABLES Current Year Prior Year Comprehensive Health Coverage Comprehensive Health Coverage 1 2 3 4 Small Group Small Group Employer Plans Employer Plans Individual Plans Individual Plans ACA Receivables and Payables 1. Permanent ACA Risk Adjustment Program 1.0 Premium adjustments receivable/(payable) 2. Transitional ACA Reinsurance Program 2.0 Total amounts recoverable for claims (paid & unpaid) 0 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 0 0 489,524 4,639,937 XXX (71,511) 0 0 0 1,380,826 XXX 0 0 0 0 ACA Receipts and Payments 4. Permanent ACA Risk Adjustment Program 4.0 Premium adjustments receipts/(payments) 5. Transitional ACA Reinsurance Program 5.0 Amounts received for claims 0 6. Temporary ACA Risk Corridors Program 6.1 Retrospective premium received 6.2 Rate credits or policy experience refunds paid 0 0 (89,247) 5,266,471 XXX (164,101) 0 0 0 0 0 5,609,648 XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF 185 Asylum Street Hartford, CT 061033408 Florida DURING THE YEAR Comprehensive Health Coverage 1 2 3 Individual Small Group Employer Small Group Employer Individual Expatriate Plans: 7 8 6 Large Group Employer Small Group 10 11 Government Business (excluded by statute) Other Health Business 9 Student Health Plans Large Group 79413 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.FL Health Premiums Earned: 11,010,789 469,387,269 1.1 Direct premiums written 0 142,290 1.2 Unearned premium prior year 0 (5,054) 1.3 Unearned premium current year 0 147,344 1.4 Change in unearned premium (Lines 1.2 - 1.3) 319,458 10,258,433 1.5 Paid rate credits 0 11,485,389 1.6 Reserve for rate credits current year 0 11,150,223 1.7 Reserve for rate credits prior year 0 335,166 1.8 Change in reserve for rate credits (Lines 1.6 - 1.7) 0 73,870 1.9 Premium balances written off 0 0 1.10 Group conversion charge 11,010,789 469,460,744 1.11 Total direct premiums earned (Lines 1.1 + 1.4 - 1.9 + 1.10) 0 0 1.12 Assumed premiums earned from non-affiliates 11,325 426,905 1.13 Net Assumed less Ceded premiums earned from affiliates 0 (534) 1.14 Ceded premiums earned to non-affiliates 0 73,870 1.15 Other Adjustments due to MLR calculation - Premiums 10,702,655 459,368,454 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 10,443,100 334,132,435 2.1 Paid claims during the year (121,426) 38,626,989 2.2 Direct claim liability current year 245,644 31,980,778 2.3 Direct claim liability prior year 34,004 2,150,836 2.4 Direct claim reserves current year 68,134 1,263,006 2.5 Direct claim reserves prior year 2,394,187 0 2.6 Direct contract reserves current year 3,030,799 0 2.7 Direct contract reserves prior year 319,458 10,258,433 2.8 Paid rate credits 0 11,485,389 2.9 Reserve for rate credits current year 0 11,150,223 2.10 Reserve for rate credits prior year 0 320,691 2.11 Incurred medical incentive pools and bonuses (Lines 2.11a + 2.11b - 2.11c) 0 251,671 2.11a Paid medical incentive pools and bonuses current year 0 550,462 2.11b Accrued medical incentive pools and bonuses current year 0 481,442 2.11c Accrued medical incentive pools and bonuses prior year 13,923 1,452,321 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 13,923 10,702,041 2.12a Healthcare receivables current year 0 9,249,719 2.12b Healthcare receivables prior year 0 0 2.13 Group conversion charge 0 0 2.14 Multi-option coverage blended rate adjustment 2.15 Total incurred claims (Lines 2.1 + 2.2 - 2.3 + 2.4 - 2.5 + 2.6 - 2.7 + 2.8 + 2.9 9,710,822 351,128,445 2.10 + 2.11 - 2.12 + 2.13 + 2.14) 0 0 2.16 Assumed incurred claims from non-affiliates 0 0 2.17 Net assumed less ceded incurred claims from affiliates 11,693 0 2.18 Ceded incurred claims to non-affiliates 0 0 2.19 Other adjustments due to MLR calculation - Claims 9,379,670 340,534,847 2.20 Net Incurred Claims (Lines 2.15 - 2.8 - 2.9 + 2.10 + 2.16 + 2.17 - 2.18 + 2.19) 3. Fraud and Abuse Recoveries that Reduced PAID Claims in Line 2.1 above 918 255,523 (informational only) 111,156,187 for stand-alone dental and $ (a) Column 13, Line 1.1 includes direct written premium of $ Large Group Employer 4 Business Subject to MLR Mini-Med Plans 5 (LOCATION) NAIC Company Code 2018 1,798,174,537 (20,811) 74,341 (95,152) 593,566 (425,857) 614,557 (1,040,414) 2,203,671 0 1,795,875,714 0 210,526 296,260,597 2,203,671 1,502,476,161 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 11,277,135 0 0 0 0 0 0 0 0 0 11,277,135 0 1,851,115 0 0 13,128,250 1,471,431,144 176,021 206,390 (30,369) (45,362,526) 1,220,699 1,295,191 (74,493) 18,966 0 1,471,381,809 0 0 2,270,701 18,966 1,514,567,092 3,349,707,693 0 0 0 23,635,564 13,813,333 31,781,084 (17,967,751) 2,503,469 0 3,347,204,224 0 211 0 2,503,469 3,344,040,091 7,110,988,567 297,500 275,677 21,823 (10,555,504) 26,093,563 44,841,055 (18,747,492) 4,799,975 0 7,106,210,415 0 2,500,082 298,530,765 4,799,975 6,844,282,703 1,454,410,721 164,722,308 156,047,368 3,581,482 3,647,107 0 0 593,566 (425,857) 614,557 1,981,931 1,111,470 2,685,850 1,815,389 690,398 37,596,828 36,906,430 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 38,197,082 6,265,569 4,273,176 79,547 28,025 0 0 0 0 0 0 0 0 0 (719,605) 1,526,884 2,246,489 0 0 1,164,244,633 141,932,266 134,962,933 51,639,893 48,900,596 442,381,094 398,912,780 (45,362,526) 1,220,699 1,295,191 0 0 0 0 99,909 100,654 744 0 0 2,782,915,598 286,982,471 326,115,517 2,266,391 254,298 0 0 23,635,564 13,813,333 31,781,084 10,246,782 10,807,851 9,337,761 9,898,831 13,458,795 254,652,521 241,193,726 0 0 5,784,343,569 638,408,176 653,625,415 59,752,153 54,161,166 444,775,281 401,943,579 (10,555,504) 26,093,563 44,841,055 12,549,404 12,170,993 12,574,073 12,195,663 14,995,743 304,592,850 289,597,107 0 0 1,463,864,722 0 0 237,919,912 0 1,226,391,657 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 40,960,601 0 0 0 0 40,960,601 1,171,884,649 0 0 764,555 0 1,216,557,113 2,748,250,444 0 0 0 0 2,742,582,632 5,785,799,683 0 0 238,696,160 0 5,576,406,519 660,876 0 0 28,974,112 for stand-alone vision policies. 0 0 0 0 10,032 0 692,746 1,620,095 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF Florida DURING THE YEAR All Expenses 1 Improve Health Outcomes 1. Individual Comprehensive Coverage Expenses: 279,653 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 13,888 for affiliated services) 1.3 EDP Equipment and Software (incl $ 1,333 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 145 for affiliated services) 1.5 Accreditation and Certification (incl $ 400,521 for affiliated services) 1.6 Other Expenses (incl $ 1.7 Subtotal before Reimbursements and Taxes (Lines 1.1 to 1.6) 1.8 Reimbursements by uninsured plans and fiscal intermediaries 1.9 Taxes, Licenses and Fees (in total, for tying purposes) 1.10 Total (1.7 to 1.9) 1.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 2. 216-4.FL Small Group Comprehensive Coverage Expenses: 15,156,145 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 1,069,684 for affiliated services) 2.3 EDP Equipment and Software (incl $ 102,677 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 11,149 for affiliated services) 2.5 Accreditation and Certification (incl $ 17,049,663 for affiliated services) 2.6 Other Expenses (incl $ 2.7 Subtotal before Reimbursements and Taxes (Lines 2.1 to 2.6) 2.8 Reimbursements by uninsured plans and fiscal intermediaries 2.9 Taxes, Licenses and Fees (in total, for tying purposes) 2.10 Total (2.7 to 2.9) 2.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 3. Large Group Comprehensive Coverage Expenses: 31,141,477 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 2,020,978 for affiliated services) 3.3 EDP Equipment and Software (incl $ 193,990 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 21,063 for affiliated services) 3.5 Accreditation and Certification (incl $ 85,931,328 for affiliated services) 3.6 Other Expenses (incl $ 3.7 Subtotal before Reimbursements and Taxes (Lines 3.1 to 3.6) 3.8 Reimbursements by uninsured plans and fiscal intermediaries 3.9 Taxes, Licenses and Fees (in total, for tying purposes) 3.10 Total (3.7 to 3.9) 3.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 185 Asylum Street Hartford, CT 061033408 0 0 0 0 0 88,086 88,086 0 XXX Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX Total (1 to 5) 0 0 0 0 0 88,086 88,086 0 XXX 0 0 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 0 0 0 0 0 0 0 XXX (LOCATION) NAIC Company Code 2018 XXX 19,575 2,103 1,635 157 17 43,782 67,269 0 XXX 63,341 3,604 2,542 244 26 79,742 149,500 0 XXX 88,086 0 0 0 0 0 0 0 0 0 88,086 0 67,269 15,791 149,500 0 0 0 0 0 0 3,755,686 3,755,686 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3,755,686 3,755,686 0 1,888,169 398,757 157,671 15,135 1,643 1,739,586 4,200,961 0 2,993,476 343,058 249,969 23,994 2,605 2,849,951 6,463,054 0 XXX 3,755,686 0 0 0 0 0 0 14,367,006 14,367,006 0 XXX 14,367,006 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 3,755,686 0 XXX 4,200,961 1,196,813 XXX 6,463,054 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 14,367,006 14,367,006 0 4,373,922 1,234,555 365,243 35,059 3,807 12,487,771 18,500,357 3,416 6,054,544 693,863 505,583 48,530 5,269 17,386,546 24,694,335 2,484 14,367,006 0 XXX 18,503,772 5,676,881 XXX 24,696,819 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 79413 9 10 General Administrative Expenses Total Expenses (6 to 9) 196,737 12,979 9,712 780 101 561,799 782,107 0 (1,943,254) (1,161,147) 0 279,653 18,686 13,888 1,181 145 773,409 1,086,962 0 (1,943,254) (856,292) 15,791 10,274,500 1,015,056 662,044 63,548 6,900 24,196,800 36,218,849 0 7,412,103 43,630,952 0 15,156,145 1,756,872 1,069,684 102,677 11,149 32,542,023 50,638,549 0 7,412,103 58,050,653 1,196,813 20,713,010 1,890,093 1,150,153 110,401 11,987 33,941,087 57,816,732 14,801 31,931,770 89,763,303 0 31,141,477 3,818,511 2,020,978 193,990 21,063 78,182,409 115,378,429 20,701 31,931,770 147,330,900 5,676,881 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 4. 5. 216-5.FL 6. Individual Mini-Med Plans Expenses: 0 for affiliated services) 4.1 Salaries (including $ 4.2 Outsourced Services 0 for affiliated services) 4.3 EDP Equipment and Software (incl $ 0 for affiliated services) 4.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 4.5 Accreditation and Certification (incl $ 0 for affiliated services) 4.6 Other Expenses (incl $ 4.7 Subtotal before Reimbursements and Taxes (Lines 4.1 to 4.6) 4.8 Reimbursements by uninsured plans and fiscal intermediaries 4.9 Taxes, Licenses and Fees (in total, for tying purposes) 4.10 Total (4.7 to 4.9) 4.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Mini-Med Plans Expenses: 0 for affiliated services) 5.1 Salaries (including $ 5.2 Outsourced Services 0 for affiliated services) 5.3 EDP Equipment and Software (incl $ 0 for affiliated services) 5.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 5.5 Accreditation and Certification (incl $ 0 for affiliated services) 5.6 Other Expenses (incl $ 5.7 Subtotal before Reimbursements and Taxes (Lines 5.1 to 5.6) 5.8 Reimbursements by uninsured plans and fiscal intermediaries 5.9 Taxes, Licenses and Fees (in total, for tying purposes) 5.10 Total (5.7 to 5.9) 5.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Mini-Med Plans Expenses: 0 for affiliated services) 6.1 Salaries (including $ 6.2 Outsourced Services 0 for affiliated services) 6.3 EDP Equipment and Software (incl $ 0 for affiliated services) 6.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 6.5 Accreditation and Certification (incl $ 0 for affiliated services) 6.6 Other Expenses (incl $ 6.7 Subtotal before Reimbursements and Taxes (Lines 6.1 to 6.6) 6.8 Reimbursements by uninsured plans and fiscal intermediaries 6.9 Taxes, Licenses and Fees (in total, for tying purposes) 6.10 Total (6.7 to 6.9) 6.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 7. 8. 216-6.FL 9. Small Group Expatriate Plans Expenses: 0 for affiliated services) 7.1 Salaries (including $ 7.2 Outsourced Services 0 for affiliated services) 7.3 EDP Equipment and Software (incl $ 0 for affiliated services) 7.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 7.5 Accreditation and Certification (incl $ 0 for affiliated services) 7.6 Other Expenses (incl $ 7.7 Subtotal before Reimbursements and Taxes (Lines 7.1 to 7.6) 7.8 Reimbursements by uninsured plans and fiscal intermediaries 7.9 Taxes, Licenses and Fees (in total, for tying purposes) 7.10 Total (7.7 to 7.9) 7.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Expatriate Plans Expenses: 0 for affiliated services) 8.1 Salaries (including $ 8.2 Outsourced Services 0 for affiliated services) 8.3 EDP Equipment and Software (incl $ 0 for affiliated services) 8.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 8.5 Accreditation and Certification (incl $ 0 for affiliated services) 8.6 Other Expenses (incl $ 8.7 Subtotal before Reimbursements and Taxes (Lines 8.1 to 8.6) 8.8 Reimbursements by uninsured plans and fiscal intermediaries 8.9 Taxes, Licenses and Fees (in total, for tying purposes) 8.10 Total (8.7 to 8.9) 8.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Student Health Plans Expenses: 0 for affiliated services) 9.1 Salaries (including $ 9.2 Outsourced Services 0 for affiliated services) 9.3 EDP Equipment and Software (incl $ 0 for affiliated services) 9.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 9.5 Accreditation and Certification (incl $ 0 for affiliated services) 9.6 Other Expenses (incl $ 9.7 Subtotal before Reimbursements and Taxes (Lines 9.1 to 9.6) 9.8 Reimbursements by uninsured plans and fiscal intermediaries 9.9 Taxes, Licenses and Fees (in total, for tying purposes) 9.10 Total (9.7 to 9.9) 9.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 *79413201821611100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes - See Cautionary Statement at http://www.naic.org/documents/committees_e_app_blanks_related_shce_cautionary_statement.pdf) UnitedHealthcare Insurance Company 2. 185 Asylum Street Hartford, CT 061033408 (LOCATION) BUSINESS IN THE STATE OF Georgia DURING THE YEAR 2018 NAIC Company Code Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 1. 216-1.GA 2. 3. 4. 5. 6. 7. 8. 9. Premium: 1.1 Health premiums earned (From Part 2, Line 1.11) 1.2 Federal high risk pools 1.3 State high risk pools 1.4 Premiums earned including state and federal high risk programs (Lines 1.1 + 1.2 + 1.3) 1.5 Federal taxes and federal assessments 1.6 State insurance, premium and other taxes (Similar local taxes of 328,245 ) $ 1.6a Community Benefit Expenditures (informational only) 1.7 Regulatory authority licenses and fees 1.8 Adjusted Premiums Earned (Lines 1.4 - 1.5 - 1.6 - 1.7) 1.9 Net Assumed less Ceded reinsurance premiums earned 1.10 Other Adjustments due to MLR calculations - Premiums 1.11 Risk Revenue 1.12 Net adjusted premiums earned after reinsurance (Lines 1.8 + 1.9 + 1.10 + 1.11) Claims: 2.1 Incurred claims excluding prescription drugs 2.2 Prescription drugs 2.3 Pharmaceutical rebates 2.4 State stop loss, market stabilization and claim/census based assessments (informational only) Incurred medical incentive pools and bonuses Deductible Fraud and Abuse Detection/Recovery Expenses (for MLR use only) 5.0 Total Incurred Claims (Lines 2.1 + 2.2 - 2.3 + 3) (From Part 2, Line 2.15) 5.1 Net Assumed less Ceded reinsurance claims incurred 5.2 Other Adjustments due to MLR calculations - Claims 5.3 Rebates paid 5.4 Estimated rebates unpaid prior year 5.5 Estimated rebates unpaid current year 5.6 Fee for service and co-pay revenue 5.7 Net incurred claims after reinsurance (Lines 5.0 + 5.1 + 5.2 + 5.3 - 5.4 + 5.5 - 5.6) Improving Health Care Quality Expenses Incurred: 6.1 Improve health outcomes 6.2 Activities to prevent hospital readmissions 6.3 Improve patient safety and reduce medical errors 6.4 Wellness and health promotion activities 6.5 Health Information Technology expenses related to health improvement 6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5) Preliminary Medical Loss Ratio: MLR ((Lines 4 + 5.0 + 6.6 - Footnote 2.0)/Line 1.8 Claims Adjustment Expenses: 8.1 Cost containment expenses not included in quality of care expenses in Line 6.6 8.2 All other claims adjustment expenses 8.3 Total claims adjustment expenses (Lines 8.1 + 8.2) Claims Adjustment Expense Ratio (Line 8.3/Line 1.8) 2 Small Group Employer 3 Large Group Employer 4 5 Small Group Employer Individual Expatriate Plans 6 Large Group Employer 7 11 Government Business (excluded by statute) Other Health Business 9 8 Small Group 10 Student Health Plans Large Group 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 79413 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 478,620,412 0 166,974 2,233,108,297 0 0 3,330,875,406 0 101,366 XXX XXX XXX 0 (294) 478,787,385 (1,917,178) 2,233,108,297 67,265,127 3,330,976,772 86,233,309 XXX 0 0 0 0 0 0 0 0 0 0 0 294 0 0 0 294 7,878,568 0 (71,767) 472,897,761 (1,054,908) 13,864 0 471,856,717 224,246 0 0 2,165,618,924 131,313 3,252,321 0 2,169,002,558 16,648,882 0 (7,040) 3,228,101,620 (64,537,942) 3,339,793 0 3,166,903,472 XXX XXX XXX XXX XXX 16,648,882 0 (7,040) 3,228,101,620 (64,537,942) 3,339,793 0 3,166,903,472 0 0 0 0 0 0 0 0 0 295,513,280 137,954,276 57,590 1,670,052,550 444,294,221 287,420,727 2,404,101,808 693,520,927 320,999,216 XXX XXX XXX 2,404,101,808 693,520,927 320,999,216 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7,373,941 272,978 1,834,299,984 0 (12,125,909) 7,557,529 0 4,568,381 0 1,834,299,984 433,219 7,807,531 449,294 2,784,431,050 (55,114,041) (15,029,631) 8,241,592 1,324,484 8,112,523 0 2,729,317,010 XXX XXX 0 0 286 0 0 433,409,965 (590,390) 0 XXX XXX XXX 0 432,819,575 433,219 7,807,531 449,294 2,784,431,050 (55,114,041) (15,029,631) 8,241,592 1,324,484 8,112,523 0 2,729,317,010 (1) 0 0 0 0 955,800 571,232 440,847 2,228,972 220,133 12,064,939 4,811,316 4,486,448 3,768,112 6,046,754 17,973,912 5,382,547 4,927,295 5,997,083 6,266,886 (1) 4,416,983 XXX 31,177,568 0.862 40,547,724 XXX 815,566 5,590,491 6,406,057 0.014 24,425,454 45,251,380 69,676,834 0.032 32,363,910 59,829,980 92,193,890 XXX 474,961 0 (36) 64,021,901 0 (4,656) 554,649,836 0 (60,916) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 474,925 14,773 64,017,245 3,141,423 554,588,920 17,729,458 0 0 0 0 0 0 0 0 0 0 0 0 6,401 0 100 453,651 1,012 0 0 454,663 807,521 0 12,331 60,055,971 29,512 45,798 0 60,131,281 7,732,146 0 52,296 529,075,020 (63,644,872) 27,810 0 465,457,958 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 323,507 68,651 18,543 40,331,318 11,031,194 3,065,197 397,881,154 100,172,586 30,437,159 0 0 0 0 0 0 0 0 0 0 0 0 58 0 7 373,615 0 0 0 0 0 0 373,615 42,156 24,935 55,870 48,322,250 0 (2,903,722) 684,063 1,324,484 3,544,142 0 48,322,250 390,719 408,655 120,439 468,025,236 (54,523,651) 0 0 0 0 0 413,501,585 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3,800 0 0 0 0 512,175 0 0 0 0 4,437,199 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3,800 0.832 512,175 0.814 4,437,199 0.893 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 4,092 7,841 11,933 0.026 623,211 945,179 1,568,390 0.026 6,495,586 8,035,089 14,530,676 0.027 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 XXX XXX XXX XXX 0 0 0 0.000 3,330,875,406 0 101,366 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 17,973,912 5,382,547 4,927,295 5,997,083 6,266,886 0 40,547,724 XXX 0 0 0 32,363,910 59,829,980 92,193,890 XXX XXX XXX 3,330,976,772 86,233,309 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 (Continued) Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 2 Small Group Employer Individual 10. General and Administrative (G&A) Expenses: 10.1 Direct sales salaries and benefits 10.2 Agents and brokers fees and commissions 10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below) 10.4 Other general and administrative expenses 10.4a Community Benefit Expenditures (informational only) 10.5 Total general and administrative (Lines 10.1 +10.2 + 10.3 + 10.4) 1,458 12,253 (6,106) 24,651 0 32,257 3 Large Group Employer 210,853 1,736,119 (34,568) 3,248,538 0 5,160,941 4 5 Small Group Employer Individual 2,374,256 1,323,908 638,439 15,101,223 0 19,437,827 0 0 0 0 0 0 Expatriate Plans 6 Large Group Employer 0 0 0 0 0 0 7 8 Small Group 0 0 0 0 0 0 Student Health Plans Large Group 0 0 0 0 0 0 10 11 Government Business (excluded by statute) Other Health Business 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,475 0 1,475 828,905 14,004,063 709,180 34,421,711 0 49,963,859 (1,181) 3,238,581 60,129,856 3,035,013 111,861,053 0 178,264,503 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 6,654,053 77,206,199 4,341,957 164,658,651 0 252,860,860 0 0 0 0 0 0 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) (21,749,756) 55,583,669 51,983,987 12. Income from fees of uninsured plans XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 13. Net investment and other gain/(loss) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 48,923,681 14. Federal income taxes (excluding taxes on Line 1.5 above) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 15. Net gain or (loss) (Lines 11 + 12 + 13 - 14) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 16. ICD-10 Implementation Expenses (informational only; already included in general expenses and line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16. 16a ICD-10 Implementation Expenses (informational only; already included in line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 33,059 4,567,525 13,550,672 0 0 0 0 0 0 XXX 6,654,053 77,206,199 4,341,957 164,658,651 0 252,860,860 51,983,987 0 (275,347) 101,183,015 XXX 0 48,923,681 XXX (275,347) XXX 101,183,015 OTHER INDICATORS: 216-2.GA 1. Number of certificates/policies 35 8,970 79,786 0 0 0 0 0 0 0 421,662 238,402 748,855 0 748,855 2. Number of Covered Lives 68 16,404 137,242 0 0 0 0 0 0 0 696,545 238,402 1,088,661 0 1,088,661 3. Number of Groups 1,496 1,050 0 0 0 0 0 0 3,591 1 6,138 0 6,138 4. Member Months 816 175,588 1,679,770 0 0 0 0 0 0 8,319,848 2,820,487 12,996,509 0 12,996,509 XXX Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ XXX 0 ] If yes, show the amount of premiums and claims included. Premiums $ 0 Claims $ 0 AFFORDABLE CARE ACT (ACA) RECEIPTS, PAYMENTS, RECEIVABLES and PAYABLES Current Year Prior Year Comprehensive Health Coverage Comprehensive Health Coverage 1 2 3 4 Small Group Small Group Employer Plans Employer Plans Individual Plans Individual Plans ACA Receivables and Payables 1. Permanent ACA Risk Adjustment Program 1.0 Premium adjustments receivable/(payable) 2. Transitional ACA Reinsurance Program 2.0 Total amounts recoverable for claims (paid & unpaid) 0 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 0 0 0 0 0 0 0 0 49,998 1,909,224 75,458 2,170,167 (6,554) 439,985 XXX 59,308 0 1,898,469 XXX ACA Receipts and Payments 4. Permanent ACA Risk Adjustment Program 4.0 Premium adjustments receipts/(payments) 5. Transitional ACA Reinsurance Program 5.0 Amounts received for claims 0 6. Temporary ACA Risk Corridors Program 6.1 Retrospective premium received 6.2 Rate credits or policy experience refunds paid 0 0 XXX 0 0 0 0 0 XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF 185 Asylum Street Hartford, CT 061033408 Georgia DURING THE YEAR Comprehensive Health Coverage 1 2 3 Individual Small Group Employer Small Group Employer Individual Expatriate Plans: 7 8 6 Large Group Employer Small Group 10 11 Government Business (excluded by statute) Other Health Business 9 Student Health Plans Large Group 79413 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.GA Health Premiums Earned: 474,961 64,072,878 1.1 Direct premiums written 0 4,971 1.2 Unearned premium prior year 0 10,151 1.3 Unearned premium current year 0 (5,179) 1.4 Change in unearned premium (Lines 1.2 - 1.3) 0 684,063 1.5 Paid rate credits 0 3,544,142 1.6 Reserve for rate credits current year 0 1,324,484 1.7 Reserve for rate credits prior year 0 2,219,659 1.8 Change in reserve for rate credits (Lines 1.6 - 1.7) 0 45,798 1.9 Premium balances written off 0 0 1.10 Group conversion charge 474,961 64,021,901 1.11 Total direct premiums earned (Lines 1.1 + 1.4 - 1.9 + 1.10) 0 0 1.12 Assumed premiums earned from non-affiliates 1,012 28,717 1.13 Net Assumed less Ceded premiums earned from affiliates 0 (795) 1.14 Ceded premiums earned to non-affiliates 0 45,798 1.15 Other Adjustments due to MLR calculation - Premiums 475,972 61,193,489 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 373,379 39,219,732 2.1 Paid claims during the year 465 5,111,326 2.2 Direct claim liability current year 229 (3,959,331) 2.3 Direct claim liability prior year 0 479,163 2.4 Direct claim reserves current year 0 362,449 2.5 Direct claim reserves prior year 0 0 2.6 Direct contract reserves current year 0 0 2.7 Direct contract reserves prior year 0 684,063 2.8 Paid rate credits 0 3,544,142 2.9 Reserve for rate credits current year 0 1,324,484 2.10 Reserve for rate credits prior year 0 24,935 2.11 Incurred medical incentive pools and bonuses (Lines 2.11a + 2.11b - 2.11c) 0 13,086 2.11a Paid medical incentive pools and bonuses current year 0 43,005 2.11b Accrued medical incentive pools and bonuses current year 0 31,156 2.11c Accrued medical incentive pools and bonuses prior year 0 3,013,511 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 0 1,364,430 2.12a Healthcare receivables current year 0 (1,649,080) 2.12b Healthcare receivables prior year 0 0 2.13 Group conversion charge 0 0 2.14 Multi-option coverage blended rate adjustment 2.15 Total incurred claims (Lines 2.1 + 2.2 - 2.3 + 2.4 - 2.5 + 2.6 - 2.7 + 2.8 + 2.9 373,615 48,322,250 2.10 + 2.11 - 2.12 + 2.13 + 2.14) 0 0 2.16 Assumed incurred claims from non-affiliates 0 0 2.17 Net assumed less ceded incurred claims from affiliates 0 0 2.18 Ceded incurred claims to non-affiliates 0 0 2.19 Other adjustments due to MLR calculation - Claims 373,615 45,418,528 2.20 Net Incurred Claims (Lines 2.15 - 2.8 - 2.9 + 2.10 + 2.16 + 2.17 - 2.18 + 2.19) 3. Fraud and Abuse Recoveries that Reduced PAID Claims in Line 2.1 above 7 55,870 (informational only) 26,156,200 for stand-alone dental and $ (a) Column 13, Line 1.1 includes direct written premium of $ Large Group Employer 4 Business Subject to MLR Mini-Med Plans 5 (LOCATION) NAIC Company Code 2018 554,669,166 (418) (8,898) 8,480 642,079 2,639,348 642,079 1,997,269 27,810 0 554,649,836 576,966 200,523 64,422,361 27,810 488,393,427 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 478,778,853 83,349 227,926 (144,577) 1,223,940 793,134 842,049 (48,915) 13,864 0 478,620,412 0 0 1,054,908 13,864 476,404,343 2,236,360,619 0 0 0 6,863,540 (5,601,487) (7,760,207) 2,158,720 3,252,321 0 2,233,108,298 0 131,313 0 3,252,321 2,227,469,672 3,334,356,477 87,903 229,179 (141,276) 9,413,622 1,375,138 (4,951,595) 6,326,733 3,339,793 0 3,330,875,407 576,966 361,566 65,476,474 3,339,793 3,253,936,903 471,551,199 55,045,218 65,698,341 916,585 1,108,664 0 0 642,079 2,639,348 642,079 408,655 296,560 720,982 608,887 (4,271,236) 12,104,868 16,376,104 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 421,333,237 32,122,623 32,001,280 18,368,737 18,695,974 41,734,832 30,622,930 1,223,940 793,134 842,049 0 0 0 0 4,304 19,360 15,056 0 0 1,835,357,264 235,404,000 227,328,277 320,766 291,064 0 0 6,863,540 (5,601,487) (7,760,207) 7,373,941 4,579,630 8,443,967 5,649,655 25,558,905 139,722,235 114,163,330 0 0 2,767,834,811 327,683,633 321,068,796 20,085,250 20,458,151 41,734,832 30,622,930 9,413,622 1,375,138 (4,951,595) 7,807,531 4,889,275 9,207,954 6,289,698 24,305,485 153,210,894 128,905,410 0 0 468,025,236 562,147 0 55,085,798 0 410,862,238 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 433,409,965 0 0 590,390 0 431,644,550 1,834,299,984 0 0 0 0 1,825,277,724 2,784,431,050 562,147 0 55,676,188 0 2,713,576,654 120,439 0 0 25,620,549 for stand-alone vision policies. 0 0 0 0 0 0 272,978 449,294 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF Georgia DURING THE YEAR All Expenses 1 Improve Health Outcomes 1. Individual Comprehensive Coverage Expenses: 11,892 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 876 for affiliated services) 1.3 EDP Equipment and Software (incl $ 84 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 9 for affiliated services) 1.5 Accreditation and Certification (incl $ 26,793 for affiliated services) 1.6 Other Expenses (incl $ 1.7 Subtotal before Reimbursements and Taxes (Lines 1.1 to 1.6) 1.8 Reimbursements by uninsured plans and fiscal intermediaries 1.9 Taxes, Licenses and Fees (in total, for tying purposes) 1.10 Total (1.7 to 1.9) 1.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 2. 216-4.GA 3. 0 0 0 0 0 3,800 3,800 0 XXX Small Group Comprehensive Coverage Expenses: 4,137,817 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 292,614 for affiliated services) 2.3 EDP Equipment and Software (incl $ 28,088 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 3,050 for affiliated services) 2.5 Accreditation and Certification (incl $ 386,857 for affiliated services) 2.6 Other Expenses (incl $ 2.7 Subtotal before Reimbursements and Taxes (Lines 2.1 to 2.6) 2.8 Reimbursements by uninsured plans and fiscal intermediaries 2.9 Taxes, Licenses and Fees (in total, for tying purposes) 2.10 Total (2.7 to 2.9) 2.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Comprehensive Coverage Expenses: 8,897,395 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 587,781 for affiliated services) 3.3 EDP Equipment and Software (incl $ 56,420 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 6,126 for affiliated services) 3.5 Accreditation and Certification (incl $ 29,207,827 for affiliated services) 3.6 Other Expenses (incl $ 3.7 Subtotal before Reimbursements and Taxes (Lines 3.1 to 3.6) 3.8 Reimbursements by uninsured plans and fiscal intermediaries 3.9 Taxes, Licenses and Fees (in total, for tying purposes) 3.10 Total (3.7 to 3.9) 3.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 185 Asylum Street Hartford, CT 061033408 Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX Total (1 to 5) 0 0 0 0 0 3,800 3,800 0 XXX 0 0 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 0 0 0 0 0 0 0 XXX (LOCATION) NAIC Company Code 2018 XXX 1,149 132 96 9 1 2,569 3,956 0 XXX 2,235 256 187 18 2 4,998 7,696 0 XXX 3,800 0 0 0 0 0 0 0 0 0 3,800 0 3,956 1,173 7,696 0 0 0 0 0 0 512,175 512,175 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 512,175 512,175 0 505,974 83,194 42,251 4,056 440 (32,360) 603,555 0 796,807 91,316 66,537 6,387 693 (37,487) 924,253 0 XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX XXX XXX 512,175 0 0 0 0 0 0 0 0 0 512,175 0 603,555 169,695 924,253 0 0 0 0 0 0 4,437,199 4,437,199 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4,437,199 4,437,199 0 1,279,054 762,738 106,807 10,252 1,113 4,141,038 6,301,003 0 1,756,600 201,310 146,684 14,080 1,529 5,748,349 7,868,552 0 4,437,199 0 XXX 6,301,003 1,795,978 XXX 7,868,552 0 XXX 4,437,199 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 79413 9 10 General Administrative Expenses Total Expenses (6 to 9) 8,508 814 593 57 6 28,282 38,260 0 778 39,038 0 11,892 1,202 876 84 9 39,649 53,712 0 778 54,489 1,173 2,835,036 279,953 183,826 17,645 1,916 1,862,222 5,180,598 0 840,777 6,021,375 0 4,137,817 454,462 292,614 28,088 3,050 2,304,550 7,220,581 0 840,777 8,061,358 169,695 5,861,741 685,344 334,290 32,088 3,484 11,720,153 18,637,100 0 8,946,290 27,583,389 0 8,897,395 1,649,392 587,781 56,420 6,126 26,046,739 37,243,853 0 8,946,290 46,190,143 1,795,978 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 4. 5. 216-5.GA 6. Individual Mini-Med Plans Expenses: 0 for affiliated services) 4.1 Salaries (including $ 4.2 Outsourced Services 0 for affiliated services) 4.3 EDP Equipment and Software (incl $ 0 for affiliated services) 4.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 4.5 Accreditation and Certification (incl $ 0 for affiliated services) 4.6 Other Expenses (incl $ 4.7 Subtotal before Reimbursements and Taxes (Lines 4.1 to 4.6) 4.8 Reimbursements by uninsured plans and fiscal intermediaries 4.9 Taxes, Licenses and Fees (in total, for tying purposes) 4.10 Total (4.7 to 4.9) 4.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Mini-Med Plans Expenses: 0 for affiliated services) 5.1 Salaries (including $ 5.2 Outsourced Services 0 for affiliated services) 5.3 EDP Equipment and Software (incl $ 0 for affiliated services) 5.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 5.5 Accreditation and Certification (incl $ 0 for affiliated services) 5.6 Other Expenses (incl $ 5.7 Subtotal before Reimbursements and Taxes (Lines 5.1 to 5.6) 5.8 Reimbursements by uninsured plans and fiscal intermediaries 5.9 Taxes, Licenses and Fees (in total, for tying purposes) 5.10 Total (5.7 to 5.9) 5.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Mini-Med Plans Expenses: 0 for affiliated services) 6.1 Salaries (including $ 6.2 Outsourced Services 0 for affiliated services) 6.3 EDP Equipment and Software (incl $ 0 for affiliated services) 6.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 6.5 Accreditation and Certification (incl $ 0 for affiliated services) 6.6 Other Expenses (incl $ 6.7 Subtotal before Reimbursements and Taxes (Lines 6.1 to 6.6) 6.8 Reimbursements by uninsured plans and fiscal intermediaries 6.9 Taxes, Licenses and Fees (in total, for tying purposes) 6.10 Total (6.7 to 6.9) 6.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 7. 8. 216-6.GA 9. Small Group Expatriate Plans Expenses: 0 for affiliated services) 7.1 Salaries (including $ 7.2 Outsourced Services 0 for affiliated services) 7.3 EDP Equipment and Software (incl $ 0 for affiliated services) 7.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 7.5 Accreditation and Certification (incl $ 0 for affiliated services) 7.6 Other Expenses (incl $ 7.7 Subtotal before Reimbursements and Taxes (Lines 7.1 to 7.6) 7.8 Reimbursements by uninsured plans and fiscal intermediaries 7.9 Taxes, Licenses and Fees (in total, for tying purposes) 7.10 Total (7.7 to 7.9) 7.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Expatriate Plans Expenses: 0 for affiliated services) 8.1 Salaries (including $ 8.2 Outsourced Services 0 for affiliated services) 8.3 EDP Equipment and Software (incl $ 0 for affiliated services) 8.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 8.5 Accreditation and Certification (incl $ 0 for affiliated services) 8.6 Other Expenses (incl $ 8.7 Subtotal before Reimbursements and Taxes (Lines 8.1 to 8.6) 8.8 Reimbursements by uninsured plans and fiscal intermediaries 8.9 Taxes, Licenses and Fees (in total, for tying purposes) 8.10 Total (8.7 to 8.9) 8.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Student Health Plans Expenses: 0 for affiliated services) 9.1 Salaries (including $ 9.2 Outsourced Services 0 for affiliated services) 9.3 EDP Equipment and Software (incl $ 0 for affiliated services) 9.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 9.5 Accreditation and Certification (incl $ 0 for affiliated services) 9.6 Other Expenses (incl $ 9.7 Subtotal before Reimbursements and Taxes (Lines 9.1 to 9.6) 9.8 Reimbursements by uninsured plans and fiscal intermediaries 9.9 Taxes, Licenses and Fees (in total, for tying purposes) 9.10 Total (9.7 to 9.9) 9.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 *79413201821612100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes - See Cautionary Statement at http://www.naic.org/documents/committees_e_app_blanks_related_shce_cautionary_statement.pdf) UnitedHealthcare Insurance Company 2. 185 Asylum Street Hartford, CT 061033408 (LOCATION) BUSINESS IN THE STATE OF Hawaii DURING THE YEAR 2018 NAIC Company Code Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 2 Small Group Employer Individual 1. 216-1.HI 2. 3. 4. 5. 6. 7. 8. 9. Premium: 1.1 Health premiums earned (From Part 2, Line 1.11) 1.2 Federal high risk pools 1.3 State high risk pools 1.4 Premiums earned including state and federal high risk programs (Lines 1.1 + 1.2 + 1.3) 1.5 Federal taxes and federal assessments 1.6 State insurance, premium and other taxes (Similar local taxes of 109,696 ) $ 1.6a Community Benefit Expenditures (informational only) 1.7 Regulatory authority licenses and fees 1.8 Adjusted Premiums Earned (Lines 1.4 - 1.5 - 1.6 - 1.7) 1.9 Net Assumed less Ceded reinsurance premiums earned 1.10 Other Adjustments due to MLR calculations - Premiums 1.11 Risk Revenue 1.12 Net adjusted premiums earned after reinsurance (Lines 1.8 + 1.9 + 1.10 + 1.11) Claims: 2.1 Incurred claims excluding prescription drugs 2.2 Prescription drugs 2.3 Pharmaceutical rebates 2.4 State stop loss, market stabilization and claim/census based assessments (informational only) Incurred medical incentive pools and bonuses Deductible Fraud and Abuse Detection/Recovery Expenses (for MLR use only) 5.0 Total Incurred Claims (Lines 2.1 + 2.2 - 2.3 + 3) (From Part 2, Line 2.15) 5.1 Net Assumed less Ceded reinsurance claims incurred 5.2 Other Adjustments due to MLR calculations - Claims 5.3 Rebates paid 5.4 Estimated rebates unpaid prior year 5.5 Estimated rebates unpaid current year 5.6 Fee for service and co-pay revenue 5.7 Net incurred claims after reinsurance (Lines 5.0 + 5.1 + 5.2 + 5.3 - 5.4 + 5.5 - 5.6) Improving Health Care Quality Expenses Incurred: 6.1 Improve health outcomes 6.2 Activities to prevent hospital readmissions 6.3 Improve patient safety and reduce medical errors 6.4 Wellness and health promotion activities 6.5 Health Information Technology expenses related to health improvement 6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5) Preliminary Medical Loss Ratio: MLR ((Lines 4 + 5.0 + 6.6 - Footnote 2.0)/Line 1.8 Claims Adjustment Expenses: 8.1 Cost containment expenses not included in quality of care expenses in Line 6.6 8.2 All other claims adjustment expenses 8.3 Total claims adjustment expenses (Lines 8.1 + 8.2) Claims Adjustment Expense Ratio (Line 8.3/Line 1.8) 3 Large Group Employer 4 5 Small Group Employer Individual Expatriate Plans 6 Large Group Employer 7 11 Government Business (excluded by statute) Other Health Business 9 8 Small Group 10 Student Health Plans Large Group 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 79413 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 0 0 0 615,045 0 (170) 4,471,885 0 (718) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 463,120,373 0 0 17,595,389 0 10,139 364,228,012 0 0 850,030,704 0 9,251 XXX XXX XXX 0 6 614,875 78,435 4,471,167 338,779 0 0 0 0 0 0 0 0 0 0 0 0 463,120,373 8,119,530 17,605,528 (38,516) 364,228,012 12,226,283 850,039,955 20,724,516 XXX 2 0 0 (8) 0 0 0 (8) 24,526 0 98 511,816 0 0 0 511,816 80,825 0 717 4,050,846 (472,458) 0 0 3,578,388 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 21,986,402 0 0 433,014,441 0 2,063,283 0 435,077,724 247,094 0 (4,186) 17,401,136 (3,272) 0 0 17,397,863 36,315 0 0 351,965,414 0 111,639 0 352,077,053 22,375,165 0 (3,371) 806,943,644 (475,731) 2,174,922 0 808,642,836 XXX XXX XXX XXX XXX 22,375,238 0 (3,371) 806,934,653 (475,731) 2,174,922 0 808,633,844 0 0 0 68,994 154,080 59,791 2,360,171 407,044 83,799 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 352,796,659 29,202,059 1,610,297 13,805,069 187,782 8,165 286,746,551 47,727,120 32,120,309 655,777,443 77,678,086 33,882,362 XXX XXX XXX 655,777,443 77,678,086 33,882,362 0 0 0 0 0 0 0 0 0 0 0 0 0 1 163,282 0 0 0 0 0 0 163,282 253 16,089 49 2,699,504 (211,317) (345,170) 314,241 273,421 304,350 0 2,488,187 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (15) 294,521 14,337 380,682,943 0 0 XXX XXX XXX 0 380,682,943 0 0 0 13,984,686 954 0 XXX XXX XXX 0 13,985,640 0 524,750 1,420 302,878,112 0 (1,157,170) 0 (403,059) 754,111 0 302,878,112 238 835,360 15,806 700,408,527 (210,364) (1,502,339) 314,241 (129,638) 1,058,461 0 700,198,163 XXX XXX 238 835,360 15,806 700,408,527 (210,364) (1,502,339) 314,241 (129,638) 1,058,461 0 700,198,163 0 0 0 0 0 4,920 0 0 0 0 35,775 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6,725,833 3,988,833 3,349,177 2,464,531 511,551 63,447 39,015 29,012 155,983 13,375 1,290,741 372,377 388,529 1,683,739 989,798 8,120,716 4,400,226 3,766,718 4,304,252 1,514,723 0 0.000 4,920 0.329 35,775 0.675 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 17,039,926 XXX 300,831 XXX 4,725,184 0.874 22,106,636 XXX 0 0 0 0.000 5,799 7,416 13,214 0.026 33,036 418,033 451,069 0.111 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 2,688,182 7,315,327 10,003,510 0.023 3,758 346,835 350,593 0.020 3,062,459 5,153,226 8,215,685 0.023 5,793,234 13,240,838 19,034,071 XXX 850,030,704 0 9,251 8,919 72 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 850,039,955 20,733,436 1,065 346 772 368 1,110 8,121,781 4,400,572 3,767,490 4,304,620 1,515,833 3,661 XXX 22,110,297 XXX 9,019 6,182 15,201 XXX 5,802,253 13,247,020 19,049,272 XXX SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 (Continued) Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 2 Small Group Employer Individual 10. General and Administrative (G&A) Expenses: 10.1 Direct sales salaries and benefits 10.2 Agents and brokers fees and commissions 10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below) 10.4 Other general and administrative expenses 10.4a Community Benefit Expenditures (informational only) 10.5 Total general and administrative (Lines 10.1 +10.2 + 10.3 + 10.4) 0 0 (32) 0 0 (32) 3 Large Group Employer 2,089 23,630 (753) 22,742 0 47,708 4 5 Small Group Employer Individual 9,610 57,823 (9,129) 84,671 0 142,975 0 0 0 0 0 0 Expatriate Plans 6 Large Group Employer 0 0 0 0 0 0 7 8 Small Group 0 0 0 0 0 0 Student Health Plans Large Group 0 0 0 0 0 0 10 11 Government Business (excluded by statute) Other Health Business 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 9 0 0 0 0 0 0 0 0 0 0 0 0 34,273 0 643,494 22,154,316 0 22,832,083 30,762 697,447 45,528 2,163,964 0 2,937,702 899,811 7,590,596 444,708 12,626,989 0 21,562,104 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 976,546 8,369,496 1,123,815 37,052,683 0 47,522,540 4,742 0 694 18,221 0 23,657 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) 14,695,968 19,781,425 12. Income from fees of uninsured plans XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 13. Net investment and other gain/(loss) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 13,115,009 XXX 14. Federal income taxes (excluding taxes on Line 1.5 above) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 452,515 XXX 452,515 15. Net gain or (loss) (Lines 11 + 12 + 13 - 14) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 32,443,919 XXX 32,479,765 16. ICD-10 Implementation Expenses (informational only; already included in general expenses and line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16. 16a ICD-10 Implementation Expenses (informational only; already included in line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 24 282,691 460,382 0 0 0 0 0 0 4,519,262 (176,903) XXX 981,288 8,369,496 1,124,509 37,070,904 0 47,546,198 19,729,914 87,357 87,357 13,115,009 OTHER INDICATORS: 216-2.HI 1. Number of certificates/policies 0 71 380 0 0 0 0 0 0 48,439 12,116 35,077 96,083 1 96,084 2. Number of Covered Lives 0 104 672 0 0 0 0 0 0 48,439 12,292 35,077 96,584 2 96,586 3. Number of Groups 25 78 0 0 0 0 0 1 23 7 134 0 134 4. Member Months 1,152 8,358 0 0 0 0 0 572,620 148,391 414,970 1,145,491 0 1,145,491 XXX 0 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ XXX 0 ] If yes, show the amount of premiums and claims included. Premiums $ 0 Claims $ 0 AFFORDABLE CARE ACT (ACA) RECEIPTS, PAYMENTS, RECEIVABLES and PAYABLES Current Year Prior Year Comprehensive Health Coverage Comprehensive Health Coverage 1 2 3 4 Small Group Small Group Employer Plans Employer Plans Individual Plans Individual Plans ACA Receivables and Payables 1. Permanent ACA Risk Adjustment Program 1.0 Premium adjustments receivable/(payable) 0 2. Transitional ACA Reinsurance Program 2.0 Total amounts recoverable for claims (paid & unpaid) 0 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 0 0 0 0 0 0 0 0 2,487 0 10,639 (47,883) XXX 0 0 1,614 XXX ACA Receipts and Payments 4. Permanent ACA Risk Adjustment Program 4.0 Premium adjustments receipts/(payments) 0 5. Transitional ACA Reinsurance Program 5.0 Amounts received for claims 0 6. Temporary ACA Risk Corridors Program 6.1 Retrospective premium received 6.2 Rate credits or policy experience refunds paid 0 0 XXX 0 0 0 0 0 XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF 185 Asylum Street Hartford, CT 061033408 Hawaii DURING THE YEAR Comprehensive Health Coverage 1 2 3 Individual Small Group Employer Large Group Employer Small Group Employer Individual Expatriate Plans: 7 8 6 Large Group Employer Small Group 10 11 Government Business (excluded by statute) Other Health Business 9 Student Health Plans Large Group 79413 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.HI Health Premiums Earned: 0 1.1 Direct premiums written 0 1.2 Unearned premium prior year 0 1.3 Unearned premium current year 0 1.4 Change in unearned premium (Lines 1.2 - 1.3) 0 1.5 Paid rate credits 0 1.6 Reserve for rate credits current year 0 1.7 Reserve for rate credits prior year 0 1.8 Change in reserve for rate credits (Lines 1.6 - 1.7) 0 1.9 Premium balances written off 0 1.10 Group conversion charge 0 1.11 Total direct premiums earned (Lines 1.1 + 1.4 - 1.9 + 1.10) 0 1.12 Assumed premiums earned from non-affiliates 0 1.13 Net Assumed less Ceded premiums earned from affiliates 0 1.14 Ceded premiums earned to non-affiliates 0 1.15 Other Adjustments due to MLR calculation - Premiums 0 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 0 2.1 Paid claims during the year 0 2.2 Direct claim liability current year 0 2.3 Direct claim liability prior year 0 2.4 Direct claim reserves current year 0 2.5 Direct claim reserves prior year 0 2.6 Direct contract reserves current year 0 2.7 Direct contract reserves prior year 0 2.8 Paid rate credits 0 2.9 Reserve for rate credits current year 0 2.10 Reserve for rate credits prior year 0 2.11 Incurred medical incentive pools and bonuses (Lines 2.11a + 2.11b - 2.11c) 0 2.11a Paid medical incentive pools and bonuses current year 0 2.11b Accrued medical incentive pools and bonuses current year 0 2.11c Accrued medical incentive pools and bonuses prior year 0 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 0 2.12a Healthcare receivables current year 0 2.12b Healthcare receivables prior year 0 2.13 Group conversion charge 0 2.14 Multi-option coverage blended rate adjustment 2.15 Total incurred claims (Lines 2.1 + 2.2 - 2.3 + 2.4 - 2.5 + 2.6 - 2.7 + 2.8 + 2.9 0 2.10 + 2.11 - 2.12 + 2.13 + 2.14) 0 2.16 Assumed incurred claims from non-affiliates 0 2.17 Net assumed less ceded incurred claims from affiliates 0 2.18 Ceded incurred claims to non-affiliates 0 2.19 Other adjustments due to MLR calculation - Claims 0 2.20 Net Incurred Claims (Lines 2.15 - 2.8 - 2.9 + 2.10 + 2.16 + 2.17 - 2.18 + 2.19) 3. Fraud and Abuse Recoveries that Reduced PAID Claims in Line 2.1 above 0 (informational only) 26,544 for stand-alone dental and $ (a) Column 13, Line 1.1 includes direct written premium of $ 4 Business Subject to MLR Mini-Med Plans 5 (LOCATION) NAIC Company Code 2018 615,045 0 0 0 0 0 0 0 0 0 615,045 0 0 0 0 615,045 4,471,885 0 0 0 314,241 304,350 273,421 30,929 0 0 4,471,885 0 0 472,458 0 3,654,257 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 465,183,656 0 0 0 (1,057,949) 9,857,741 12,304,674 (2,446,934) 2,063,283 0 463,120,373 0 0 0 2,063,283 468,688,538 17,595,389 0 0 0 (262,881) 55,828 55,793 35 0 0 17,595,389 0 0 3,272 0 17,854,963 364,339,651 0 0 0 904,486 317,460 34,165 283,295 111,639 0 364,228,012 0 0 0 111,639 363,151,871 852,205,627 0 0 0 (102,104) 10,535,378 12,668,053 (2,132,675) 2,174,922 0 850,030,704 0 0 475,731 2,174,922 853,964,674 252,963 17,480 91,556 273 5,055 0 0 0 0 0 0 0 0 0 10,824 14,319 3,495 0 0 2,247,520 281,668 187,271 4,662 4,392 0 0 314,241 304,350 273,421 16,089 14,268 1,824 4 3,943 75,628 71,685 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 389,189,638 45,701,082 51,003,317 328,956 301,406 0 0 (1,057,949) 9,857,741 12,304,674 294,521 270,740 316,572 292,791 21,650 1,255,556 1,233,907 0 0 13,497,787 2,254,787 2,062,956 964,246 398,794 81,160 86,487 (262,881) 55,828 55,793 0 0 0 0 2,211 2,211 0 0 0 297,462,470 34,242,714 30,582,530 580,828 608,175 0 0 904,486 317,460 34,165 524,750 441,387 242,919 159,555 (70,274) 14,569,317 14,639,591 0 0 702,650,379 82,497,732 83,927,629 1,878,966 1,317,821 81,160 86,487 (102,104) 10,535,378 12,668,053 835,360 726,394 561,315 452,349 (31,647) 15,917,031 15,948,678 0 0 163,282 0 0 0 0 163,282 2,699,504 0 0 211,317 0 2,143,017 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 380,682,943 0 0 0 0 384,187,825 13,984,686 0 0 (954) 0 14,248,486 302,878,112 0 0 0 0 301,690,331 700,408,527 0 0 210,364 0 702,432,942 49 0 0 6,619 for stand-alone vision policies. 0 0 0 0 14,337 1,420 15,806 1 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF Hawaii DURING THE YEAR All Expenses 1 2. Individual Comprehensive Coverage Expenses: 0 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 0 for affiliated services) 1.3 EDP Equipment and Software (incl $ 0 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 1.5 Accreditation and Certification (incl $ 0 for affiliated services) 1.6 Other Expenses (incl $ 1.7 Subtotal before Reimbursements and Taxes (Lines 1.1 to 1.6) 1.8 Reimbursements by uninsured plans and fiscal intermediaries 1.9 Taxes, Licenses and Fees (in total, for tying purposes) 1.10 Total (1.7 to 1.9) 1.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 216-4.HI 2.7 Subtotal before Reimbursements and Taxes (Lines 2.1 to 2.6) 2.8 Reimbursements by uninsured plans and fiscal intermediaries 2.9 Taxes, Licenses and Fees (in total, for tying purposes) 2.10 Total (2.7 to 2.9) 2.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 3. 0 0 0 0 0 0 0 0 XXX Small Group Comprehensive Coverage Expenses: 12,172 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 848 for affiliated services) 2.3 EDP Equipment and Software (incl $ 81 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 9 for affiliated services) 2.5 Accreditation and Certification (incl $ 27,603 for affiliated services) 2.6 Other Expenses (incl $ 3.7 Subtotal before Reimbursements and Taxes (Lines 3.1 to 3.6) 3.8 Reimbursements by uninsured plans and fiscal intermediaries 3.9 Taxes, Licenses and Fees (in total, for tying purposes) 3.10 Total (3.7 to 3.9) 3.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX Total (1 to 5) 0 0 0 0 0 0 0 0 XXX 0 0 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 0 0 0 0 0 0 0 XXX (LOCATION) NAIC Company Code 2018 XXX 0 0 0 0 0 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4,920 4,920 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4,920 4,920 0 1,585 330 132 13 1 3,546 5,608 0 2,095 240 175 17 2 4,686 7,216 0 XXX Large Group Comprehensive Coverage Expenses: 172,857 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 13,661 for affiliated services) 3.3 EDP Equipment and Software (incl $ 1,311 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 142 for affiliated services) 3.5 Accreditation and Certification (incl $ 390,926 for affiliated services) 3.6 Other Expenses (incl $ Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions Improve Health Outcomes 1. 185 Asylum Street Hartford, CT 061033408 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX XXX XXX 4,920 0 0 0 0 0 0 0 0 0 4,920 0 5,608 1,654 7,216 0 0 0 0 0 0 35,775 35,775 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 35,775 35,775 0 7,999 5,006 668 64 7 17,891 31,635 450 121,078 13,876 10,111 971 105 270,799 416,940 328 XXX XXX XXX 0 0 0 XXX 35,775 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 35,775 0 XXX 32,085 8,908 417,268 0 79413 9 10 General Administrative Expenses Total Expenses (6 to 9) 0 0 0 0 0 0 0 0 (30) (30) 0 0 0 0 0 0 0 0 0 (30) (30) 0 8,491 760 541 52 6 38,466 48,315 0 24,408 72,723 0 12,172 1,330 848 81 9 51,619 66,059 0 24,408 90,467 1,654 43,780 7,338 2,882 277 30 95,122 149,429 1,952 74,852 226,233 0 172,857 26,219 13,661 1,311 142 419,588 633,779 2,730 74,852 711,361 8,908 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 4. 5. 216-5.HI 6. Individual Mini-Med Plans Expenses: 0 for affiliated services) 4.1 Salaries (including $ 4.2 Outsourced Services 0 for affiliated services) 4.3 EDP Equipment and Software (incl $ 0 for affiliated services) 4.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 4.5 Accreditation and Certification (incl $ 0 for affiliated services) 4.6 Other Expenses (incl $ 4.7 Subtotal before Reimbursements and Taxes (Lines 4.1 to 4.6) 4.8 Reimbursements by uninsured plans and fiscal intermediaries 4.9 Taxes, Licenses and Fees (in total, for tying purposes) 4.10 Total (4.7 to 4.9) 4.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Mini-Med Plans Expenses: 0 for affiliated services) 5.1 Salaries (including $ 5.2 Outsourced Services 0 for affiliated services) 5.3 EDP Equipment and Software (incl $ 0 for affiliated services) 5.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 5.5 Accreditation and Certification (incl $ 0 for affiliated services) 5.6 Other Expenses (incl $ 5.7 Subtotal before Reimbursements and Taxes (Lines 5.1 to 5.6) 5.8 Reimbursements by uninsured plans and fiscal intermediaries 5.9 Taxes, Licenses and Fees (in total, for tying purposes) 5.10 Total (5.7 to 5.9) 5.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Mini-Med Plans Expenses: 0 for affiliated services) 6.1 Salaries (including $ 6.2 Outsourced Services 0 for affiliated services) 6.3 EDP Equipment and Software (incl $ 0 for affiliated services) 6.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 6.5 Accreditation and Certification (incl $ 0 for affiliated services) 6.6 Other Expenses (incl $ 6.7 Subtotal before Reimbursements and Taxes (Lines 6.1 to 6.6) 6.8 Reimbursements by uninsured plans and fiscal intermediaries 6.9 Taxes, Licenses and Fees (in total, for tying purposes) 6.10 Total (6.7 to 6.9) 6.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 7. 8. 216-6.HI 9. Small Group Expatriate Plans Expenses: 0 for affiliated services) 7.1 Salaries (including $ 7.2 Outsourced Services 0 for affiliated services) 7.3 EDP Equipment and Software (incl $ 0 for affiliated services) 7.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 7.5 Accreditation and Certification (incl $ 0 for affiliated services) 7.6 Other Expenses (incl $ 7.7 Subtotal before Reimbursements and Taxes (Lines 7.1 to 7.6) 7.8 Reimbursements by uninsured plans and fiscal intermediaries 7.9 Taxes, Licenses and Fees (in total, for tying purposes) 7.10 Total (7.7 to 7.9) 7.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Expatriate Plans Expenses: 0 for affiliated services) 8.1 Salaries (including $ 8.2 Outsourced Services 0 for affiliated services) 8.3 EDP Equipment and Software (incl $ 0 for affiliated services) 8.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 8.5 Accreditation and Certification (incl $ 0 for affiliated services) 8.6 Other Expenses (incl $ 8.7 Subtotal before Reimbursements and Taxes (Lines 8.1 to 8.6) 8.8 Reimbursements by uninsured plans and fiscal intermediaries 8.9 Taxes, Licenses and Fees (in total, for tying purposes) 8.10 Total (8.7 to 8.9) 8.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Student Health Plans Expenses: 0 for affiliated services) 9.1 Salaries (including $ 9.2 Outsourced Services 0 for affiliated services) 9.3 EDP Equipment and Software (incl $ 0 for affiliated services) 9.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 9.5 Accreditation and Certification (incl $ 0 for affiliated services) 9.6 Other Expenses (incl $ 9.7 Subtotal before Reimbursements and Taxes (Lines 9.1 to 9.6) 9.8 Reimbursements by uninsured plans and fiscal intermediaries 9.9 Taxes, Licenses and Fees (in total, for tying purposes) 9.10 Total (9.7 to 9.9) 9.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 *79413201821613100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes - See Cautionary Statement at http://www.naic.org/documents/committees_e_app_blanks_related_shce_cautionary_statement.pdf) UnitedHealthcare Insurance Company 2. 185 Asylum Street Hartford, CT 061033408 (LOCATION) BUSINESS IN THE STATE OF Idaho DURING THE YEAR 2018 NAIC Company Code Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 2 Small Group Employer Individual 1. 216-1.ID 2. 3. 4. 5. 6. 7. 8. 9. Premium: 1.1 Health premiums earned (From Part 2, Line 1.11) 1.2 Federal high risk pools 1.3 State high risk pools 1.4 Premiums earned including state and federal high risk programs (Lines 1.1 + 1.2 + 1.3) 1.5 Federal taxes and federal assessments 1.6 State insurance, premium and other taxes (Similar local taxes of 1,008,197 ) $ 1.6a Community Benefit Expenditures (informational only) 1.7 Regulatory authority licenses and fees 1.8 Adjusted Premiums Earned (Lines 1.4 - 1.5 - 1.6 - 1.7) 1.9 Net Assumed less Ceded reinsurance premiums earned 1.10 Other Adjustments due to MLR calculations - Premiums 1.11 Risk Revenue 1.12 Net adjusted premiums earned after reinsurance (Lines 1.8 + 1.9 + 1.10 + 1.11) Claims: 2.1 Incurred claims excluding prescription drugs 2.2 Prescription drugs 2.3 Pharmaceutical rebates 2.4 State stop loss, market stabilization and claim/census based assessments (informational only) Incurred medical incentive pools and bonuses Deductible Fraud and Abuse Detection/Recovery Expenses (for MLR use only) 5.0 Total Incurred Claims (Lines 2.1 + 2.2 - 2.3 + 3) (From Part 2, Line 2.15) 5.1 Net Assumed less Ceded reinsurance claims incurred 5.2 Other Adjustments due to MLR calculations - Claims 5.3 Rebates paid 5.4 Estimated rebates unpaid prior year 5.5 Estimated rebates unpaid current year 5.6 Fee for service and co-pay revenue 5.7 Net incurred claims after reinsurance (Lines 5.0 + 5.1 + 5.2 + 5.3 - 5.4 + 5.5 - 5.6) Improving Health Care Quality Expenses Incurred: 6.1 Improve health outcomes 6.2 Activities to prevent hospital readmissions 6.3 Improve patient safety and reduce medical errors 6.4 Wellness and health promotion activities 6.5 Health Information Technology expenses related to health improvement 6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5) Preliminary Medical Loss Ratio: MLR ((Lines 4 + 5.0 + 6.6 - Footnote 2.0)/Line 1.8 Claims Adjustment Expenses: 8.1 Cost containment expenses not included in quality of care expenses in Line 6.6 8.2 All other claims adjustment expenses 8.3 Total claims adjustment expenses (Lines 8.1 + 8.2) Claims Adjustment Expense Ratio (Line 8.3/Line 1.8) 3 Large Group Employer 4 5 Small Group Employer Individual Expatriate Plans 6 Large Group Employer 7 11 Government Business (excluded by statute) Other Health Business 9 8 Small Group 10 Student Health Plans Large Group 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 79413 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 6,442 0 0 1,395,111 0 0 2,941,932 0 (943) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 41,781,596 0 24,265 243,959,770 0 0 290,084,851 0 23,321 XXX XXX XXX 6,442 (1,035) 1,395,111 61,738 2,940,989 155,513 0 0 0 0 0 0 0 0 0 0 0 0 0 0 41,805,860 326,389 243,959,770 11,811,356 290,108,172 12,353,960 XXX 34 0 0 7,443 0 0 0 7,443 25,744 0 3 1,307,626 0 0 0 1,307,626 93,319 0 0 2,692,157 (372,757) 0 0 2,319,400 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 662,050 0 (10,277) 40,827,699 0 44 0 40,827,743 941,864 0 0 231,206,550 43,099 192,581 0 231,442,230 1,723,011 0 (10,274) 276,041,475 (329,658) 192,625 0 275,904,442 XXX XXX XXX XXX XXX 1,723,011 0 (10,274) 276,041,475 (329,658) 192,625 0 275,904,442 12,238 0 0 870,259 155,242 38,300 1,775,689 358,413 85,265 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 32,537,774 41,535 13,368 154,789,364 45,891,265 24,923,551 189,985,323 46,446,455 25,060,484 XXX XXX XXX 189,985,323 46,446,455 25,060,484 0 0 0 12,238 0 0 0 0 0 0 12,238 1,156 329 3 987,529 0 0 0 0 0 0 987,529 4,916 2,498 10,476 2,051,334 (305,997) 0 0 0 0 0 1,745,337 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3,326,316 26,515 179,083,393 0 0 0 0 0 0 179,083,393 6,072 3,329,142 36,993 214,700,436 (305,997) 0 0 0 0 0 214,394,438 XXX XXX 0 0 0 0 0 32,565,942 0 0 XXX XXX XXX 0 32,565,942 6,072 3,329,142 36,993 214,700,436 (305,997) 0 0 0 0 0 214,394,438 52 0 0 0 0 11,161 0 0 0 0 23,535 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 89,666 15,652 11,681 341,050 17,060 1,562,132 463,688 372,911 878,062 775,950 1,686,546 479,340 384,592 1,219,112 793,010 52 1.651 11,161 0.764 23,535 0.775 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 475,109 XXX 4,052,743 0.792 4,562,600 XXX 0 0 0 0.000 12,953 18,681 31,634 0.024 36,357 42,989 79,346 0.029 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 8,353 620,679 629,032 0.015 2,096,784 4,115,338 6,212,121 0.027 2,154,446 4,797,687 6,952,134 XXX XXX XXX XXX XXX 0 0 0 0.000 290,084,851 0 23,321 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 1,686,546 479,340 384,592 1,219,112 793,010 0 4,562,600 XXX 0 0 0 2,154,446 4,797,687 6,952,134 XXX XXX XXX 290,108,172 12,353,960 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 (Continued) Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 2 Small Group Employer Individual 10. General and Administrative (G&A) Expenses: 10.1 Direct sales salaries and benefits 10.2 Agents and brokers fees and commissions 10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below) 10.4 Other general and administrative expenses 10.4a Community Benefit Expenditures (informational only) 10.5 Total general and administrative (Lines 10.1 +10.2 + 10.3 + 10.4) 0 0 (502) (52) 0 (554) 3 Large Group Employer 4,537 39,362 (3,205) 45,130 0 85,824 4 5 Small Group Employer Individual 14,989 45,998 3,290 76,080 0 140,356 0 0 0 0 0 0 Expatriate Plans 6 Large Group Employer 0 0 0 0 0 0 7 8 Small Group 0 0 0 0 0 0 Student Health Plans Large Group 0 0 0 0 0 0 10 11 Government Business (excluded by statute) Other Health Business 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 52,289 1,521,113 31,257 4,213,922 0 5,818,581 449,830 5,528,668 290,235 9,316,234 0 15,584,966 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 521,645 7,135,141 321,074 13,651,315 0 21,629,174 0 0 0 0 0 0 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) 26,509,007 28,366,096 12. Income from fees of uninsured plans XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 13. Net investment and other gain/(loss) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 14. Federal income taxes (excluding taxes on Line 1.5 above) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 15. Net gain or (loss) (Lines 11 + 12 + 13 - 14) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 16. ICD-10 Implementation Expenses (informational only; already included in general expenses and line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16. 16a ICD-10 Implementation Expenses (informational only; already included in line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (4,293) 191,478 330,825 0 0 0 0 0 0 0 1,339,078 XXX 521,645 7,135,141 321,074 13,651,315 0 21,629,174 28,366,096 0 0 4,165,194 XXX XXX 241,908 XXX 241,908 XXX 32,289,382 XXX 32,289,382 4,165,194 OTHER INDICATORS: 216-2.ID 1. Number of certificates/policies 0 163 400 0 0 0 0 0 0 0 20,785 34,201 55,549 0 55,549 2. Number of Covered Lives 0 271 669 0 0 0 0 0 0 0 21,358 34,201 56,499 0 56,499 3. Number of Groups 36 11 0 0 0 0 0 0 44 0 91 0 91 4. Member Months 19 2,446 8,563 0 0 0 0 0 0 249,943 407,453 668,424 0 668,424 XXX Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ XXX 0 ] If yes, show the amount of premiums and claims included. Premiums $ 0 Claims $ 0 AFFORDABLE CARE ACT (ACA) RECEIPTS, PAYMENTS, RECEIVABLES and PAYABLES Current Year Prior Year Comprehensive Health Coverage Comprehensive Health Coverage 1 2 3 4 Small Group Small Group Employer Plans Employer Plans Individual Plans Individual Plans ACA Receivables and Payables 1. Permanent ACA Risk Adjustment Program 1.0 Premium adjustments receivable/(payable) 0 2. Transitional ACA Reinsurance Program 2.0 Total amounts recoverable for claims (paid & unpaid) 0 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 0 0 0 0 0 0 0 0 1,625 0 139,606 262,287 XXX 0 0 (88,969) XXX ACA Receipts and Payments 4. Permanent ACA Risk Adjustment Program 4.0 Premium adjustments receipts/(payments) 0 5. Transitional ACA Reinsurance Program 5.0 Amounts received for claims 0 6. Temporary ACA Risk Corridors Program 6.1 Retrospective premium received 6.2 Rate credits or policy experience refunds paid 0 0 XXX 0 0 0 0 0 XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF 185 Asylum Street Hartford, CT 061033408 Idaho DURING THE YEAR Comprehensive Health Coverage 1 2 3 Individual Small Group Employer Large Group Employer Small Group Employer Individual Expatriate Plans: 7 8 6 Large Group Employer Small Group 10 11 Government Business (excluded by statute) Other Health Business 9 Student Health Plans Large Group 79413 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.ID Health Premiums Earned: 6,442 1,395,111 1.1 Direct premiums written 0 0 1.2 Unearned premium prior year 0 0 1.3 Unearned premium current year 0 0 1.4 Change in unearned premium (Lines 1.2 - 1.3) 0 0 1.5 Paid rate credits 0 0 1.6 Reserve for rate credits current year 0 0 1.7 Reserve for rate credits prior year 0 0 1.8 Change in reserve for rate credits (Lines 1.6 - 1.7) 0 0 1.9 Premium balances written off 0 0 1.10 Group conversion charge 6,442 1,395,111 1.11 Total direct premiums earned (Lines 1.1 + 1.4 - 1.9 + 1.10) 0 0 1.12 Assumed premiums earned from non-affiliates 0 0 1.13 Net Assumed less Ceded premiums earned from affiliates 0 0 1.14 Ceded premiums earned to non-affiliates 0 0 1.15 Other Adjustments due to MLR calculation - Premiums 6,442 1,395,111 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 12,237 867,388 2.1 Paid claims during the year 3 152,875 2.2 Direct claim liability current year 2 38,951 2.3 Direct claim liability prior year 0 2,769 2.4 Direct claim reserves current year 0 163 2.5 Direct claim reserves prior year 0 0 2.6 Direct contract reserves current year 0 0 2.7 Direct contract reserves prior year 0 0 2.8 Paid rate credits 0 0 2.9 Reserve for rate credits current year 0 0 2.10 Reserve for rate credits prior year 0 329 2.11 Incurred medical incentive pools and bonuses (Lines 2.11a + 2.11b - 2.11c) 0 159 2.11a Paid medical incentive pools and bonuses current year 0 170 2.11b Accrued medical incentive pools and bonuses current year 0 0 2.11c Accrued medical incentive pools and bonuses prior year 0 (3,284) 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 0 15,107 2.12a Healthcare receivables current year 0 18,390 2.12b Healthcare receivables prior year 0 0 2.13 Group conversion charge 0 0 2.14 Multi-option coverage blended rate adjustment 2.15 Total incurred claims (Lines 2.1 + 2.2 - 2.3 + 2.4 - 2.5 + 2.6 - 2.7 + 2.8 + 2.9 12,238 987,529 2.10 + 2.11 - 2.12 + 2.13 + 2.14) 0 0 2.16 Assumed incurred claims from non-affiliates 0 0 2.17 Net assumed less ceded incurred claims from affiliates 0 0 2.18 Ceded incurred claims to non-affiliates 0 0 2.19 Other adjustments due to MLR calculation - Claims 12,238 987,529 2.20 Net Incurred Claims (Lines 2.15 - 2.8 - 2.9 + 2.10 + 2.16 + 2.17 - 2.18 + 2.19) 3. Fraud and Abuse Recoveries that Reduced PAID Claims in Line 2.1 above 1 3 (informational only) 67,083 for stand-alone dental and $ (a) Column 13, Line 1.1 includes direct written premium of $ 4 Business Subject to MLR Mini-Med Plans 5 (LOCATION) NAIC Company Code 2018 2,941,932 0 0 0 0 0 0 0 0 0 2,941,932 0 0 372,757 0 2,569,175 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 41,781,640 0 0 0 (1,470,760) 0 0 0 44 0 41,781,596 0 0 0 44 43,252,399 244,152,351 0 0 0 436,652 441,944 1,045,266 (603,322) 192,581 0 243,959,770 0 43,099 0 192,581 244,362,120 290,277,475 0 0 0 (1,034,108) 441,944 1,045,266 (603,322) 192,625 0 290,084,851 0 43,099 372,757 192,625 291,585,247 2,247,713 293,232 505,652 3,482 15,552 0 0 0 0 0 2,498 68 2,891 461 (25,613) 37,311 62,924 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 32,150,371 4,696,683 4,188,173 1,192,473 1,147,047 4,921,397 3,585,094 (1,470,760) 0 0 0 0 0 0 3,909 3,909 0 0 0 176,957,502 23,029,383 23,726,536 29,389 26,938 0 0 436,652 441,944 1,045,266 3,326,316 2,860,767 3,163,593 2,698,045 339,054 11,115,762 10,776,708 0 0 212,235,212 28,172,176 28,459,315 1,228,113 1,189,700 4,921,397 3,585,094 (1,034,108) 441,944 1,045,266 3,329,142 2,860,994 3,166,655 2,698,506 314,066 11,172,088 10,858,022 0 0 2,051,334 0 0 305,997 0 1,745,337 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 32,565,942 0 0 0 0 34,036,702 179,083,393 0 0 0 0 179,250,063 214,700,436 0 0 305,997 0 216,031,868 93,652 0 0 21,276 for stand-alone vision policies. 0 0 0 0 0 0 26,515 120,170 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF Idaho DURING THE YEAR All Expenses 1 2. Individual Comprehensive Coverage Expenses: 0 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 0 for affiliated services) 1.3 EDP Equipment and Software (incl $ 0 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 1.5 Accreditation and Certification (incl $ 0 for affiliated services) 1.6 Other Expenses (incl $ 1.7 Subtotal before Reimbursements and Taxes (Lines 1.1 to 1.6) 1.8 Reimbursements by uninsured plans and fiscal intermediaries 1.9 Taxes, Licenses and Fees (in total, for tying purposes) 1.10 Total (1.7 to 1.9) 1.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 216-4.ID 2.7 Subtotal before Reimbursements and Taxes (Lines 2.1 to 2.6) 2.8 Reimbursements by uninsured plans and fiscal intermediaries 2.9 Taxes, Licenses and Fees (in total, for tying purposes) 2.10 Total (2.7 to 2.9) 2.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 3. 0 0 0 0 0 52 52 0 XXX Small Group Comprehensive Coverage Expenses: 26,178 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 1,821 for affiliated services) 2.3 EDP Equipment and Software (incl $ 175 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 19 for affiliated services) 2.5 Accreditation and Certification (incl $ 58,189 for affiliated services) 2.6 Other Expenses (incl $ 3.7 Subtotal before Reimbursements and Taxes (Lines 3.1 to 3.6) 3.8 Reimbursements by uninsured plans and fiscal intermediaries 3.9 Taxes, Licenses and Fees (in total, for tying purposes) 3.10 Total (3.7 to 3.9) 3.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX Total (1 to 5) 0 0 0 0 0 52 52 0 XXX 0 0 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 0 0 0 0 0 0 0 XXX (LOCATION) NAIC Company Code 2018 XXX 0 0 0 0 0 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX 52 0 0 0 0 0 0 0 0 0 52 0 0 0 0 0 0 0 0 0 0 11,161 11,161 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 11,161 11,161 0 3,530 555 295 28 3 8,119 12,530 0 5,294 607 442 42 5 11,841 18,231 0 XXX Large Group Comprehensive Coverage Expenses: 66,907 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 4,380 for affiliated services) 3.3 EDP Equipment and Software (incl $ 420 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 46 for affiliated services) 3.5 Accreditation and Certification (incl $ 146,306 for affiliated services) 3.6 Other Expenses (incl $ Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions Improve Health Outcomes 1. 185 Asylum Street Hartford, CT 061033408 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX XXX XXX 11,161 0 0 0 0 0 0 0 0 0 11,161 0 12,530 3,652 18,231 0 0 0 0 0 0 23,535 23,535 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 23,535 23,535 0 9,427 3,186 787 76 8 21,730 35,214 0 12,190 1,397 1,018 98 11 27,263 41,977 0 XXX XXX XXX 0 0 0 XXX 23,535 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 23,535 0 XXX 35,214 10,476 41,977 0 79413 9 10 General Administrative Expenses Total Expenses (6 to 9) 0 0 0 0 0 (52) (52) 0 (468) (520) 0 0 0 0 0 0 0 0 0 (468) (468) 0 17,353 1,589 1,084 104 11 68,566 88,708 0 23,736 112,444 0 26,178 2,751 1,821 175 19 99,687 130,629 0 23,736 154,366 3,652 45,290 3,729 2,575 247 27 84,203 136,071 0 99,759 235,830 0 66,907 8,312 4,380 420 46 156,732 236,798 0 99,759 336,557 10,476 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 4. 5. 216-5.ID 6. Individual Mini-Med Plans Expenses: 0 for affiliated services) 4.1 Salaries (including $ 4.2 Outsourced Services 0 for affiliated services) 4.3 EDP Equipment and Software (incl $ 0 for affiliated services) 4.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 4.5 Accreditation and Certification (incl $ 0 for affiliated services) 4.6 Other Expenses (incl $ 4.7 Subtotal before Reimbursements and Taxes (Lines 4.1 to 4.6) 4.8 Reimbursements by uninsured plans and fiscal intermediaries 4.9 Taxes, Licenses and Fees (in total, for tying purposes) 4.10 Total (4.7 to 4.9) 4.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Mini-Med Plans Expenses: 0 for affiliated services) 5.1 Salaries (including $ 5.2 Outsourced Services 0 for affiliated services) 5.3 EDP Equipment and Software (incl $ 0 for affiliated services) 5.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 5.5 Accreditation and Certification (incl $ 0 for affiliated services) 5.6 Other Expenses (incl $ 5.7 Subtotal before Reimbursements and Taxes (Lines 5.1 to 5.6) 5.8 Reimbursements by uninsured plans and fiscal intermediaries 5.9 Taxes, Licenses and Fees (in total, for tying purposes) 5.10 Total (5.7 to 5.9) 5.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Mini-Med Plans Expenses: 0 for affiliated services) 6.1 Salaries (including $ 6.2 Outsourced Services 0 for affiliated services) 6.3 EDP Equipment and Software (incl $ 0 for affiliated services) 6.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 6.5 Accreditation and Certification (incl $ 0 for affiliated services) 6.6 Other Expenses (incl $ 6.7 Subtotal before Reimbursements and Taxes (Lines 6.1 to 6.6) 6.8 Reimbursements by uninsured plans and fiscal intermediaries 6.9 Taxes, Licenses and Fees (in total, for tying purposes) 6.10 Total (6.7 to 6.9) 6.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 7. 8. 216-6.ID 9. Small Group Expatriate Plans Expenses: 0 for affiliated services) 7.1 Salaries (including $ 7.2 Outsourced Services 0 for affiliated services) 7.3 EDP Equipment and Software (incl $ 0 for affiliated services) 7.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 7.5 Accreditation and Certification (incl $ 0 for affiliated services) 7.6 Other Expenses (incl $ 7.7 Subtotal before Reimbursements and Taxes (Lines 7.1 to 7.6) 7.8 Reimbursements by uninsured plans and fiscal intermediaries 7.9 Taxes, Licenses and Fees (in total, for tying purposes) 7.10 Total (7.7 to 7.9) 7.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Expatriate Plans Expenses: 0 for affiliated services) 8.1 Salaries (including $ 8.2 Outsourced Services 0 for affiliated services) 8.3 EDP Equipment and Software (incl $ 0 for affiliated services) 8.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 8.5 Accreditation and Certification (incl $ 0 for affiliated services) 8.6 Other Expenses (incl $ 8.7 Subtotal before Reimbursements and Taxes (Lines 8.1 to 8.6) 8.8 Reimbursements by uninsured plans and fiscal intermediaries 8.9 Taxes, Licenses and Fees (in total, for tying purposes) 8.10 Total (8.7 to 8.9) 8.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Student Health Plans Expenses: 0 for affiliated services) 9.1 Salaries (including $ 9.2 Outsourced Services 0 for affiliated services) 9.3 EDP Equipment and Software (incl $ 0 for affiliated services) 9.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 9.5 Accreditation and Certification (incl $ 0 for affiliated services) 9.6 Other Expenses (incl $ 9.7 Subtotal before Reimbursements and Taxes (Lines 9.1 to 9.6) 9.8 Reimbursements by uninsured plans and fiscal intermediaries 9.9 Taxes, Licenses and Fees (in total, for tying purposes) 9.10 Total (9.7 to 9.9) 9.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 *79413201821614100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes - See Cautionary Statement at http://www.naic.org/documents/committees_e_app_blanks_related_shce_cautionary_statement.pdf) UnitedHealthcare Insurance Company 2. 185 Asylum Street Hartford, CT 061033408 (LOCATION) BUSINESS IN THE STATE OF Illinois DURING THE YEAR 2018 NAIC Company Code Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 1. 216-1.IL 2. 3. 4. 5. 6. 7. 8. 9. Premium: 1.1 Health premiums earned (From Part 2, Line 1.11) 1.2 Federal high risk pools 1.3 State high risk pools 1.4 Premiums earned including state and federal high risk programs (Lines 1.1 + 1.2 + 1.3) 1.5 Federal taxes and federal assessments 1.6 State insurance, premium and other taxes (Similar local taxes of 7,284,152 ) $ 1.6a Community Benefit Expenditures (informational only) 1.7 Regulatory authority licenses and fees 1.8 Adjusted Premiums Earned (Lines 1.4 - 1.5 - 1.6 - 1.7) 1.9 Net Assumed less Ceded reinsurance premiums earned 1.10 Other Adjustments due to MLR calculations - Premiums 1.11 Risk Revenue 1.12 Net adjusted premiums earned after reinsurance (Lines 1.8 + 1.9 + 1.10 + 1.11) Claims: 2.1 Incurred claims excluding prescription drugs 2.2 Prescription drugs 2.3 Pharmaceutical rebates 2.4 State stop loss, market stabilization and claim/census based assessments (informational only) Incurred medical incentive pools and bonuses Deductible Fraud and Abuse Detection/Recovery Expenses (for MLR use only) 5.0 Total Incurred Claims (Lines 2.1 + 2.2 - 2.3 + 3) (From Part 2, Line 2.15) 5.1 Net Assumed less Ceded reinsurance claims incurred 5.2 Other Adjustments due to MLR calculations - Claims 5.3 Rebates paid 5.4 Estimated rebates unpaid prior year 5.5 Estimated rebates unpaid current year 5.6 Fee for service and co-pay revenue 5.7 Net incurred claims after reinsurance (Lines 5.0 + 5.1 + 5.2 + 5.3 - 5.4 + 5.5 - 5.6) Improving Health Care Quality Expenses Incurred: 6.1 Improve health outcomes 6.2 Activities to prevent hospital readmissions 6.3 Improve patient safety and reduce medical errors 6.4 Wellness and health promotion activities 6.5 Health Information Technology expenses related to health improvement 6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5) Preliminary Medical Loss Ratio: MLR ((Lines 4 + 5.0 + 6.6 - Footnote 2.0)/Line 1.8 Claims Adjustment Expenses: 8.1 Cost containment expenses not included in quality of care expenses in Line 6.6 8.2 All other claims adjustment expenses 8.3 Total claims adjustment expenses (Lines 8.1 + 8.2) Claims Adjustment Expense Ratio (Line 8.3/Line 1.8) 2 Small Group Employer 3 Large Group Employer 4 5 Small Group Employer Individual Expatriate Plans 6 Large Group Employer 7 11 Government Business (excluded by statute) Other Health Business 9 8 Small Group 10 Student Health Plans Large Group 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 79413 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 662,025 0 (1,493) 7,267 0 10 97,652,755 0 (60,130) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,813 0 0 528,318,567 0 135,829 202,964,379 0 0 829,606,807 0 74,216 XXX XXX XXX 829,606,807 0 74,216 660,532 (19,113) 7,277 20,245 97,592,625 7,276,279 0 0 0 0 0 0 0 0 0 0 0 0 1,813 361 528,454,396 6,910,961 202,964,379 9,427,387 829,681,023 23,616,121 XXX (62,892) 829,681,023 23,553,228 22,344 0 605 656,696 15,463 0 0 672,159 (4,842) 0 (15) (8,110) 54,406 0 0 46,296 2,777,835 0 20,460 87,518,051 (1,506,856) 0 0 86,011,195 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 186 0 0 1,266 0 0 0 1,266 9,973,369 0 (63,464) 511,633,530 (402,474) 9,414 0 511,240,470 2,801,692 0 0 190,735,300 1,680,518 2,361,624 0 194,777,442 15,570,584 0 (42,414) 790,536,732 (158,942) 2,371,038 0 792,748,828 (31,391) 0 0 XXX XXX XXX XXX XXX 15,539,194 0 (42,414) 790,631,015 (158,942) 2,371,038 0 792,843,110 615,146 72,076 7,526 (24,415) 5,445 0 60,306,318 15,683,239 4,822,263 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 289,070,589 155,329,076 84,368 13,984,632 302,442,409 166,964,148 363,952,270 473,532,244 171,878,305 XXX XXX XXX 363,952,270 473,532,244 171,878,305 9,612 0 0 679,696 71,992 0 0 0 0 0 751,688 0 2,253 0 (16,718) 104,564 0 0 0 0 0 87,846 215,856 70,521 266,479 71,237,815 (921,446) 0 0 0 0 0 70,316,369 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (655,389) 33,923 148,807,505 (50,681) 0 0 0 0 0 148,756,824 225,639 (582,615) 300,402 665,023,595 (1,161,597) 0 0 0 0 0 663,861,997 XXX XXX 0 0 171 0 0 444,315,297 (366,026) 0 XXX XXX XXX 0 443,949,271 225,639 (582,615) 300,402 665,023,595 (1,161,597) 0 0 0 0 0 663,861,997 0 0 0 0 0 707,502 226,037 197,095 2,148,699 178,473 0 3,457,807 XXX 1,569,544 0.789 5,813,928 XXX 283,778 XXX 6,097,706 XXX 0 0 0 0.000 960,689 5,673,457 6,634,146 0.013 2,951,956 11,550,284 14,502,239 0.076 4,906,032 18,518,614 23,424,646 XXX 411,599 3,176,239 3,587,838 XXX 5,317,632 21,694,853 27,012,485 XXX 5,296 0 0 0 0 58 0 0 0 0 781,222 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5,296 1.043 58 2.054 781,222 0.826 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 2,689 11,456 14,144 0.022 1,093 45,612 46,705 (5.759) 989,606 1,237,806 2,227,412 0.025 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 XXX XXX XXX XXX 348,786 115,417 565,646 (103,456) 643,151 1,842,865 341,455 762,741 2,045,243 821,624 0 XXX XXX XXX XXX XXX XXX XXX XXX 41,262 183 158,955 (21,962) 105,340 1,884,127 341,637 921,696 2,023,282 926,964 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 (Continued) Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 2 Small Group Employer Individual 10. General and Administrative (G&A) Expenses: 10.1 Direct sales salaries and benefits 10.2 Agents and brokers fees and commissions 10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below) 10.4 Other general and administrative expenses 10.4a Community Benefit Expenditures (informational only) 10.5 Total general and administrative (Lines 10.1 +10.2 + 10.3 + 10.4) 148 0 (7,426) 65,433 0 58,156 3 Large Group Employer (23) 131 (151,193) 2,131 0 (148,954) 4 5 Small Group Employer Individual 73,849 24,918 51,349 1,717,976 0 1,868,092 0 0 0 0 0 0 Expatriate Plans 6 Large Group Employer 0 0 0 0 0 0 7 8 Small Group 0 0 0 0 0 0 Student Health Plans Large Group 0 0 0 0 0 0 10 11 Government Business (excluded by statute) Other Health Business 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 978,042 16,099,201 416,937 33,853,349 0 51,347,530 455,964 1,585,780 492,263 14,872,971 0 17,406,978 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 1,507,981 17,710,030 801,930 50,511,860 0 70,531,801 65,831 0 9,892 201,017 0 276,739 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) 12,541,856 29,116,455 12. Income from fees of uninsured plans XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 13. Net investment and other gain/(loss) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 13,206,459 XXX 14. Federal income taxes (excluding taxes on Line 1.5 above) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 630,211 XXX 630,211 15. Net gain or (loss) (Lines 11 + 12 + 13 - 14) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 41,692,703 XXX 41,471,825 16. ICD-10 Implementation Expenses (informational only; already included in general expenses and line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16. 16a ICD-10 Implementation Expenses (informational only; already included in line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (157,125) 60,641 10,818,101 0 0 0 0 0 0 1,266 5,851,716 XXX 1,573,811 17,710,030 811,822 50,712,877 0 70,808,540 25,062,383 3,833,195 3,833,195 13,206,459 OTHER INDICATORS: 216-2.IL 1. Number of certificates/policies 68 0 7,114 0 0 0 0 0 0 0 380,183 186,214 573,579 51,123 624,702 2. Number of Covered Lives 65 0 14,875 0 0 0 0 0 0 1 604,444 186,214 805,599 78,081 883,680 3. Number of Groups 0 14 0 0 0 0 0 0 6,541 13 6,568 1,470 8,038 4. Member Months 956 1,800 210,165 0 0 0 0 0 12 7,471,800 2,286,149 9,970,882 959,771 10,930,653 XXX Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ XXX 0 ] If yes, show the amount of premiums and claims included. Premiums $ 0 Claims $ 0 AFFORDABLE CARE ACT (ACA) RECEIPTS, PAYMENTS, RECEIVABLES and PAYABLES Current Year Prior Year Comprehensive Health Coverage Comprehensive Health Coverage 1 2 3 4 Small Group Small Group Employer Plans Employer Plans Individual Plans Individual Plans ACA Receivables and Payables 1. Permanent ACA Risk Adjustment Program 1.0 Premium adjustments receivable/(payable) 0 2. Transitional ACA Reinsurance Program 2.0 Total amounts recoverable for claims (paid & unpaid) 0 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 0 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 XXX ACA Receipts and Payments 4. Permanent ACA Risk Adjustment Program 4.0 Premium adjustments receipts/(payments) 0 5. Transitional ACA Reinsurance Program 5.0 Amounts received for claims 0 6. Temporary ACA Risk Corridors Program 6.1 Retrospective premium received 6.2 Rate credits or policy experience refunds paid 0 0 XXX 0 0 0 0 0 XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF 185 Asylum Street Hartford, CT 061033408 Illinois DURING THE YEAR Comprehensive Health Coverage 1 2 3 Individual Small Group Employer Small Group Employer Individual Expatriate Plans: 7 8 6 Large Group Employer Small Group 10 11 Government Business (excluded by statute) Other Health Business 9 Student Health Plans Large Group 79413 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.IL Health Premiums Earned: 662,025 1.1 Direct premiums written 0 1.2 Unearned premium prior year 0 1.3 Unearned premium current year 0 1.4 Change in unearned premium (Lines 1.2 - 1.3) (182,073) 1.5 Paid rate credits 0 1.6 Reserve for rate credits current year 0 1.7 Reserve for rate credits prior year 0 1.8 Change in reserve for rate credits (Lines 1.6 - 1.7) 0 1.9 Premium balances written off 0 1.10 Group conversion charge 662,025 1.11 Total direct premiums earned (Lines 1.1 + 1.4 - 1.9 + 1.10) 0 1.12 Assumed premiums earned from non-affiliates 15,463 1.13 Net Assumed less Ceded premiums earned from affiliates 0 1.14 Ceded premiums earned to non-affiliates 0 1.15 Other Adjustments due to MLR calculation - Premiums 859,562 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 904,261 2.1 Paid claims during the year 224,782 2.2 Direct claim liability current year 82,386 2.3 Direct claim liability prior year 13,078 2.4 Direct claim reserves current year 14,593 2.5 Direct claim reserves prior year 392,037 2.6 Direct contract reserves current year 572,135 2.7 Direct contract reserves prior year (182,073) 2.8 Paid rate credits 0 2.9 Reserve for rate credits current year 0 2.10 Reserve for rate credits prior year 0 2.11 Incurred medical incentive pools and bonuses (Lines 2.11a + 2.11b - 2.11c) 0 2.11a Paid medical incentive pools and bonuses current year 0 2.11b Accrued medical incentive pools and bonuses current year 0 2.11c Accrued medical incentive pools and bonuses prior year 3,274 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 3,274 2.12a Healthcare receivables current year 0 2.12b Healthcare receivables prior year 0 2.13 Group conversion charge 0 2.14 Multi-option coverage blended rate adjustment 2.15 Total incurred claims (Lines 2.1 + 2.2 - 2.3 + 2.4 - 2.5 + 2.6 - 2.7 + 2.8 + 2.9 679,696 2.10 + 2.11 - 2.12 + 2.13 + 2.14) 0 2.16 Assumed incurred claims from non-affiliates 71,992 2.17 Net assumed less ceded incurred claims from affiliates 0 2.18 Ceded incurred claims to non-affiliates 0 2.19 Other adjustments due to MLR calculation - Claims 933,761 2.20 Net Incurred Claims (Lines 2.15 - 2.8 - 2.9 + 2.10 + 2.16 + 2.17 - 2.18 + 2.19) 3. Fraud and Abuse Recoveries that Reduced PAID Claims in Line 2.1 above 0 (informational only) 46,468,169 for stand-alone dental and $ (a) Column 13, Line 1.1 includes direct written premium of $ Large Group Employer 4 Business Subject to MLR Mini-Med Plans 5 (LOCATION) NAIC Company Code 2018 7,267 0 0 0 0 0 0 0 0 0 7,267 0 54,406 0 0 61,673 97,652,755 0 0 0 189,391 (470,000) (377,242) (92,758) 0 0 97,652,755 (2,920) (665,944) 837,992 0 96,049,267 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,813 0 0 0 0 0 0 0 0 0 1,813 0 0 0 0 1,813 528,374,482 117,242 163,743 (46,501) (2,998,017) 3,323,113 3,010,986 312,127 9,414 0 528,318,567 0 0 402,474 9,414 530,611,397 205,326,003 0 0 0 8,898,931 233,514 9,056,405 (8,822,891) 2,361,624 0 202,964,379 0 1,680,518 0 2,361,624 206,930,480 832,024,346 117,242 163,743 (46,501) 5,908,232 3,086,627 11,690,149 (8,603,521) 2,371,038 0 829,606,807 (2,920) 1,084,443 1,240,466 2,371,038 834,514,192 14,007 84,537 117,591 201 123 0 0 0 0 0 2,253 71 2,182 0 0 0 0 0 0 75,251,759 9,537,917 14,867,962 201,855 309,556 0 0 189,391 (470,000) (377,242) 70,521 90,688 169,615 189,782 (1,256,648) 1,961,352 3,217,999 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 442,474,042 43,963,957 42,383,920 24,249,766 21,476,536 497,605 298,999 (2,998,017) 3,323,113 3,010,986 0 0 0 0 24,728 24,728 0 0 0 151,952,976 4,852,651 14,928,596 345 440 0 0 8,898,931 233,514 9,056,405 (655,389) 1,807 32,198 689,393 (7,509,916) 50,353,110 57,863,026 0 0 670,597,045 58,663,843 72,380,454 24,465,245 21,801,249 889,641 871,134 5,908,232 3,086,627 11,690,149 (582,615) 92,566 203,994 879,175 (8,738,561) 52,342,464 61,081,025 0 0 (16,718) 0 104,564 0 0 87,846 71,237,815 (105,441) (564,795) 251,210 0 70,219,736 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 444,315,297 0 0 366,026 0 446,635,160 148,807,505 0 (50,681) 0 0 148,680,783 665,023,595 (105,441) (438,920) 617,236 0 666,557,287 411,721 0 0 17,223,057 for stand-alone vision policies. 0 0 0 0 0 0 755 143,330 555,806 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF Illinois DURING THE YEAR All Expenses 1 Individual Comprehensive Coverage Expenses: 20,272 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 421 for affiliated services) 1.3 EDP Equipment and Software (incl $ 40 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 4 for affiliated services) 1.5 Accreditation and Certification (incl $ 9,480 for affiliated services) 1.6 Other Expenses (incl $ 1.7 Subtotal before Reimbursements and Taxes (Lines 1.1 to 1.6) 1.8 Reimbursements by uninsured plans and fiscal intermediaries 1.9 Taxes, Licenses and Fees (in total, for tying purposes) 1.10 Total (1.7 to 1.9) 1.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 2. 216-4.IL 2.7 Subtotal before Reimbursements and Taxes (Lines 2.1 to 2.6) 2.8 Reimbursements by uninsured plans and fiscal intermediaries 2.9 Taxes, Licenses and Fees (in total, for tying purposes) 2.10 Total (2.7 to 2.9) 2.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 3. 0 0 0 0 0 5,296 5,296 0 XXX Small Group Comprehensive Coverage Expenses: 13,191 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 1,103 for affiliated services) 2.3 EDP Equipment and Software (incl $ 106 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 12 for affiliated services) 2.5 Accreditation and Certification (incl $ 30,066 for affiliated services) 2.6 Other Expenses (incl $ 3.7 Subtotal before Reimbursements and Taxes (Lines 3.1 to 3.6) 3.8 Reimbursements by uninsured plans and fiscal intermediaries 3.9 Taxes, Licenses and Fees (in total, for tying purposes) 3.10 Total (3.7 to 3.9) 3.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX Total (1 to 5) 0 0 0 0 0 5,296 5,296 0 XXX 0 0 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 5,296 0 0 0 0 0 0 58 58 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 58 58 0 XXX 0 0 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 700 337 58 6 1 1,573 2,675 0 XXX 0 0 XXX (LOCATION) NAIC Company Code 2018 5,296 0 XXX Large Group Comprehensive Coverage Expenses: 1,130,544 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 88,461 for affiliated services) 3.3 EDP Equipment and Software (incl $ 8,491 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 922 for affiliated services) 3.5 Accreditation and Certification (incl $ 3,196,257 for affiliated services) 3.6 Other Expenses (incl $ Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions Improve Health Outcomes 1. 185 Asylum Street Hartford, CT 061033408 XXX 6,507 162 104 10 1 4,657 11,441 0 XXX 2,675 120 11,441 0 (17) 1,089 (1) 0 0 25 1,095 0 13,246 1,518 1,106 106 12 29,625 45,612 0 XXX XXX 58 0 0 0 0 0 0 0 0 0 58 0 1,095 0 45,612 0 0 0 0 0 0 781,222 781,222 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 781,222 781,222 0 245,116 132,343 20,468 1,965 213 561,653 961,757 1 353,824 40,558 29,546 2,836 308 791,352 1,218,424 0 961,758 266,479 XXX 1,218,425 0 XXX XXX XXX 0 0 0 XXX 781,222 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 781,222 0 79413 9 10 General Administrative Expenses Total Expenses (6 to 9) 13,065 243 258 1 3 52,002 65,571 0 15,563 81,134 0 20,272 742 421 16 4 63,528 84,983 0 15,563 100,545 120 (38) 1,024 (1) 0 0 1,245 2,230 0 (156,044) (153,814) 0 13,191 3,631 1,103 106 12 30,953 48,995 0 (156,044) (107,049) 0 531,604 84,171 38,446 3,690 401 1,144,459 1,802,771 2 2,910,842 4,713,616 0 1,130,544 257,072 88,461 8,491 922 3,278,685 4,764,175 3 2,910,842 7,675,021 266,479 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 4. 5. 216-5.IL 6. Individual Mini-Med Plans Expenses: 0 for affiliated services) 4.1 Salaries (including $ 4.2 Outsourced Services 0 for affiliated services) 4.3 EDP Equipment and Software (incl $ 0 for affiliated services) 4.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 4.5 Accreditation and Certification (incl $ 0 for affiliated services) 4.6 Other Expenses (incl $ 4.7 Subtotal before Reimbursements and Taxes (Lines 4.1 to 4.6) 4.8 Reimbursements by uninsured plans and fiscal intermediaries 4.9 Taxes, Licenses and Fees (in total, for tying purposes) 4.10 Total (4.7 to 4.9) 4.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Mini-Med Plans Expenses: 0 for affiliated services) 5.1 Salaries (including $ 5.2 Outsourced Services 0 for affiliated services) 5.3 EDP Equipment and Software (incl $ 0 for affiliated services) 5.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 5.5 Accreditation and Certification (incl $ 0 for affiliated services) 5.6 Other Expenses (incl $ 5.7 Subtotal before Reimbursements and Taxes (Lines 5.1 to 5.6) 5.8 Reimbursements by uninsured plans and fiscal intermediaries 5.9 Taxes, Licenses and Fees (in total, for tying purposes) 5.10 Total (5.7 to 5.9) 5.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Mini-Med Plans Expenses: 0 for affiliated services) 6.1 Salaries (including $ 6.2 Outsourced Services 0 for affiliated services) 6.3 EDP Equipment and Software (incl $ 0 for affiliated services) 6.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 6.5 Accreditation and Certification (incl $ 0 for affiliated services) 6.6 Other Expenses (incl $ 6.7 Subtotal before Reimbursements and Taxes (Lines 6.1 to 6.6) 6.8 Reimbursements by uninsured plans and fiscal intermediaries 6.9 Taxes, Licenses and Fees (in total, for tying purposes) 6.10 Total (6.7 to 6.9) 6.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 7. 8. 216-6.IL 9. Small Group Expatriate Plans Expenses: 0 for affiliated services) 7.1 Salaries (including $ 7.2 Outsourced Services 0 for affiliated services) 7.3 EDP Equipment and Software (incl $ 0 for affiliated services) 7.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 7.5 Accreditation and Certification (incl $ 0 for affiliated services) 7.6 Other Expenses (incl $ 7.7 Subtotal before Reimbursements and Taxes (Lines 7.1 to 7.6) 7.8 Reimbursements by uninsured plans and fiscal intermediaries 7.9 Taxes, Licenses and Fees (in total, for tying purposes) 7.10 Total (7.7 to 7.9) 7.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Expatriate Plans Expenses: 0 for affiliated services) 8.1 Salaries (including $ 8.2 Outsourced Services 0 for affiliated services) 8.3 EDP Equipment and Software (incl $ 0 for affiliated services) 8.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 8.5 Accreditation and Certification (incl $ 0 for affiliated services) 8.6 Other Expenses (incl $ 8.7 Subtotal before Reimbursements and Taxes (Lines 8.1 to 8.6) 8.8 Reimbursements by uninsured plans and fiscal intermediaries 8.9 Taxes, Licenses and Fees (in total, for tying purposes) 8.10 Total (8.7 to 8.9) 8.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Student Health Plans Expenses: 0 for affiliated services) 9.1 Salaries (including $ 9.2 Outsourced Services 0 for affiliated services) 9.3 EDP Equipment and Software (incl $ 0 for affiliated services) 9.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 9.5 Accreditation and Certification (incl $ 0 for affiliated services) 9.6 Other Expenses (incl $ 9.7 Subtotal before Reimbursements and Taxes (Lines 9.1 to 9.6) 9.8 Reimbursements by uninsured plans and fiscal intermediaries 9.9 Taxes, Licenses and Fees (in total, for tying purposes) 9.10 Total (9.7 to 9.9) 9.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 *79413201821615100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes - See Cautionary Statement at http://www.naic.org/documents/committees_e_app_blanks_related_shce_cautionary_statement.pdf) UnitedHealthcare Insurance Company 2. 185 Asylum Street Hartford, CT 061033408 (LOCATION) BUSINESS IN THE STATE OF Indiana DURING THE YEAR 2018 NAIC Company Code Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 1. 216-1.IN 2. 3. 4. 5. 6. 7. 8. 9. Premium: 1.1 Health premiums earned (From Part 2, Line 1.11) 1.2 Federal high risk pools 1.3 State high risk pools 1.4 Premiums earned including state and federal high risk programs (Lines 1.1 + 1.2 + 1.3) 1.5 Federal taxes and federal assessments 1.6 State insurance, premium and other taxes (Similar local taxes of 195,862 ) $ 1.6a Community Benefit Expenditures (informational only) 1.7 Regulatory authority licenses and fees 1.8 Adjusted Premiums Earned (Lines 1.4 - 1.5 - 1.6 - 1.7) 1.9 Net Assumed less Ceded reinsurance premiums earned 1.10 Other Adjustments due to MLR calculations - Premiums 1.11 Risk Revenue 1.12 Net adjusted premiums earned after reinsurance (Lines 1.8 + 1.9 + 1.10 + 1.11) Claims: 2.1 Incurred claims excluding prescription drugs 2.2 Prescription drugs 2.3 Pharmaceutical rebates 2.4 State stop loss, market stabilization and claim/census based assessments (informational only) Incurred medical incentive pools and bonuses Deductible Fraud and Abuse Detection/Recovery Expenses (for MLR use only) 5.0 Total Incurred Claims (Lines 2.1 + 2.2 - 2.3 + 3) (From Part 2, Line 2.15) 5.1 Net Assumed less Ceded reinsurance claims incurred 5.2 Other Adjustments due to MLR calculations - Claims 5.3 Rebates paid 5.4 Estimated rebates unpaid prior year 5.5 Estimated rebates unpaid current year 5.6 Fee for service and co-pay revenue 5.7 Net incurred claims after reinsurance (Lines 5.0 + 5.1 + 5.2 + 5.3 - 5.4 + 5.5 - 5.6) Improving Health Care Quality Expenses Incurred: 6.1 Improve health outcomes 6.2 Activities to prevent hospital readmissions 6.3 Improve patient safety and reduce medical errors 6.4 Wellness and health promotion activities 6.5 Health Information Technology expenses related to health improvement 6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5) Preliminary Medical Loss Ratio: MLR ((Lines 4 + 5.0 + 6.6 - Footnote 2.0)/Line 1.8 Claims Adjustment Expenses: 8.1 Cost containment expenses not included in quality of care expenses in Line 6.6 8.2 All other claims adjustment expenses 8.3 Total claims adjustment expenses (Lines 8.1 + 8.2) Claims Adjustment Expense Ratio (Line 8.3/Line 1.8) 2 Small Group Employer 3 Large Group Employer 4 5 Small Group Employer Individual Expatriate Plans 6 Large Group Employer 7 11 Government Business (excluded by statute) Other Health Business 9 8 Small Group 10 Student Health Plans Large Group 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 79413 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 3,316,510 0 (205) 339,774,078 0 (25,069) 413,942,132 0 (55,725) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 282,435,747 0 135,332 842,705,487 0 0 1,882,173,954 0 54,333 XXX XXX XXX 3,316,305 172,935 339,749,009 10,872,750 413,886,407 8,927,921 0 0 0 0 0 0 0 0 0 0 0 0 0 0 282,571,079 4,492,665 842,705,487 38,718,260 1,882,228,287 63,184,531 XXX 39,483 0 22 3,103,866 0 0 0 3,103,866 4,713,544 0 2,782 324,159,932 0 112,205 0 324,272,137 5,732,968 0 18,031 399,207,487 (45,273,741) (45,559) 0 353,888,187 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4,144,999 0 (58,722) 273,992,137 (430,019) 9,167 0 273,571,284 86,345 0 0 803,900,882 1,863,480 927,417 0 806,691,780 14,717,340 0 (37,887) 1,804,364,304 (43,840,280) 1,003,229 0 1,761,527,253 XXX XXX XXX XXX XXX 14,717,340 0 (37,887) 1,804,364,304 (43,840,280) 1,003,229 0 1,761,527,253 2,030,611 412,464 138,313 236,134,602 53,055,877 17,571,162 310,472,903 60,609,974 19,797,911 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 214,056,005 1,212,436 75,937 519,452,530 238,676,214 138,224,589 1,282,146,651 353,966,966 175,807,911 XXX XXX XXX 1,282,146,651 353,966,966 175,807,911 4 0 1 2,304,762 0 0 0 0 0 0 2,304,762 36,395 58,108 55,531 271,677,426 0 (5,564) 5,564 0 0 0 271,677,426 107,380 116,222 14,565 351,401,188 (38,324,280) 0 0 0 0 0 313,076,908 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 9,632,613 55,407 629,536,768 0 0 0 0 0 0 629,536,768 143,800 9,806,943 125,504 1,470,112,649 (38,172,691) (5,564) 5,564 0 0 0 1,431,939,959 XXX XXX 0 0 21 0 0 215,192,505 151,590 0 XXX XXX XXX 0 215,344,094 143,800 9,806,943 125,504 1,470,112,649 (38,172,691) (5,564) 5,564 0 0 0 1,431,939,959 26,532 0 0 0 0 2,718,193 0 0 0 0 3,311,537 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 859,351 381,554 292,519 1,862,211 157,623 5,727,700 1,382,195 1,256,939 2,291,608 2,304,855 12,643,312 1,763,749 1,549,459 4,153,819 2,462,478 26,532 0.751 2,718,193 0.847 3,311,537 0.889 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 3,553,257 XXX 12,963,297 0.799 22,572,816 XXX 26,969 44,924 71,893 0.023 3,437,022 5,162,477 8,599,499 0.027 4,295,057 6,029,210 10,324,267 0.026 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 351,372 3,829,080 4,180,452 0.015 6,687,040 14,451,535 21,138,576 0.026 14,797,460 29,517,226 44,314,687 XXX XXX XXX XXX XXX 0 0 0 0.000 1,882,173,954 0 54,333 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 12,643,312 1,763,749 1,549,459 4,153,819 2,462,478 0 22,572,816 XXX 0 0 0 14,797,460 29,517,226 44,314,687 XXX XXX XXX 1,882,228,287 63,184,531 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 (Continued) Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 2 Small Group Employer Individual 10. General and Administrative (G&A) Expenses: 10.1 Direct sales salaries and benefits 10.2 Agents and brokers fees and commissions 10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below) 10.4 Other general and administrative expenses 10.4a Community Benefit Expenditures (informational only) 10.5 Total general and administrative (Lines 10.1 +10.2 + 10.3 + 10.4) 9,580 69,244 (3,401) 110,311 0 185,734 3 Large Group Employer 1,169,643 10,247,186 397,867 15,051,618 0 26,866,314 4 5 Small Group Employer Individual 1,739,910 12,950,324 536,935 11,801,005 0 27,028,174 0 0 0 0 0 0 Expatriate Plans 6 Large Group Employer 0 0 0 0 0 0 7 8 Small Group 0 0 0 0 0 0 Student Health Plans Large Group 0 0 0 0 0 0 10 11 Government Business (excluded by statute) Other Health Business 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 532,969 10,550,545 474,856 24,985,442 0 36,543,812 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 1,454,003 15,689,010 1,153,609 39,727,428 0 58,024,051 4,906,105 49,506,310 2,559,866 91,675,804 0 148,648,085 0 0 0 0 0 0 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) 13,949,668 85,029,087 114,051,707 12. Income from fees of uninsured plans XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 13. Net investment and other gain/(loss) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 27,225,728 XXX 14. Federal income taxes (excluding taxes on Line 1.5 above) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 1,579,563 XXX 1,579,563 15. Net gain or (loss) (Lines 11 + 12 + 13 - 14) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 139,697,872 XXX 139,697,872 16. ICD-10 Implementation Expenses (informational only; already included in general expenses and line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16. 16a ICD-10 Implementation Expenses (informational only; already included in line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 514,945 14,410,706 147,301 0 0 0 0 0 0 0 XXX 4,906,105 49,506,310 2,559,866 91,675,804 0 148,648,085 114,051,707 0 0 27,225,728 OTHER INDICATORS: 216-2.IN 1. Number of certificates/policies 227 32,233 41,191 0 0 0 0 0 0 0 228,506 156,426 458,583 0 458,583 2. Number of Covered Lives 465 55,670 72,711 0 0 0 0 0 0 0 344,322 156,426 629,594 0 629,594 3. Number of Groups 5,200 1,080 0 0 0 0 0 0 4,006 7 10,293 0 10,293 4. Member Months 655,858 965,589 0 0 0 0 0 0 4,053,980 1,892,921 7,573,709 0 7,573,709 XXX 5,361 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ XXX 0 ] If yes, show the amount of premiums and claims included. Premiums $ 0 Claims $ 0 AFFORDABLE CARE ACT (ACA) RECEIPTS, PAYMENTS, RECEIVABLES and PAYABLES Current Year Prior Year Comprehensive Health Coverage Comprehensive Health Coverage 1 2 3 4 Small Group Small Group Employer Plans Employer Plans Individual Plans Individual Plans ACA Receivables and Payables 1. Permanent ACA Risk Adjustment Program 1.0 Premium adjustments receivable/(payable) 2. Transitional ACA Reinsurance Program 2.0 Total amounts recoverable for claims (paid & unpaid) 0 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 0 0 419,130 (2,012,766) XXX 63,499 0 0 0 (10,329,612) XXX 0 0 0 0 ACA Receipts and Payments 4. Permanent ACA Risk Adjustment Program 4.0 Premium adjustments receipts/(payments) 5. Transitional ACA Reinsurance Program 5.0 Amounts received for claims 0 6. Temporary ACA Risk Corridors Program 6.1 Retrospective premium received 6.2 Rate credits or policy experience refunds paid 0 0 256,384 (6,374,828) XXX 589,387 0 0 0 0 0 (11,269,234) XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF 185 Asylum Street Hartford, CT 061033408 Indiana DURING THE YEAR Comprehensive Health Coverage 1 2 3 Individual Small Group Employer Large Group Employer Small Group Employer Individual Expatriate Plans: 7 8 6 Large Group Employer Small Group 10 11 Government Business (excluded by statute) Other Health Business 9 Student Health Plans Large Group 79413 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.IN Health Premiums Earned: 3,316,510 339,922,978 1.1 Direct premiums written 0 64,747 1.2 Unearned premium prior year 0 101,442 1.3 Unearned premium current year 0 (36,696) 1.4 Change in unearned premium (Lines 1.2 - 1.3) 8 5,564 1.5 Paid rate credits 0 0 1.6 Reserve for rate credits current year 0 0 1.7 Reserve for rate credits prior year 0 0 1.8 Change in reserve for rate credits (Lines 1.6 - 1.7) 0 112,205 1.9 Premium balances written off 0 0 1.10 Group conversion charge 3,316,510 339,774,078 1.11 Total direct premiums earned (Lines 1.1 + 1.4 - 1.9 + 1.10) 0 0 1.12 Assumed premiums earned from non-affiliates 0 0 1.13 Net Assumed less Ceded premiums earned from affiliates 0 0 1.14 Ceded premiums earned to non-affiliates 0 112,205 1.15 Other Adjustments due to MLR calculation - Premiums 3,316,502 339,880,719 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 2,305,501 258,677,467 2.1 Paid claims during the year 213,034 44,672,422 2.2 Direct claim liability current year 213,781 32,024,267 2.3 Direct claim liability prior year 0 1,047,519 2.4 Direct claim reserves current year 0 778,906 2.5 Direct claim reserves prior year 0 0 2.6 Direct contract reserves current year 0 0 2.7 Direct contract reserves prior year 8 5,564 2.8 Paid rate credits 0 0 2.9 Reserve for rate credits current year 0 0 2.10 Reserve for rate credits prior year 0 58,108 2.11 Incurred medical incentive pools and bonuses (Lines 2.11a + 2.11b - 2.11c) 0 10,472 2.11a Paid medical incentive pools and bonuses current year 0 189,915 2.11b Accrued medical incentive pools and bonuses current year 0 142,278 2.11c Accrued medical incentive pools and bonuses prior year 0 (19,519) 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 0 7,576,446 2.12a Healthcare receivables current year 0 7,595,964 2.12b Healthcare receivables prior year 0 0 2.13 Group conversion charge 0 0 2.14 Multi-option coverage blended rate adjustment 2.15 Total incurred claims (Lines 2.1 + 2.2 - 2.3 + 2.4 - 2.5 + 2.6 - 2.7 + 2.8 + 2.9 2,304,762 271,677,426 2.10 + 2.11 - 2.12 + 2.13 + 2.14) 0 0 2.16 Assumed incurred claims from non-affiliates 0 0 2.17 Net assumed less ceded incurred claims from affiliates 0 0 2.18 Ceded incurred claims to non-affiliates 0 0 2.19 Other adjustments due to MLR calculation - Claims 2,304,754 271,671,862 2.20 Net Incurred Claims (Lines 2.15 - 2.8 - 2.9 + 2.10 + 2.16 + 2.17 - 2.18 + 2.19) 3. Fraud and Abuse Recoveries that Reduced PAID Claims in Line 2.1 above 1 55,531 (informational only) 14,394,141 for stand-alone dental and $ (a) Column 13, Line 1.1 includes direct written premium of $ 4 Business Subject to MLR Mini-Med Plans 5 (LOCATION) NAIC Company Code 2018 413,896,574 0 0 0 (8) 1,132,286 0 1,132,286 (45,559) 0 413,942,132 0 0 45,273,741 (45,559) 367,490,555 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 282,448,778 8,392 12,256 (3,865) 1,284,906 1,060,451 1,211,607 (151,156) 9,167 0 282,435,747 0 0 430,019 9,167 280,881,145 843,632,904 0 0 0 1,656,849 (195,023) 5,613,485 (5,808,508) 927,417 0 842,705,487 0 1,863,480 0 927,417 849,648,043 1,883,217,744 73,138 113,699 (40,560) 2,947,318 1,997,713 6,825,091 (4,827,378) 1,003,229 0 1,882,173,954 0 1,863,480 45,703,760 1,003,229 1,841,216,964 344,589,733 43,581,153 37,083,227 1,007,895 795,238 0 0 (8) 1,132,286 0 116,222 46,969 415,473 346,220 1,147,627 7,659,618 6,511,991 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 216,042,603 35,858,190 35,138,821 10,207,933 12,913,774 373,039 368,889 1,284,906 1,060,451 1,211,607 0 0 0 0 1,526 25,507 23,981 0 0 632,781,999 72,716,152 75,003,023 102,590 88,691 0 0 1,656,849 (195,023) 5,613,485 9,632,613 10,627,219 9,921,642 10,916,248 6,453,213 69,357,476 62,904,262 0 0 1,454,397,302 197,040,951 179,463,118 12,365,937 14,576,609 373,039 368,890 2,947,318 1,997,713 6,825,091 9,806,943 10,684,660 10,527,029 11,404,746 7,582,847 84,619,046 77,036,199 0 0 351,401,188 0 0 38,324,280 0 311,944,630 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 215,192,505 0 0 (151,590) 0 214,210,345 629,536,768 0 0 0 0 633,688,427 1,470,112,649 0 0 38,172,691 0 1,433,820,018 14,565 0 0 7,312,131 for stand-alone vision policies. 0 0 0 0 0 55,407 125,504 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF Indiana DURING THE YEAR All Expenses 1 Improve Health Outcomes 1. Individual Comprehensive Coverage Expenses: 62,318 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 4,433 for affiliated services) 1.3 EDP Equipment and Software (incl $ 425 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 46 for affiliated services) 1.5 Accreditation and Certification (incl $ 140,530 for affiliated services) 1.6 Other Expenses (incl $ 1.7 Subtotal before Reimbursements and Taxes (Lines 1.1 to 1.6) 1.8 Reimbursements by uninsured plans and fiscal intermediaries 1.9 Taxes, Licenses and Fees (in total, for tying purposes) 1.10 Total (1.7 to 1.9) 1.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 2. 216-4.IN Small Group Comprehensive Coverage Expenses: 10,828,587 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 766,964 for affiliated services) 2.3 EDP Equipment and Software (incl $ 73,620 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 7,994 for affiliated services) 2.5 Accreditation and Certification (incl $ 13,796,321 for affiliated services) 2.6 Other Expenses (incl $ 2.7 Subtotal before Reimbursements and Taxes (Lines 2.1 to 2.6) 2.8 Reimbursements by uninsured plans and fiscal intermediaries 2.9 Taxes, Licenses and Fees (in total, for tying purposes) 2.10 Total (2.7 to 2.9) 2.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 3. Large Group Comprehensive Coverage Expenses: 5,772,977 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 385,120 for affiliated services) 3.3 EDP Equipment and Software (incl $ 36,967 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 4,014 for affiliated services) 3.5 Accreditation and Certification (incl $ 23,620,744 for affiliated services) 3.6 Other Expenses (incl $ 3.7 Subtotal before Reimbursements and Taxes (Lines 3.1 to 3.6) 3.8 Reimbursements by uninsured plans and fiscal intermediaries 3.9 Taxes, Licenses and Fees (in total, for tying purposes) 3.10 Total (3.7 to 3.9) 3.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 185 Asylum Street Hartford, CT 061033408 0 0 0 0 0 26,532 26,532 0 XXX Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX Total (1 to 5) 0 0 0 0 0 26,532 26,532 0 XXX 0 0 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 0 0 0 0 0 0 0 XXX (LOCATION) NAIC Company Code 2018 XXX 7,574 864 632 61 7 16,942 26,080 (5) XXX 12,783 1,465 1,067 102 11 28,591 44,020 (47) XXX 26,532 0 0 0 0 0 0 0 0 0 26,532 0 26,076 7,707 43,973 0 0 0 0 0 0 2,718,193 2,718,193 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,718,193 2,718,193 0 1,329,232 255,476 110,997 10,654 1,157 1,620,352 3,327,869 60 2,116,269 242,529 176,718 16,963 1,842 2,491,477 5,045,797 582 XXX 3,327,929 942,028 XXX 5,046,378 0 XXX 2,718,193 0 0 0 0 0 0 3,311,537 3,311,537 0 XXX 3,311,537 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 2,718,193 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3,311,537 3,311,537 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 3,311,537 0 738,867 207,767 61,699 5,922 643 3,142,052 4,156,950 (56) XXX 4,156,895 1,249,753 1,062,905 121,811 88,758 8,520 925 4,618,957 5,901,875 (535) XXX 5,901,340 0 79413 9 10 General Administrative Expenses Total Expenses (6 to 9) 41,960 3,751 2,733 262 28 139,724 188,458 0 38,625 227,083 0 62,318 6,080 4,433 425 46 211,789 285,091 (52) 38,625 323,664 7,707 7,383,086 724,808 479,248 46,002 4,995 17,747,588 26,385,728 5 5,422,097 31,807,831 0 10,828,587 1,222,814 766,964 73,620 7,994 24,577,609 37,477,587 647 5,422,097 42,900,331 942,028 3,971,205 380,901 234,664 22,525 2,446 21,762,632 26,374,372 (5) 6,670,839 33,045,206 0 5,772,977 710,478 385,120 36,967 4,014 32,835,179 39,744,735 (596) 6,670,839 46,414,978 1,249,753 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 4. 5. 216-5.IN 6. Individual Mini-Med Plans Expenses: 0 for affiliated services) 4.1 Salaries (including $ 4.2 Outsourced Services 0 for affiliated services) 4.3 EDP Equipment and Software (incl $ 0 for affiliated services) 4.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 4.5 Accreditation and Certification (incl $ 0 for affiliated services) 4.6 Other Expenses (incl $ 4.7 Subtotal before Reimbursements and Taxes (Lines 4.1 to 4.6) 4.8 Reimbursements by uninsured plans and fiscal intermediaries 4.9 Taxes, Licenses and Fees (in total, for tying purposes) 4.10 Total (4.7 to 4.9) 4.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Mini-Med Plans Expenses: 0 for affiliated services) 5.1 Salaries (including $ 5.2 Outsourced Services 0 for affiliated services) 5.3 EDP Equipment and Software (incl $ 0 for affiliated services) 5.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 5.5 Accreditation and Certification (incl $ 0 for affiliated services) 5.6 Other Expenses (incl $ 5.7 Subtotal before Reimbursements and Taxes (Lines 5.1 to 5.6) 5.8 Reimbursements by uninsured plans and fiscal intermediaries 5.9 Taxes, Licenses and Fees (in total, for tying purposes) 5.10 Total (5.7 to 5.9) 5.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Mini-Med Plans Expenses: 0 for affiliated services) 6.1 Salaries (including $ 6.2 Outsourced Services 0 for affiliated services) 6.3 EDP Equipment and Software (incl $ 0 for affiliated services) 6.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 6.5 Accreditation and Certification (incl $ 0 for affiliated services) 6.6 Other Expenses (incl $ 6.7 Subtotal before Reimbursements and Taxes (Lines 6.1 to 6.6) 6.8 Reimbursements by uninsured plans and fiscal intermediaries 6.9 Taxes, Licenses and Fees (in total, for tying purposes) 6.10 Total (6.7 to 6.9) 6.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 7. 8. 216-6.IN 9. Small Group Expatriate Plans Expenses: 0 for affiliated services) 7.1 Salaries (including $ 7.2 Outsourced Services 0 for affiliated services) 7.3 EDP Equipment and Software (incl $ 0 for affiliated services) 7.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 7.5 Accreditation and Certification (incl $ 0 for affiliated services) 7.6 Other Expenses (incl $ 7.7 Subtotal before Reimbursements and Taxes (Lines 7.1 to 7.6) 7.8 Reimbursements by uninsured plans and fiscal intermediaries 7.9 Taxes, Licenses and Fees (in total, for tying purposes) 7.10 Total (7.7 to 7.9) 7.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Expatriate Plans Expenses: 0 for affiliated services) 8.1 Salaries (including $ 8.2 Outsourced Services 0 for affiliated services) 8.3 EDP Equipment and Software (incl $ 0 for affiliated services) 8.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 8.5 Accreditation and Certification (incl $ 0 for affiliated services) 8.6 Other Expenses (incl $ 8.7 Subtotal before Reimbursements and Taxes (Lines 8.1 to 8.6) 8.8 Reimbursements by uninsured plans and fiscal intermediaries 8.9 Taxes, Licenses and Fees (in total, for tying purposes) 8.10 Total (8.7 to 8.9) 8.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Student Health Plans Expenses: 0 for affiliated services) 9.1 Salaries (including $ 9.2 Outsourced Services 0 for affiliated services) 9.3 EDP Equipment and Software (incl $ 0 for affiliated services) 9.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 9.5 Accreditation and Certification (incl $ 0 for affiliated services) 9.6 Other Expenses (incl $ 9.7 Subtotal before Reimbursements and Taxes (Lines 9.1 to 9.6) 9.8 Reimbursements by uninsured plans and fiscal intermediaries 9.9 Taxes, Licenses and Fees (in total, for tying purposes) 9.10 Total (9.7 to 9.9) 9.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 *79413201821616100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes - See Cautionary Statement at http://www.naic.org/documents/committees_e_app_blanks_related_shce_cautionary_statement.pdf) UnitedHealthcare Insurance Company 2. 185 Asylum Street Hartford, CT 061033408 (LOCATION) BUSINESS IN THE STATE OF Iowa DURING THE YEAR 2018 NAIC Company Code Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 1. 216-1.IA 2. 3. 4. 5. 6. 7. 8. 9. Premium: 1.1 Health premiums earned (From Part 2, Line 1.11) 1.2 Federal high risk pools 1.3 State high risk pools 1.4 Premiums earned including state and federal high risk programs (Lines 1.1 + 1.2 + 1.3) 1.5 Federal taxes and federal assessments 1.6 State insurance, premium and other taxes (Similar local taxes of 33,183 ) $ 1.6a Community Benefit Expenditures (informational only) 1.7 Regulatory authority licenses and fees 1.8 Adjusted Premiums Earned (Lines 1.4 - 1.5 - 1.6 - 1.7) 1.9 Net Assumed less Ceded reinsurance premiums earned 1.10 Other Adjustments due to MLR calculations - Premiums 1.11 Risk Revenue 1.12 Net adjusted premiums earned after reinsurance (Lines 1.8 + 1.9 + 1.10 + 1.11) Claims: 2.1 Incurred claims excluding prescription drugs 2.2 Prescription drugs 2.3 Pharmaceutical rebates 2.4 State stop loss, market stabilization and claim/census based assessments (informational only) Incurred medical incentive pools and bonuses Deductible Fraud and Abuse Detection/Recovery Expenses (for MLR use only) 5.0 Total Incurred Claims (Lines 2.1 + 2.2 - 2.3 + 3) (From Part 2, Line 2.15) 5.1 Net Assumed less Ceded reinsurance claims incurred 5.2 Other Adjustments due to MLR calculations - Claims 5.3 Rebates paid 5.4 Estimated rebates unpaid prior year 5.5 Estimated rebates unpaid current year 5.6 Fee for service and co-pay revenue 5.7 Net incurred claims after reinsurance (Lines 5.0 + 5.1 + 5.2 + 5.3 - 5.4 + 5.5 - 5.6) Improving Health Care Quality Expenses Incurred: 6.1 Improve health outcomes 6.2 Activities to prevent hospital readmissions 6.3 Improve patient safety and reduce medical errors 6.4 Wellness and health promotion activities 6.5 Health Information Technology expenses related to health improvement 6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5) Preliminary Medical Loss Ratio: MLR ((Lines 4 + 5.0 + 6.6 - Footnote 2.0)/Line 1.8 Claims Adjustment Expenses: 8.1 Cost containment expenses not included in quality of care expenses in Line 6.6 8.2 All other claims adjustment expenses 8.3 Total claims adjustment expenses (Lines 8.1 + 8.2) Claims Adjustment Expense Ratio (Line 8.3/Line 1.8) 2 Small Group Employer 3 Large Group Employer 4 5 Small Group Employer Individual Expatriate Plans 6 Large Group Employer 7 11 Government Business (excluded by statute) Other Health Business 9 8 Small Group 10 Student Health Plans Large Group 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 79413 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 380,886 0 (2,632) 69,840,283 0 (363,431) 128,197,419 0 (344,182) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 48,391,157 0 9,614 26,885,403 0 0 273,695,148 0 (700,632) XXX XXX XXX 378,254 14,945 69,476,852 2,204,677 127,853,237 4,852,673 0 0 0 0 0 0 0 0 0 0 0 0 0 548,498 48,400,771 401,791 26,885,403 1,981,633 272,994,517 10,004,216 XXX 1,746 0 10 361,554 263 0 0 361,817 520,734 0 1,374 66,750,068 49,044 12,063 0 66,811,175 620,561 0 2,856 122,377,147 (17,467,720) 65,834 0 104,975,260 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (548,498) 3,037,461 0 0 2,488,963 1,458,535 0 (9,265) 46,549,710 (78,006) 1,919 0 46,473,623 3,292 0 0 24,900,478 481,705 167,931 0 25,550,114 2,604,867 0 (5,025) 260,390,458 (13,977,253) 247,747 0 246,660,952 XXX XXX XXX XXX XXX 2,604,867 0 (5,025) 260,390,458 (13,977,253) 247,747 0 246,660,952 228,218 14,855 5,094 45,059,903 10,328,720 3,409,435 87,873,459 21,073,544 7,020,340 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 45,330 0 0 36,410,901 519,062 10,720 (108,124) 35,433,247 21,440,954 169,509,687 67,369,427 31,886,543 XXX XXX XXX 169,509,687 67,369,427 31,886,543 0 0 0 237,978 0 0 0 0 0 0 237,978 25,907 301,667 11,284 52,280,854 0 0 0 0 0 0 52,280,854 10,491 641,906 9,210 102,568,569 (13,913,909) 0 0 0 0 0 88,654,660 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 45,330 239,236 0 XXX XXX XXX 0 284,565 0 0 0 36,919,243 (148,414) 0 XXX XXX XXX 0 36,770,830 0 0 0 13,884,169 0 0 0 0 0 0 13,884,169 36,399 943,573 20,494 205,936,144 (13,823,087) 0 0 0 0 0 192,113,057 XXX XXX 36,399 943,573 20,494 205,936,144 (13,823,087) 0 0 0 0 0 192,113,057 3,047 0 0 0 0 558,722 0 0 0 0 1,025,579 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 192,207 118,219 90,804 308,425 38,369 3,047 0.667 558,722 0.792 1,025,579 0.847 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 6,264 10,244 16,508 0.046 884,634 1,323,705 2,208,339 0.033 1,420,436 1,996,709 3,417,145 0.028 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 XXX 0 0 0 0.000 38,319 10,679 84,416 (14,799) 81,691 1,817,875 128,898 175,220 293,626 120,059 748,024 XXX 200,305 0.566 2,535,678 XXX 112,313 785,776 898,089 0.019 120,345 1,715,873 1,836,219 0.074 2,543,992 5,832,308 8,376,300 XXX 273,695,148 0 (700,632) 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 1,817,875 128,898 175,220 293,626 120,059 0 2,535,678 XXX 0 0 0 2,543,992 5,832,308 8,376,300 XXX XXX XXX 272,994,517 10,004,216 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 (Continued) Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 2 Small Group Employer Individual 10. General and Administrative (G&A) Expenses: 10.1 Direct sales salaries and benefits 10.2 Agents and brokers fees and commissions 10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below) 10.4 Other general and administrative expenses 10.4a Community Benefit Expenditures (informational only) 10.5 Total general and administrative (Lines 10.1 +10.2 + 10.3 + 10.4) 2,227 23,568 (801) 26,272 0 51,265 3 Large Group Employer 297,545 3,394,357 89,886 3,667,648 0 7,449,437 4 5 Small Group Employer Individual 583,023 838,672 183,505 4,058,385 0 5,663,585 0 0 0 0 0 0 Expatriate Plans 6 Large Group Employer 0 0 0 0 0 0 7 8 Small Group 0 0 0 0 0 0 Student Health Plans Large Group 0 0 0 0 0 0 10 11 Government Business (excluded by statute) Other Health Business 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 118,451 2,150,387 91,072 4,456,525 0 6,816,435 55,446 83,177 64,291 1,947,957 0 2,150,871 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 1,056,692 6,490,161 427,953 14,156,787 0 22,131,593 0 0 0 0 0 0 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) 12. Income from fees of uninsured plans XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 13. Net investment and other gain/(loss) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 14. Federal income taxes (excluding taxes on Line 1.5 above) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 15. Net gain or (loss) (Lines 11 + 12 + 13 - 14) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 16. ICD-10 Implementation Expenses (informational only; already included in general expenses and line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16. 16a ICD-10 Implementation Expenses (informational only; already included in line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 61 8,921 14,611 0 0 0 0 0 0 0 55,524 24,568 103,685 0 103,685 118 15,448 23,836 0 0 0 0 0 0 0 91,225 24,568 155,195 0 155,195 1,424 317 0 0 0 0 0 0 952 0 2,693 0 2,693 166,509 304,465 0 0 0 0 0 0 1,088,539 294,628 1,855,387 0 1,855,387 53,018 4,313,823 6,214,291 0 0 0 0 0 0 2,204,397 1,240,246 7,478,550 21,504,324 XXX 1,056,692 6,490,161 427,953 14,156,787 0 22,131,593 XXX 21,504,325 0 0 3,934,737 XXX XXX 228,682 XXX 228,682 XXX 25,210,380 XXX 25,210,380 3,934,737 OTHER INDICATORS: 216-2.IA 1. Number of certificates/policies 2. Number of Covered Lives 3. Number of Groups 4. Member Months XXX 1,246 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ XXX 0 ] If yes, show the amount of premiums and claims included. Premiums $ 0 Claims $ 0 AFFORDABLE CARE ACT (ACA) RECEIPTS, PAYMENTS, RECEIVABLES and PAYABLES Current Year Prior Year Comprehensive Health Coverage Comprehensive Health Coverage 1 2 3 4 Small Group Small Group Employer Plans Employer Plans Individual Plans Individual Plans ACA Receivables and Payables 1. Permanent ACA Risk Adjustment Program 1.0 Premium adjustments receivable/(payable) 2. Transitional ACA Reinsurance Program 2.0 Total amounts recoverable for claims (paid & unpaid) 0 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 0 0 (159,951) (1,843,314) XXX 13,460 0 0 0 (1,782,713) XXX 0 0 0 0 ACA Receipts and Payments 4. Permanent ACA Risk Adjustment Program 4.0 Premium adjustments receipts/(payments) 5. Transitional ACA Reinsurance Program 5.0 Amounts received for claims 0 6. Temporary ACA Risk Corridors Program 6.1 Retrospective premium received 6.2 Rate credits or policy experience refunds paid 0 0 39,395 (1,212,400) XXX (39,986) 0 0 0 0 0 (1,223,386) XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF 185 Asylum Street Hartford, CT 061033408 Iowa DURING THE YEAR Comprehensive Health Coverage 1 2 3 Individual Small Group Employer Large Group Employer Small Group Employer Individual Expatriate Plans: 7 8 6 Large Group Employer Small Group 10 11 Government Business (excluded by statute) Other Health Business 9 Student Health Plans Large Group 79413 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.IA Health Premiums Earned: 380,886 69,850,137 1.1 Direct premiums written 0 3,872 1.2 Unearned premium prior year 0 1,662 1.3 Unearned premium current year 0 2,209 1.4 Change in unearned premium (Lines 1.2 - 1.3) 96 0 1.5 Paid rate credits 0 0 1.6 Reserve for rate credits current year 0 0 1.7 Reserve for rate credits prior year 0 0 1.8 Change in reserve for rate credits (Lines 1.6 - 1.7) 0 12,063 1.9 Premium balances written off 0 0 1.10 Group conversion charge 380,886 69,840,283 1.11 Total direct premiums earned (Lines 1.1 + 1.4 - 1.9 + 1.10) 0 0 1.12 Assumed premiums earned from non-affiliates 263 49,044 1.13 Net Assumed less Ceded premiums earned from affiliates 0 0 1.14 Ceded premiums earned to non-affiliates 0 12,063 1.15 Other Adjustments due to MLR calculation - Premiums 381,054 69,901,391 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 237,884 49,673,230 2.1 Paid claims during the year 1 7,452,647 2.2 Direct claim liability current year 2 4,782,898 2.3 Direct claim liability prior year 0 131,040 2.4 Direct claim reserves current year 0 89,274 2.5 Direct claim reserves prior year 0 0 2.6 Direct contract reserves current year 0 0 2.7 Direct contract reserves prior year 96 0 2.8 Paid rate credits 0 0 2.9 Reserve for rate credits current year 0 0 2.10 Reserve for rate credits prior year 0 301,667 2.11 Incurred medical incentive pools and bonuses (Lines 2.11a + 2.11b - 2.11c) 0 144,425 2.11a Paid medical incentive pools and bonuses current year 0 176,131 2.11b Accrued medical incentive pools and bonuses current year 0 18,889 2.11c Accrued medical incentive pools and bonuses prior year 0 405,557 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 0 1,631,065 2.12a Healthcare receivables current year 0 1,225,508 2.12b Healthcare receivables prior year 0 0 2.13 Group conversion charge 0 0 2.14 Multi-option coverage blended rate adjustment 2.15 Total incurred claims (Lines 2.1 + 2.2 - 2.3 + 2.4 - 2.5 + 2.6 - 2.7 + 2.8 + 2.9 237,978 52,280,854 2.10 + 2.11 - 2.12 + 2.13 + 2.14) 0 0 2.16 Assumed incurred claims from non-affiliates 0 0 2.17 Net assumed less ceded incurred claims from affiliates 0 0 2.18 Ceded incurred claims to non-affiliates 0 0 2.19 Other adjustments due to MLR calculation - Claims 237,883 52,280,854 2.20 Net Incurred Claims (Lines 2.15 - 2.8 - 2.9 + 2.10 + 2.16 + 2.17 - 2.18 + 2.19) 3. Fraud and Abuse Recoveries that Reduced PAID Claims in Line 2.1 above 0 11,284 (informational only) 4,716,214 for stand-alone dental and $ (a) Column 13, Line 1.1 includes direct written premium of $ 4 Business Subject to MLR Mini-Med Plans 5 (LOCATION) NAIC Company Code 2018 128,263,253 0 0 0 (96) 0 24,117 (24,117) 65,834 0 128,197,419 0 71,305 17,539,025 65,834 110,819,745 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3,037,461 0 0 3,037,461 48,393,061 105 90 16 (840,870) 136,588 121,070 15,518 1,919 0 48,391,157 0 0 78,006 1,919 49,140,423 27,053,333 0 0 0 0 1,191,042 1,303,315 (112,273) 167,931 0 26,885,403 0 481,705 0 167,931 27,647,311 273,940,670 3,977 1,752 2,225 (840,870) 1,327,630 1,448,501 (120,872) 247,747 0 273,695,148 0 3,639,778 17,617,030 247,747 260,927,384 100,997,851 11,878,640 11,077,945 234,209 217,047 0 0 (96) 0 24,117 641,906 352,024 437,379 147,497 (135,167) 2,643,262 2,778,428 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (739,281) 1,000,420 215,809 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 37,449,435 5,218,280 4,944,154 2,219,638 2,244,677 80,030 30,939 (840,870) 136,588 121,070 0 0 0 0 3,017 3,567 551 0 0 21,206,774 1,116,255 671,069 0 0 0 0 0 1,191,042 1,303,315 0 0 0 0 7,655,517 18,285,487 10,629,970 0 0 208,825,894 26,666,243 21,691,878 2,584,886 2,550,999 80,030 30,939 (840,870) 1,327,630 1,448,501 943,573 496,449 613,510 166,386 7,928,924 22,563,382 14,634,457 0 0 102,568,569 0 0 13,913,909 0 88,678,872 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 45,330 0 239,236 0 0 284,565 36,919,243 0 0 148,414 0 37,596,182 13,884,169 0 0 0 0 13,996,442 205,936,144 0 239,236 14,062,322 0 193,074,799 9,210 0 0 2,597,579 for stand-alone vision policies. 0 0 0 0 0 0 0 20,494 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF Iowa DURING THE YEAR All Expenses 1 Improve Health Outcomes 1. Individual Comprehensive Coverage Expenses: 13,709 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 966 for affiliated services) 1.3 EDP Equipment and Software (incl $ 93 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 10 for affiliated services) 1.5 Accreditation and Certification (incl $ 30,954 for affiliated services) 1.6 Other Expenses (incl $ 1.7 Subtotal before Reimbursements and Taxes (Lines 1.1 to 1.6) 1.8 Reimbursements by uninsured plans and fiscal intermediaries 1.9 Taxes, Licenses and Fees (in total, for tying purposes) 1.10 Total (1.7 to 1.9) 1.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 2. 216-4.IA 3. 0 0 0 0 0 3,047 3,047 0 XXX Small Group Comprehensive Coverage Expenses: 1,877,362 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 132,816 for affiliated services) 2.3 EDP Equipment and Software (incl $ 12,749 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 1,384 for affiliated services) 2.5 Accreditation and Certification (incl $ 4,274,694 for affiliated services) 2.6 Other Expenses (incl $ 2.7 Subtotal before Reimbursements and Taxes (Lines 2.1 to 2.6) 2.8 Reimbursements by uninsured plans and fiscal intermediaries 2.9 Taxes, Licenses and Fees (in total, for tying purposes) 2.10 Total (2.7 to 2.9) 2.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Comprehensive Coverage Expenses: 2,996,391 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 203,278 for affiliated services) 3.3 EDP Equipment and Software (incl $ 19,512 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 2,119 for affiliated services) 3.5 Accreditation and Certification (incl $ 6,679,525 for affiliated services) 3.6 Other Expenses (incl $ 3.7 Subtotal before Reimbursements and Taxes (Lines 3.1 to 3.6) 3.8 Reimbursements by uninsured plans and fiscal intermediaries 3.9 Taxes, Licenses and Fees (in total, for tying purposes) 3.10 Total (3.7 to 3.9) 3.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 185 Asylum Street Hartford, CT 061033408 Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX Total (1 to 5) 0 0 0 0 0 3,047 3,047 0 XXX 0 0 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 0 0 0 0 0 0 0 XXX (LOCATION) NAIC Company Code 2018 XXX 1,759 202 147 14 2 3,933 6,056 0 XXX 2,911 334 243 23 3 6,510 10,023 0 XXX 3,047 0 0 0 0 0 0 0 0 0 3,047 0 6,056 1,791 10,023 0 0 0 0 0 0 558,722 558,722 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 558,722 558,722 0 233,242 64,006 19,477 1,870 203 538,099 856,897 0 375,825 43,070 31,383 3,012 327 840,558 1,294,176 0 XXX XXX XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 558,722 0 856,897 239,475 XXX 1,294,176 0 0 0 0 0 0 1,025,579 1,025,579 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,025,579 1,025,579 0 373,486 108,365 31,188 2,994 325 859,395 1,375,753 0 568,289 65,127 47,455 4,555 495 1,271,016 1,956,936 0 1,025,579 0 XXX 1,375,753 408,848 XXX 1,956,936 0 XXX XXX 0 0 0 558,722 0 XXX 1,025,579 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX XXX 0 0 79413 9 10 General Administrative Expenses Total Expenses (6 to 9) 9,039 790 576 55 6 41,443 51,909 0 1,541 53,449 0 13,709 1,325 966 93 10 54,934 71,036 0 1,541 72,576 1,791 1,268,295 131,509 81,956 7,867 854 5,848,029 7,338,509 0 690,302 8,028,811 0 1,877,362 238,585 132,816 12,749 1,384 7,785,408 10,048,304 0 690,302 10,738,606 239,475 2,054,616 202,087 124,636 11,964 1,299 3,046,855 5,441,455 0 930,003 6,371,458 0 2,996,391 375,579 203,278 19,512 2,119 6,202,845 9,799,724 0 930,003 10,729,726 408,848 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 4. 5. 216-5.IA 6. Individual Mini-Med Plans Expenses: 0 for affiliated services) 4.1 Salaries (including $ 4.2 Outsourced Services 0 for affiliated services) 4.3 EDP Equipment and Software (incl $ 0 for affiliated services) 4.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 4.5 Accreditation and Certification (incl $ 0 for affiliated services) 4.6 Other Expenses (incl $ 4.7 Subtotal before Reimbursements and Taxes (Lines 4.1 to 4.6) 4.8 Reimbursements by uninsured plans and fiscal intermediaries 4.9 Taxes, Licenses and Fees (in total, for tying purposes) 4.10 Total (4.7 to 4.9) 4.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Mini-Med Plans Expenses: 0 for affiliated services) 5.1 Salaries (including $ 5.2 Outsourced Services 0 for affiliated services) 5.3 EDP Equipment and Software (incl $ 0 for affiliated services) 5.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 5.5 Accreditation and Certification (incl $ 0 for affiliated services) 5.6 Other Expenses (incl $ 5.7 Subtotal before Reimbursements and Taxes (Lines 5.1 to 5.6) 5.8 Reimbursements by uninsured plans and fiscal intermediaries 5.9 Taxes, Licenses and Fees (in total, for tying purposes) 5.10 Total (5.7 to 5.9) 5.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Mini-Med Plans Expenses: 0 for affiliated services) 6.1 Salaries (including $ 6.2 Outsourced Services 0 for affiliated services) 6.3 EDP Equipment and Software (incl $ 0 for affiliated services) 6.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 6.5 Accreditation and Certification (incl $ 0 for affiliated services) 6.6 Other Expenses (incl $ 6.7 Subtotal before Reimbursements and Taxes (Lines 6.1 to 6.6) 6.8 Reimbursements by uninsured plans and fiscal intermediaries 6.9 Taxes, Licenses and Fees (in total, for tying purposes) 6.10 Total (6.7 to 6.9) 6.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 7. 8. 216-6.IA 9. Small Group Expatriate Plans Expenses: 0 for affiliated services) 7.1 Salaries (including $ 7.2 Outsourced Services 0 for affiliated services) 7.3 EDP Equipment and Software (incl $ 0 for affiliated services) 7.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 7.5 Accreditation and Certification (incl $ 0 for affiliated services) 7.6 Other Expenses (incl $ 7.7 Subtotal before Reimbursements and Taxes (Lines 7.1 to 7.6) 7.8 Reimbursements by uninsured plans and fiscal intermediaries 7.9 Taxes, Licenses and Fees (in total, for tying purposes) 7.10 Total (7.7 to 7.9) 7.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Expatriate Plans Expenses: 0 for affiliated services) 8.1 Salaries (including $ 8.2 Outsourced Services 0 for affiliated services) 8.3 EDP Equipment and Software (incl $ 0 for affiliated services) 8.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 8.5 Accreditation and Certification (incl $ 0 for affiliated services) 8.6 Other Expenses (incl $ 8.7 Subtotal before Reimbursements and Taxes (Lines 8.1 to 8.6) 8.8 Reimbursements by uninsured plans and fiscal intermediaries 8.9 Taxes, Licenses and Fees (in total, for tying purposes) 8.10 Total (8.7 to 8.9) 8.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Student Health Plans Expenses: 0 for affiliated services) 9.1 Salaries (including $ 9.2 Outsourced Services 0 for affiliated services) 9.3 EDP Equipment and Software (incl $ 0 for affiliated services) 9.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 9.5 Accreditation and Certification (incl $ 0 for affiliated services) 9.6 Other Expenses (incl $ 9.7 Subtotal before Reimbursements and Taxes (Lines 9.1 to 9.6) 9.8 Reimbursements by uninsured plans and fiscal intermediaries 9.9 Taxes, Licenses and Fees (in total, for tying purposes) 9.10 Total (9.7 to 9.9) 9.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 *79413201821617100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes - See Cautionary Statement at http://www.naic.org/documents/committees_e_app_blanks_related_shce_cautionary_statement.pdf) UnitedHealthcare Insurance Company 2. 185 Asylum Street Hartford, CT 061033408 (LOCATION) BUSINESS IN THE STATE OF Kansas DURING THE YEAR 2018 NAIC Company Code Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 1. 216-1.KS 2. 3. 4. 5. 6. 7. 8. 9. Premium: 1.1 Health premiums earned (From Part 2, Line 1.11) 1.2 Federal high risk pools 1.3 State high risk pools 1.4 Premiums earned including state and federal high risk programs (Lines 1.1 + 1.2 + 1.3) 1.5 Federal taxes and federal assessments 1.6 State insurance, premium and other taxes (Similar local taxes of 39,428 ) $ 1.6a Community Benefit Expenditures (informational only) 1.7 Regulatory authority licenses and fees 1.8 Adjusted Premiums Earned (Lines 1.4 - 1.5 - 1.6 - 1.7) 1.9 Net Assumed less Ceded reinsurance premiums earned 1.10 Other Adjustments due to MLR calculations - Premiums 1.11 Risk Revenue 1.12 Net adjusted premiums earned after reinsurance (Lines 1.8 + 1.9 + 1.10 + 1.11) Claims: 2.1 Incurred claims excluding prescription drugs 2.2 Prescription drugs 2.3 Pharmaceutical rebates 2.4 State stop loss, market stabilization and claim/census based assessments (informational only) Incurred medical incentive pools and bonuses Deductible Fraud and Abuse Detection/Recovery Expenses (for MLR use only) 5.0 Total Incurred Claims (Lines 2.1 + 2.2 - 2.3 + 3) (From Part 2, Line 2.15) 5.1 Net Assumed less Ceded reinsurance claims incurred 5.2 Other Adjustments due to MLR calculations - Claims 5.3 Rebates paid 5.4 Estimated rebates unpaid prior year 5.5 Estimated rebates unpaid current year 5.6 Fee for service and co-pay revenue 5.7 Net incurred claims after reinsurance (Lines 5.0 + 5.1 + 5.2 + 5.3 - 5.4 + 5.5 - 5.6) Improving Health Care Quality Expenses Incurred: 6.1 Improve health outcomes 6.2 Activities to prevent hospital readmissions 6.3 Improve patient safety and reduce medical errors 6.4 Wellness and health promotion activities 6.5 Health Information Technology expenses related to health improvement 6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5) Preliminary Medical Loss Ratio: MLR ((Lines 4 + 5.0 + 6.6 - Footnote 2.0)/Line 1.8 Claims Adjustment Expenses: 8.1 Cost containment expenses not included in quality of care expenses in Line 6.6 8.2 All other claims adjustment expenses 8.3 Total claims adjustment expenses (Lines 8.1 + 8.2) Claims Adjustment Expense Ratio (Line 8.3/Line 1.8) 2 Small Group Employer 3 Large Group Employer 4 5 Small Group Employer Individual Expatriate Plans 6 Large Group Employer 7 11 Government Business (excluded by statute) Other Health Business 9 8 Small Group 10 Student Health Plans Large Group 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 79413 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 588,938 0 (19) 93,704,860 0 (2,677) 127,221,853 0 (11,878) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 94,278,395 0 41,168 50,987,093 0 0 366,781,138 0 26,594 XXX XXX XXX 588,918 (88,289) 93,702,182 3,206,829 127,209,976 4,046,026 0 0 0 0 0 0 0 0 0 0 0 0 0 3,642,755 94,319,562 1,466,570 50,987,093 2,939,393 366,807,731 15,213,285 XXX 896 0 23 676,288 17,639 0 0 693,927 73,538 0 3,360 90,418,454 0 12,019 0 90,430,474 (305,109) 0 5,754 123,463,304 (12,480,861) 173,804 0 111,156,247 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (3,642,755) 673,681,304 0 0 670,038,549 1,212,695 0 (16,707) 91,657,004 (29,494) 2,482 0 91,629,992 5,406 0 0 48,042,294 206,890 460,490 0 48,709,674 987,426 0 (7,569) 350,614,590 661,395,477 648,796 0 1,012,658,862 XXX XXX XXX XXX XXX 987,426 0 (7,569) 350,614,590 661,395,477 648,796 0 1,012,658,862 897,238 122,591 42,112 62,995,136 15,756,298 5,389,948 89,019,222 22,557,073 7,316,971 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 63,370,270 10,988,856 16,748 13,578,745 51,172,576 29,993,850 229,860,611 100,597,395 42,759,628 XXX XXX XXX 229,860,611 100,597,395 42,759,628 4 0 0 977,718 (4,319) 0 0 0 0 0 973,399 44,360 29,940 4,220 73,391,426 (6) 0 0 0 0 0 73,391,420 51,729 47,820 2,758 104,307,144 (9,432,820) 0 0 0 0 0 94,874,324 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 555,956,669 0 XXX XXX XXX 0 555,956,669 346,862 0 0 74,342,379 17,286 0 XXX XXX XXX 0 74,359,664 0 0 3,243 34,757,471 0 0 0 0 0 0 34,757,471 442,955 77,760 10,221 287,776,138 546,536,809 0 0 0 0 0 834,312,947 XXX XXX 442,955 77,760 10,221 287,776,138 546,536,809 0 0 0 0 0 834,312,947 0 0 0 0 0 227,066 139,668 105,684 546,283 50,138 0 1,068,840 XXX 476,559 0.733 3,317,524 XXX 65,767 1,101,000 1,166,768 0.013 556,473 2,665,956 3,222,429 0.067 3,306,498 7,483,085 10,789,583 XXX 4,712 0 0 0 0 749,639 0 0 0 0 1,017,775 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4,712 1.453 749,639 0.820 1,017,775 0.853 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 7,801 12,971 20,772 0.031 1,202,125 1,649,458 2,851,583 0.032 1,474,332 2,053,700 3,528,032 0.029 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 XXX 0 0 0 0.000 148,745 41,495 140,206 (14,774) 160,886 366,781,138 0 26,594 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 2,147,937 181,163 245,890 531,510 211,024 0 0 0 0 0 2,147,937 181,163 245,890 531,510 211,024 0 3,317,524 XXX 0 0 0 3,306,498 7,483,085 10,789,583 XXX XXX XXX 366,807,731 15,213,285 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 (Continued) Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 2 Small Group Employer Individual 10. General and Administrative (G&A) Expenses: 10.1 Direct sales salaries and benefits 10.2 Agents and brokers fees and commissions 10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below) 10.4 Other general and administrative expenses 10.4a Community Benefit Expenditures (informational only) 10.5 Total general and administrative (Lines 10.1 +10.2 + 10.3 + 10.4) 2,764 19,894 (1,734) 54,111 0 75,035 3 Large Group Employer 375,783 3,008,687 118,099 4,583,353 0 8,085,923 4 5 Small Group Employer Individual 552,693 4,461,526 171,333 4,583,410 0 9,768,962 0 0 0 0 0 0 Expatriate Plans 6 Large Group Employer 0 0 0 0 0 0 7 8 Small Group 0 0 0 0 0 0 Student Health Plans Large Group 0 0 0 0 0 0 10 11 Government Business (excluded by statute) Other Health Business 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 99,441,751 0 99,441,751 120,320 2,826,652 148,802 7,681,042 0 10,776,817 97,062 432,965 83,598 2,574,711 0 3,188,336 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 1,148,623 10,749,724 520,098 118,918,378 0 131,336,824 0 0 0 0 0 0 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) 12. Income from fees of uninsured plans XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 13. Net investment and other gain/(loss) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 14. Federal income taxes (excluding taxes on Line 1.5 above) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 15. Net gain or (loss) (Lines 11 + 12 + 13 - 14) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 16. ICD-10 Implementation Expenses (informational only; already included in general expenses and line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16. 16a ICD-10 Implementation Expenses (informational only; already included in line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 59 9,990 13,261 0 0 0 0 0 0 0 48,546 31,235 103,091 0 103,091 137 17,590 23,306 0 0 0 0 0 0 0 65,147 31,235 137,415 0 137,415 1,686 315 0 0 0 0 0 0 935 12 2,948 0 2,948 210,325 298,296 0 0 0 0 0 0 776,421 378,657 1,665,246 0 1,665,246 (379,990) 5,351,909 1,967,154 0 0 0 0 0 0 14,640,129 4,257,904 7,064,879 32,901,984 XXX 1,148,623 10,749,724 520,098 118,918,378 0 131,336,824 XXX 32,901,984 0 0 5,155,459 XXX XXX 299,434 XXX 299,434 XXX 37,758,010 XXX 37,758,010 5,155,459 OTHER INDICATORS: 216-2.KS 1. Number of certificates/policies 2. Number of Covered Lives 3. Number of Groups 4. Member Months XXX 1,547 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ XXX 0 ] If yes, show the amount of premiums and claims included. Premiums $ 0 Claims $ 0 AFFORDABLE CARE ACT (ACA) RECEIPTS, PAYMENTS, RECEIVABLES and PAYABLES Current Year Prior Year Comprehensive Health Coverage Comprehensive Health Coverage 1 2 3 4 Small Group Small Group Employer Plans Employer Plans Individual Plans Individual Plans ACA Receivables and Payables 1. Permanent ACA Risk Adjustment Program 1.0 Premium adjustments receivable/(payable) 2. Transitional ACA Reinsurance Program 2.0 Total amounts recoverable for claims (paid & unpaid) 0 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 0 0 0 0 19,961 2,107,712 (129,153) 2,655,426 XXX (48,824) 0 1,692,122 XXX 0 0 0 0 ACA Receipts and Payments 4. Permanent ACA Risk Adjustment Program 4.0 Premium adjustments receipts/(payments) 5. Transitional ACA Reinsurance Program 5.0 Amounts received for claims 0 6. Temporary ACA Risk Corridors Program 6.1 Retrospective premium received 6.2 Rate credits or policy experience refunds paid 0 0 XXX (65,763) 0 0 0 0 0 (98,732) XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF 185 Asylum Street Hartford, CT 061033408 Kansas DURING THE YEAR Comprehensive Health Coverage 1 2 3 Individual Small Group Employer Large Group Employer Small Group Employer Individual Expatriate Plans: 7 8 6 Large Group Employer Small Group 10 11 Government Business (excluded by statute) Other Health Business 9 Student Health Plans Large Group 79413 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.KS Health Premiums Earned: 588,938 93,721,214 1.1 Direct premiums written 0 24,149 1.2 Unearned premium prior year 0 28,485 1.3 Unearned premium current year 0 (4,335) 1.4 Change in unearned premium (Lines 1.2 - 1.3) 0 0 1.5 Paid rate credits 0 0 1.6 Reserve for rate credits current year 0 0 1.7 Reserve for rate credits prior year 0 0 1.8 Change in reserve for rate credits (Lines 1.6 - 1.7) 0 12,019 1.9 Premium balances written off 0 0 1.10 Group conversion charge 588,938 93,704,860 1.11 Total direct premiums earned (Lines 1.1 + 1.4 - 1.9 + 1.10) 0 0 1.12 Assumed premiums earned from non-affiliates 17,639 0 1.13 Net Assumed less Ceded premiums earned from affiliates 0 0 1.14 Ceded premiums earned to non-affiliates 0 12,019 1.15 Other Adjustments due to MLR calculation - Premiums 606,577 93,716,879 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 977,716 70,631,111 2.1 Paid claims during the year 26 10,610,220 2.2 Direct claim liability current year 24 7,747,354 2.3 Direct claim liability prior year 0 271,500 2.4 Direct claim reserves current year 0 192,977 2.5 Direct claim reserves prior year 0 0 2.6 Direct contract reserves current year 0 0 2.7 Direct contract reserves prior year 0 0 2.8 Paid rate credits 0 0 2.9 Reserve for rate credits current year 0 0 2.10 Reserve for rate credits prior year 0 29,940 2.11 Incurred medical incentive pools and bonuses (Lines 2.11a + 2.11b - 2.11c) 0 16,961 2.11a Paid medical incentive pools and bonuses current year 0 36,607 2.11b Accrued medical incentive pools and bonuses current year 0 23,628 2.11c Accrued medical incentive pools and bonuses prior year 0 211,014 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 0 2,592,728 2.12a Healthcare receivables current year 0 2,381,714 2.12b Healthcare receivables prior year 0 0 2.13 Group conversion charge 0 0 2.14 Multi-option coverage blended rate adjustment 2.15 Total incurred claims (Lines 2.1 + 2.2 - 2.3 + 2.4 - 2.5 + 2.6 - 2.7 + 2.8 + 2.9 977,718 73,391,426 2.10 + 2.11 - 2.12 + 2.13 + 2.14) 0 0 2.16 Assumed incurred claims from non-affiliates (4,319) (6) 2.17 Net assumed less ceded incurred claims from affiliates 0 0 2.18 Ceded incurred claims to non-affiliates 0 0 2.19 Other adjustments due to MLR calculation - Claims 973,399 73,391,420 2.20 Net Incurred Claims (Lines 2.15 - 2.8 - 2.9 + 2.10 + 2.16 + 2.17 - 2.18 + 2.19) 3. Fraud and Abuse Recoveries that Reduced PAID Claims in Line 2.1 above 0 4,220 (informational only) 3,187,067 for stand-alone dental and $ (a) Column 13, Line 1.1 includes direct written premium of $ 4 Business Subject to MLR Mini-Med Plans 5 (LOCATION) NAIC Company Code 2018 127,395,658 0 0 0 197,366 1,675 109,051 (107,376) 173,804 0 127,221,853 0 0 12,480,861 173,804 114,824,806 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 673,681,304 0 0 673,681,304 104,042,820 10,934,069 11,319,288 272,181 272,529 0 0 197,366 1,675 109,051 47,820 19,677 107,042 78,899 (512,080) 2,361,832 2,873,912 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 104,307,144 0 1,222 9,434,042 0 94,784,334 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 555,956,669 0 0 555,956,669 2,758 0 0 779,853 for stand-alone vision policies. 0 0 0 0 0 (4,239,959) 5,731,501 1,491,541 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 94,420,519 120,159 259,801 (139,643) (995,413) 145,276 124,452 20,824 2,482 0 94,278,395 0 0 29,494 2,482 95,225,972 51,447,583 0 0 0 2,880,595 1,553,361 3,041,259 (1,487,898) 460,490 0 50,987,093 0 206,890 0 460,490 50,261,775 367,573,911 144,308 288,286 (143,978) 2,082,548 1,700,312 3,274,763 (1,574,450) 648,796 0 366,781,138 0 673,905,832 12,510,355 648,796 1,028,317,312 75,633,841 8,837,900 8,882,145 2,892,931 3,147,580 10,535 23,652 (995,413) 145,276 124,452 0 0 0 0 4,861 4,861 0 0 0 35,438,812 1,188,069 3,905,212 3,796 2,615 0 0 2,880,595 1,553,361 3,041,259 0 0 0 0 (641,923) 10,537,315 11,179,238 0 0 282,484,341 37,301,785 33,345,564 3,440,408 3,615,701 10,535 23,652 2,082,548 1,700,312 3,274,763 77,760 36,639 143,649 102,527 (938,128) 15,496,736 16,434,864 0 0 74,342,379 0 0 (17,286) 0 75,334,254 34,757,471 0 0 0 0 33,364,773 287,776,138 0 555,953,566 9,416,756 0 833,804,849 3,243 10,221 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF Kansas DURING THE YEAR Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities All Expenses 1 Improve Health Outcomes 1. Individual Comprehensive Coverage Expenses: 17,297 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 1,222 for affiliated services) 1.3 EDP Equipment and Software (incl $ 117 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 13 for affiliated services) 1.5 Accreditation and Certification (incl $ 38,435 for affiliated services) 1.6 Other Expenses (incl $ 1.7 Subtotal before Reimbursements and Taxes (Lines 1.1 to 1.6) 1.8 Reimbursements by uninsured plans and fiscal intermediaries 1.9 Taxes, Licenses and Fees (in total, for tying purposes) 1.10 Total (1.7 to 1.9) 1.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 2. 216-4.KS 3. 0 0 0 0 0 4,712 4,712 0 XXX Small Group Comprehensive Coverage Expenses: 2,361,918 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 166,980 for affiliated services) 2.3 EDP Equipment and Software (incl $ 16,028 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 1,740 for affiliated services) 2.5 Accreditation and Certification (incl $ 5,300,325 for affiliated services) 2.6 Other Expenses (incl $ 2.7 Subtotal before Reimbursements and Taxes (Lines 2.1 to 2.6) 2.8 Reimbursements by uninsured plans and fiscal intermediaries 2.9 Taxes, Licenses and Fees (in total, for tying purposes) 2.10 Total (2.7 to 2.9) 2.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Comprehensive Coverage Expenses: 2,931,422 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 200,295 for affiliated services) 3.3 EDP Equipment and Software (incl $ 19,226 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 2,088 for affiliated services) 3.5 Accreditation and Certification (incl $ 6,605,249 for affiliated services) 3.6 Other Expenses (incl $ 3.7 Subtotal before Reimbursements and Taxes (Lines 3.1 to 3.6) 3.8 Reimbursements by uninsured plans and fiscal intermediaries 3.9 Taxes, Licenses and Fees (in total, for tying purposes) 3.10 Total (3.7 to 3.9) 3.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 185 Asylum Street Hartford, CT 061033408 2 Activities to Prevent Hospital Readmissions 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX Total (1 to 5) 0 0 0 0 0 4,712 4,712 0 XXX 0 0 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 0 0 0 0 0 0 0 XXX (LOCATION) NAIC Company Code 2018 XXX 2,190 253 183 18 2 4,898 7,543 0 XXX 3,687 423 308 30 3 8,246 12,696 0 XXX 4,712 0 0 0 0 0 0 0 0 0 4,712 0 7,543 2,224 12,696 0 0 0 0 0 0 749,639 749,639 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 749,639 749,639 0 295,362 161,739 24,664 2,367 257 682,690 1,167,079 0 468,168 53,653 39,094 3,753 407 1,047,090 1,612,165 0 XXX XXX XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 749,639 0 XXX 1,167,079 302,679 XXX 1,612,165 0 0 0 0 0 0 1,017,775 1,017,775 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,017,775 1,017,775 0 393,365 93,973 32,848 3,153 342 903,535 1,427,216 0 584,036 66,932 48,770 4,681 508 1,306,236 2,011,164 0 1,017,775 0 XXX 1,427,216 428,393 XXX 2,011,164 0 XXX XXX 0 0 0 749,639 0 XXX 1,017,775 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 79413 9 10 General Administrative Expenses Total Expenses (6 to 9) 11,420 1,003 731 70 8 63,342 76,574 0 (88) 76,486 0 17,297 1,679 1,222 117 13 81,198 101,525 0 (88) 101,437 2,224 1,598,388 201,274 103,222 9,908 1,076 6,027,386 7,941,253 0 293,908 8,235,161 0 2,361,918 416,666 166,980 16,028 1,740 8,506,804 11,470,136 0 293,908 11,764,044 302,679 1,954,021 208,510 118,677 11,392 1,237 7,265,547 9,559,384 0 (124) 9,559,259 0 2,931,422 369,415 200,295 19,226 2,088 10,493,093 14,015,539 0 (124) 14,015,414 428,393 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 4. 5. 216-5.KS 6. Individual Mini-Med Plans Expenses: 0 for affiliated services) 4.1 Salaries (including $ 4.2 Outsourced Services 0 for affiliated services) 4.3 EDP Equipment and Software (incl $ 0 for affiliated services) 4.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 4.5 Accreditation and Certification (incl $ 0 for affiliated services) 4.6 Other Expenses (incl $ 4.7 Subtotal before Reimbursements and Taxes (Lines 4.1 to 4.6) 4.8 Reimbursements by uninsured plans and fiscal intermediaries 4.9 Taxes, Licenses and Fees (in total, for tying purposes) 4.10 Total (4.7 to 4.9) 4.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Mini-Med Plans Expenses: 0 for affiliated services) 5.1 Salaries (including $ 5.2 Outsourced Services 0 for affiliated services) 5.3 EDP Equipment and Software (incl $ 0 for affiliated services) 5.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 5.5 Accreditation and Certification (incl $ 0 for affiliated services) 5.6 Other Expenses (incl $ 5.7 Subtotal before Reimbursements and Taxes (Lines 5.1 to 5.6) 5.8 Reimbursements by uninsured plans and fiscal intermediaries 5.9 Taxes, Licenses and Fees (in total, for tying purposes) 5.10 Total (5.7 to 5.9) 5.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Mini-Med Plans Expenses: 0 for affiliated services) 6.1 Salaries (including $ 6.2 Outsourced Services 0 for affiliated services) 6.3 EDP Equipment and Software (incl $ 0 for affiliated services) 6.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 6.5 Accreditation and Certification (incl $ 0 for affiliated services) 6.6 Other Expenses (incl $ 6.7 Subtotal before Reimbursements and Taxes (Lines 6.1 to 6.6) 6.8 Reimbursements by uninsured plans and fiscal intermediaries 6.9 Taxes, Licenses and Fees (in total, for tying purposes) 6.10 Total (6.7 to 6.9) 6.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 7. 8. 216-6.KS 9. Small Group Expatriate Plans Expenses: 0 for affiliated services) 7.1 Salaries (including $ 7.2 Outsourced Services 0 for affiliated services) 7.3 EDP Equipment and Software (incl $ 0 for affiliated services) 7.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 7.5 Accreditation and Certification (incl $ 0 for affiliated services) 7.6 Other Expenses (incl $ 7.7 Subtotal before Reimbursements and Taxes (Lines 7.1 to 7.6) 7.8 Reimbursements by uninsured plans and fiscal intermediaries 7.9 Taxes, Licenses and Fees (in total, for tying purposes) 7.10 Total (7.7 to 7.9) 7.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Expatriate Plans Expenses: 0 for affiliated services) 8.1 Salaries (including $ 8.2 Outsourced Services 0 for affiliated services) 8.3 EDP Equipment and Software (incl $ 0 for affiliated services) 8.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 8.5 Accreditation and Certification (incl $ 0 for affiliated services) 8.6 Other Expenses (incl $ 8.7 Subtotal before Reimbursements and Taxes (Lines 8.1 to 8.6) 8.8 Reimbursements by uninsured plans and fiscal intermediaries 8.9 Taxes, Licenses and Fees (in total, for tying purposes) 8.10 Total (8.7 to 8.9) 8.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Student Health Plans Expenses: 0 for affiliated services) 9.1 Salaries (including $ 9.2 Outsourced Services 0 for affiliated services) 9.3 EDP Equipment and Software (incl $ 0 for affiliated services) 9.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 9.5 Accreditation and Certification (incl $ 0 for affiliated services) 9.6 Other Expenses (incl $ 9.7 Subtotal before Reimbursements and Taxes (Lines 9.1 to 9.6) 9.8 Reimbursements by uninsured plans and fiscal intermediaries 9.9 Taxes, Licenses and Fees (in total, for tying purposes) 9.10 Total (9.7 to 9.9) 9.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 *79413201821618100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes - See Cautionary Statement at http://www.naic.org/documents/committees_e_app_blanks_related_shce_cautionary_statement.pdf) UnitedHealthcare Insurance Company 2. 185 Asylum Street Hartford, CT 061033408 (LOCATION) BUSINESS IN THE STATE OF Kentucky DURING THE YEAR 2018 NAIC Company Code Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 1. 216-1.KY 2. 3. 4. 5. 6. 7. 8. 9. Premium: 1.1 Health premiums earned (From Part 2, Line 1.11) 1.2 Federal high risk pools 1.3 State high risk pools 1.4 Premiums earned including state and federal high risk programs (Lines 1.1 + 1.2 + 1.3) 1.5 Federal taxes and federal assessments 1.6 State insurance, premium and other taxes (Similar local taxes of 30,770 ) $ 1.6a Community Benefit Expenditures (informational only) 1.7 Regulatory authority licenses and fees 1.8 Adjusted Premiums Earned (Lines 1.4 - 1.5 - 1.6 - 1.7) 1.9 Net Assumed less Ceded reinsurance premiums earned 1.10 Other Adjustments due to MLR calculations - Premiums 1.11 Risk Revenue 1.12 Net adjusted premiums earned after reinsurance (Lines 1.8 + 1.9 + 1.10 + 1.11) Claims: 2.1 Incurred claims excluding prescription drugs 2.2 Prescription drugs 2.3 Pharmaceutical rebates 2.4 State stop loss, market stabilization and claim/census based assessments (informational only) Incurred medical incentive pools and bonuses Deductible Fraud and Abuse Detection/Recovery Expenses (for MLR use only) 5.0 Total Incurred Claims (Lines 2.1 + 2.2 - 2.3 + 3) (From Part 2, Line 2.15) 5.1 Net Assumed less Ceded reinsurance claims incurred 5.2 Other Adjustments due to MLR calculations - Claims 5.3 Rebates paid 5.4 Estimated rebates unpaid prior year 5.5 Estimated rebates unpaid current year 5.6 Fee for service and co-pay revenue 5.7 Net incurred claims after reinsurance (Lines 5.0 + 5.1 + 5.2 + 5.3 - 5.4 + 5.5 - 5.6) Improving Health Care Quality Expenses Incurred: 6.1 Improve health outcomes 6.2 Activities to prevent hospital readmissions 6.3 Improve patient safety and reduce medical errors 6.4 Wellness and health promotion activities 6.5 Health Information Technology expenses related to health improvement 6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5) Preliminary Medical Loss Ratio: MLR ((Lines 4 + 5.0 + 6.6 - Footnote 2.0)/Line 1.8 Claims Adjustment Expenses: 8.1 Cost containment expenses not included in quality of care expenses in Line 6.6 8.2 All other claims adjustment expenses 8.3 Total claims adjustment expenses (Lines 8.1 + 8.2) Claims Adjustment Expense Ratio (Line 8.3/Line 1.8) 2 Small Group Employer 3 Large Group Employer 4 5 Small Group Employer Individual Expatriate Plans 6 Large Group Employer 7 11 Government Business (excluded by statute) Other Health Business 9 8 Small Group 10 Student Health Plans Large Group 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 79413 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 32,271 0 0 878,094 0 (5,890) 62,020,519 0 (454,357) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 154,253,620 0 22,322 85,632,909 0 0 302,817,413 0 (437,925) XXX XXX XXX 32,271 (16,468) 872,203 40,054 61,566,163 2,096,023 0 0 0 0 0 0 0 0 0 0 0 0 0 0 154,275,941 1,840,290 85,632,909 5,150,978 302,379,488 9,110,876 XXX 101,715 0 0 (52,975) 925 0 0 (52,050) 22,663 0 14 809,472 88,692 0 0 898,165 1,474,746 0 7,437 57,987,957 (12,000,349) 3,623 0 45,991,231 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,732,201 0 (33,789) 149,737,239 (113,443) 12,240 0 149,636,036 9,018 0 0 80,472,913 55,465 1,421,167 0 81,949,545 4,340,343 0 (26,338) 288,954,606 (11,968,709) 1,437,030 0 278,422,927 XXX XXX XXX XXX XXX 4,340,343 0 (26,338) 288,954,606 (11,968,709) 1,437,030 0 278,422,927 12,964 0 0 526,604 190,262 30,641 42,159,009 8,068,064 3,012,995 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 115,078,370 2,882,958 28,606 12,008,365 102,644,354 56,814,436 169,785,312 113,785,637 59,886,679 XXX XXX XXX 169,785,312 113,785,637 59,886,679 1 0 0 12,964 0 0 0 0 0 0 12,964 6,515 7,077 2,371 693,302 0 0 0 0 0 0 693,302 45,876 69,750 13,060 47,283,827 (9,126,640) 0 0 0 0 0 38,157,186 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,031 57,838,283 0 0 0 0 0 0 57,838,283 52,393 76,827 17,462 223,761,097 (9,171,992) 0 0 0 0 0 214,589,105 XXX XXX 0 0 0 0 0 117,932,721 (45,351) 0 XXX XXX XXX 0 117,887,370 52,393 76,827 17,462 223,761,097 (9,171,992) 0 0 0 0 0 214,589,105 258 0 0 0 0 7,025 0 0 0 0 496,164 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 325,294 75,254 56,629 1,111,901 60,926 258 (0.250) 7,025 0.868 496,164 0.824 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 1,630,004 XXX 1,124,605 0.733 3,258,057 XXX 530 10,314 10,844 (0.205) 12,095 14,886 26,981 0.033 771,014 948,317 1,719,331 0.030 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 109,499 2,165,930 2,275,430 0.015 2,950,813 9,501,144 12,451,957 0.155 3,843,951 12,640,592 16,484,542 XXX XXX XXX XXX XXX 0 0 0 0.000 230,250 38,808 482,744 (36,649) 409,452 302,817,413 0 (437,925) 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 1,058,991 114,062 539,373 1,075,252 470,378 0 0 0 0 0 1,058,991 114,062 539,373 1,075,252 470,378 0 3,258,057 XXX 0 0 0 3,843,951 12,640,592 16,484,542 XXX XXX XXX 302,379,488 9,110,876 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 (Continued) Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 2 Small Group Employer Individual 10. General and Administrative (G&A) Expenses: 10.1 Direct sales salaries and benefits 10.2 Agents and brokers fees and commissions 10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below) 10.4 Other general and administrative expenses 10.4a Community Benefit Expenditures (informational only) 10.5 Total general and administrative (Lines 10.1 +10.2 + 10.3 + 10.4) 43 0 (5,748) 505 0 (5,200) 3 Large Group Employer 3,718 50,091 (17,718) 55,854 0 91,946 4 5 Small Group Employer Individual 330,743 2,095,479 69,130 1,630,544 0 4,125,895 0 0 0 0 0 0 Expatriate Plans 6 Large Group Employer 0 0 0 0 0 0 7 8 Small Group 0 0 0 0 0 0 Student Health Plans Large Group 0 0 0 0 0 0 10 11 Government Business (excluded by statute) Other Health Business 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 215,667 5,825,353 290,733 14,920,860 0 21,252,614 131,452 1,210,522 157,864 5,480,292 0 6,980,130 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 681,624 9,181,446 494,261 22,088,055 0 32,445,385 0 0 0 0 0 0 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) 12. Income from fees of uninsured plans XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 13. Net investment and other gain/(loss) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 14. Federal income taxes (excluding taxes on Line 1.5 above) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 15. Net gain or (loss) (Lines 11 + 12 + 13 - 14) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 16. ICD-10 Implementation Expenses (informational only; already included in general expenses and line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16. 16a ICD-10 Implementation Expenses (informational only; already included in line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (70,916) 78,911 1,492,654 0 0 0 0 0 0 0 6,590,618 3,554,570 11,645,837 XXX 681,624 9,181,446 494,261 22,088,055 0 32,445,385 XXX 11,645,837 0 0 3,768,846 XXX XXX 219,100 XXX 219,100 XXX 15,195,583 XXX 15,195,583 3,768,846 OTHER INDICATORS: 216-2.KY 1. Number of certificates/policies 2 53 5,645 0 0 0 0 0 0 0 108,681 50,037 164,418 0 164,418 2. Number of Covered Lives 2 115 9,976 0 0 0 0 0 0 0 151,206 50,037 211,336 0 211,336 3. Number of Groups 12 40 0 0 0 0 0 0 918 2 972 0 972 4. Member Months 2,081 168,364 0 0 0 0 0 0 1,866,232 614,677 2,651,378 0 2,651,378 XXX 24 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ XXX 0 ] If yes, show the amount of premiums and claims included. Premiums $ 0 Claims $ 0 AFFORDABLE CARE ACT (ACA) RECEIPTS, PAYMENTS, RECEIVABLES and PAYABLES Current Year Prior Year Comprehensive Health Coverage Comprehensive Health Coverage 1 2 3 4 Small Group Small Group Employer Plans Employer Plans Individual Plans Individual Plans ACA Receivables and Payables 1. Permanent ACA Risk Adjustment Program 1.0 Premium adjustments receivable/(payable) 0 2. Transitional ACA Reinsurance Program 2.0 Total amounts recoverable for claims (paid & unpaid) 0 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 0 0 0 0 0 0 54,617 0 (165,678) XXX 0 0 (64,634) XXX 0 0 ACA Receipts and Payments 4. Permanent ACA Risk Adjustment Program 4.0 Premium adjustments receipts/(payments) 0 5. Transitional ACA Reinsurance Program 5.0 Amounts received for claims 0 6. Temporary ACA Risk Corridors Program 6.1 Retrospective premium received 6.2 Rate credits or policy experience refunds paid 0 0 XXX 0 0 0 0 0 (222,329) XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF 185 Asylum Street Hartford, CT 061033408 Kentucky DURING THE YEAR Comprehensive Health Coverage 1 2 3 Individual Small Group Employer Large Group Employer Small Group Employer Individual Expatriate Plans: 7 8 6 Large Group Employer Small Group 10 11 Government Business (excluded by statute) Other Health Business 9 Student Health Plans Large Group 79413 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.KY Health Premiums Earned: 32,271 1.1 Direct premiums written 0 1.2 Unearned premium prior year 0 1.3 Unearned premium current year 0 1.4 Change in unearned premium (Lines 1.2 - 1.3) 58 1.5 Paid rate credits 0 1.6 Reserve for rate credits current year 0 1.7 Reserve for rate credits prior year 0 1.8 Change in reserve for rate credits (Lines 1.6 - 1.7) 0 1.9 Premium balances written off 0 1.10 Group conversion charge 32,271 1.11 Total direct premiums earned (Lines 1.1 + 1.4 - 1.9 + 1.10) 0 1.12 Assumed premiums earned from non-affiliates 925 1.13 Net Assumed less Ceded premiums earned from affiliates 0 1.14 Ceded premiums earned to non-affiliates 0 1.15 Other Adjustments due to MLR calculation - Premiums 33,138 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 17,683 2.1 Paid claims during the year 2,730 2.2 Direct claim liability current year 7,507 2.3 Direct claim liability prior year 0 2.4 Direct claim reserves current year 0 2.5 Direct claim reserves prior year 0 2.6 Direct contract reserves current year 0 2.7 Direct contract reserves prior year 58 2.8 Paid rate credits 0 2.9 Reserve for rate credits current year 0 2.10 Reserve for rate credits prior year 0 2.11 Incurred medical incentive pools and bonuses (Lines 2.11a + 2.11b - 2.11c) 0 2.11a Paid medical incentive pools and bonuses current year 0 2.11b Accrued medical incentive pools and bonuses current year 0 2.11c Accrued medical incentive pools and bonuses prior year 0 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 0 2.12a Healthcare receivables current year 0 2.12b Healthcare receivables prior year 0 2.13 Group conversion charge 0 2.14 Multi-option coverage blended rate adjustment 2.15 Total incurred claims (Lines 2.1 + 2.2 - 2.3 + 2.4 - 2.5 + 2.6 - 2.7 + 2.8 + 2.9 12,964 2.10 + 2.11 - 2.12 + 2.13 + 2.14) 0 2.16 Assumed incurred claims from non-affiliates 0 2.17 Net assumed less ceded incurred claims from affiliates 0 2.18 Ceded incurred claims to non-affiliates 0 2.19 Other adjustments due to MLR calculation - Claims 12,906 2.20 Net Incurred Claims (Lines 2.15 - 2.8 - 2.9 + 2.10 + 2.16 + 2.17 - 2.18 + 2.19) 3. Fraud and Abuse Recoveries that Reduced PAID Claims in Line 2.1 above 0 (informational only) 1,103,092 for stand-alone dental and $ (a) Column 13, Line 1.1 includes direct written premium of $ 4 Business Subject to MLR Mini-Med Plans 5 (LOCATION) NAIC Company Code 2018 878,095 (2) 0 (2) 0 0 0 0 0 0 878,094 0 88,692 0 0 966,786 62,024,142 0 0 0 285,428 0 0 0 3,623 0 62,020,519 0 94,287 12,094,636 3,623 49,738,366 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 154,266,022 24 186 (162) 4,553,550 214,965 266,740 (51,775) 12,240 0 154,253,620 0 0 113,443 12,240 149,650,642 87,054,077 0 0 0 10,611,214 5,114,111 7,397,542 (2,283,430) 1,421,167 0 85,632,909 0 55,465 0 1,421,167 78,781,757 304,254,607 22 186 (164) 15,450,251 5,329,076 7,664,282 (2,335,206) 1,437,030 0 302,817,413 0 239,369 12,208,079 1,437,030 279,170,689 687,970 137,851 165,662 3,011 1,988 0 0 0 0 0 7,077 3,651 5,972 2,546 (25,042) 22,448 47,489 0 0 49,447,887 4,355,123 7,306,851 95,576 181,131 0 0 285,428 0 0 69,750 47,445 110,250 87,946 (518,046) 1,019,585 1,537,631 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 113,170,927 16,180,034 16,051,625 4,937,377 4,836,237 65,234 26,326 4,553,550 214,965 266,740 0 0 0 0 8,437 8,437 0 0 0 48,485,670 4,577,451 6,926,594 1,872 2,858 0 0 10,611,214 5,114,111 7,397,542 0 0 8,915 8,915 (3,374,957) 11,010,660 14,385,617 0 0 211,810,137 25,253,189 30,458,239 5,037,836 5,022,214 65,234 26,326 15,450,251 5,329,076 7,664,282 76,827 51,096 125,137 99,406 (3,909,607) 12,061,129 15,970,737 0 0 693,302 0 0 0 0 693,302 47,283,827 0 0 9,126,640 0 37,871,759 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 117,932,721 0 0 45,351 0 113,385,595 57,838,283 0 0 0 0 49,510,499 223,761,097 0 0 9,171,992 0 201,474,060 13,060 0 0 4,496,828 for stand-alone vision policies. 0 0 0 0 0 0 2,031 17,462 2,371 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF Kentucky DURING THE YEAR All Expenses 1 Individual Comprehensive Coverage Expenses: 3,196 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 263 for affiliated services) 1.3 EDP Equipment and Software (incl $ 25 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 3 for affiliated services) 1.5 Accreditation and Certification (incl $ 7,115 for affiliated services) 1.6 Other Expenses (incl $ 1.7 Subtotal before Reimbursements and Taxes (Lines 1.1 to 1.6) 1.8 Reimbursements by uninsured plans and fiscal intermediaries 1.9 Taxes, Licenses and Fees (in total, for tying purposes) 1.10 Total (1.7 to 1.9) 1.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 2. 216-4.KY 2.7 Subtotal before Reimbursements and Taxes (Lines 2.1 to 2.6) 2.8 Reimbursements by uninsured plans and fiscal intermediaries 2.9 Taxes, Licenses and Fees (in total, for tying purposes) 2.10 Total (2.7 to 2.9) 2.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 3. 0 0 0 0 0 258 258 0 XXX Small Group Comprehensive Coverage Expenses: 25,441 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 1,825 for affiliated services) 2.3 EDP Equipment and Software (incl $ 175 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 19 for affiliated services) 2.5 Accreditation and Certification (incl $ 58,848 for affiliated services) 2.6 Other Expenses (incl $ 3.7 Subtotal before Reimbursements and Taxes (Lines 3.1 to 3.6) 3.8 Reimbursements by uninsured plans and fiscal intermediaries 3.9 Taxes, Licenses and Fees (in total, for tying purposes) 3.10 Total (3.7 to 3.9) 3.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX Total (1 to 5) 0 0 0 0 0 258 258 0 XXX 0 0 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 0 0 0 0 0 0 0 XXX (LOCATION) NAIC Company Code 2018 XXX 32 419 3 0 0 72 526 0 XXX 2,994 343 250 24 3 6,696 10,310 0 XXX 258 0 0 0 0 0 0 0 0 0 258 0 526 35 10,310 0 0 0 0 0 0 7,025 7,025 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7,025 7,025 0 2,863 1,955 239 23 2 6,666 11,748 0 4,216 483 352 34 4 9,429 14,517 0 XXX Large Group Comprehensive Coverage Expenses: 1,486,575 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 97,511 for affiliated services) 3.3 EDP Equipment and Software (incl $ 9,360 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 1,016 for affiliated services) 3.5 Accreditation and Certification (incl $ 3,324,063 for affiliated services) 3.6 Other Expenses (incl $ Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions Improve Health Outcomes 1. 185 Asylum Street Hartford, CT 061033408 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX XXX XXX 7,025 0 0 0 0 0 0 0 0 0 7,025 0 11,748 2,994 14,517 0 0 0 0 0 0 496,164 496,164 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 496,164 496,164 0 193,758 89,723 16,180 1,553 169 446,459 747,842 0 270,020 30,945 22,548 2,164 235 603,918 929,830 0 XXX XXX XXX 0 0 0 XXX 496,164 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 496,164 0 XXX 747,842 218,374 929,830 0 79413 9 10 General Administrative Expenses Total Expenses (6 to 9) 170 272 11 1 0 91 545 0 95,978 96,523 0 3,196 1,034 263 25 3 7,118 11,639 0 95,978 107,617 35 18,362 2,590 1,234 118 13 87,082 109,400 0 5,938 115,338 0 25,441 5,028 1,825 175 19 110,202 142,690 0 5,938 148,628 2,994 1,022,797 110,062 58,783 5,642 613 2,837,544 4,035,441 0 1,614,296 5,649,737 0 1,486,575 230,730 97,511 9,360 1,016 4,384,085 6,209,277 0 1,614,296 7,823,573 218,374 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 4. 5. 216-5.KY 6. Individual Mini-Med Plans Expenses: 0 for affiliated services) 4.1 Salaries (including $ 4.2 Outsourced Services 0 for affiliated services) 4.3 EDP Equipment and Software (incl $ 0 for affiliated services) 4.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 4.5 Accreditation and Certification (incl $ 0 for affiliated services) 4.6 Other Expenses (incl $ 4.7 Subtotal before Reimbursements and Taxes (Lines 4.1 to 4.6) 4.8 Reimbursements by uninsured plans and fiscal intermediaries 4.9 Taxes, Licenses and Fees (in total, for tying purposes) 4.10 Total (4.7 to 4.9) 4.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Mini-Med Plans Expenses: 0 for affiliated services) 5.1 Salaries (including $ 5.2 Outsourced Services 0 for affiliated services) 5.3 EDP Equipment and Software (incl $ 0 for affiliated services) 5.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 5.5 Accreditation and Certification (incl $ 0 for affiliated services) 5.6 Other Expenses (incl $ 5.7 Subtotal before Reimbursements and Taxes (Lines 5.1 to 5.6) 5.8 Reimbursements by uninsured plans and fiscal intermediaries 5.9 Taxes, Licenses and Fees (in total, for tying purposes) 5.10 Total (5.7 to 5.9) 5.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Mini-Med Plans Expenses: 0 for affiliated services) 6.1 Salaries (including $ 6.2 Outsourced Services 0 for affiliated services) 6.3 EDP Equipment and Software (incl $ 0 for affiliated services) 6.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 6.5 Accreditation and Certification (incl $ 0 for affiliated services) 6.6 Other Expenses (incl $ 6.7 Subtotal before Reimbursements and Taxes (Lines 6.1 to 6.6) 6.8 Reimbursements by uninsured plans and fiscal intermediaries 6.9 Taxes, Licenses and Fees (in total, for tying purposes) 6.10 Total (6.7 to 6.9) 6.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 7. 8. 216-6.KY 9. Small Group Expatriate Plans Expenses: 0 for affiliated services) 7.1 Salaries (including $ 7.2 Outsourced Services 0 for affiliated services) 7.3 EDP Equipment and Software (incl $ 0 for affiliated services) 7.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 7.5 Accreditation and Certification (incl $ 0 for affiliated services) 7.6 Other Expenses (incl $ 7.7 Subtotal before Reimbursements and Taxes (Lines 7.1 to 7.6) 7.8 Reimbursements by uninsured plans and fiscal intermediaries 7.9 Taxes, Licenses and Fees (in total, for tying purposes) 7.10 Total (7.7 to 7.9) 7.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Expatriate Plans Expenses: 0 for affiliated services) 8.1 Salaries (including $ 8.2 Outsourced Services 0 for affiliated services) 8.3 EDP Equipment and Software (incl $ 0 for affiliated services) 8.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 8.5 Accreditation and Certification (incl $ 0 for affiliated services) 8.6 Other Expenses (incl $ 8.7 Subtotal before Reimbursements and Taxes (Lines 8.1 to 8.6) 8.8 Reimbursements by uninsured plans and fiscal intermediaries 8.9 Taxes, Licenses and Fees (in total, for tying purposes) 8.10 Total (8.7 to 8.9) 8.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Student Health Plans Expenses: 0 for affiliated services) 9.1 Salaries (including $ 9.2 Outsourced Services 0 for affiliated services) 9.3 EDP Equipment and Software (incl $ 0 for affiliated services) 9.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 9.5 Accreditation and Certification (incl $ 0 for affiliated services) 9.6 Other Expenses (incl $ 9.7 Subtotal before Reimbursements and Taxes (Lines 9.1 to 9.6) 9.8 Reimbursements by uninsured plans and fiscal intermediaries 9.9 Taxes, Licenses and Fees (in total, for tying purposes) 9.10 Total (9.7 to 9.9) 9.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 *79413201821619100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes - See Cautionary Statement at http://www.naic.org/documents/committees_e_app_blanks_related_shce_cautionary_statement.pdf) UnitedHealthcare Insurance Company 2. 185 Asylum Street Hartford, CT 061033408 (LOCATION) BUSINESS IN THE STATE OF Louisiana DURING THE YEAR 2018 NAIC Company Code Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 1. 216-1.LA 2. 3. 4. 5. 6. 7. 8. 9. Premium: 1.1 Health premiums earned (From Part 2, Line 1.11) 1.2 Federal high risk pools 1.3 State high risk pools 1.4 Premiums earned including state and federal high risk programs (Lines 1.1 + 1.2 + 1.3) 1.5 Federal taxes and federal assessments 1.6 State insurance, premium and other taxes (Similar local taxes of 3,427,899 ) $ 1.6a Community Benefit Expenditures (informational only) 1.7 Regulatory authority licenses and fees 1.8 Adjusted Premiums Earned (Lines 1.4 - 1.5 - 1.6 - 1.7) 1.9 Net Assumed less Ceded reinsurance premiums earned 1.10 Other Adjustments due to MLR calculations - Premiums 1.11 Risk Revenue 1.12 Net adjusted premiums earned after reinsurance (Lines 1.8 + 1.9 + 1.10 + 1.11) Claims: 2.1 Incurred claims excluding prescription drugs 2.2 Prescription drugs 2.3 Pharmaceutical rebates 2.4 State stop loss, market stabilization and claim/census based assessments (informational only) Incurred medical incentive pools and bonuses Deductible Fraud and Abuse Detection/Recovery Expenses (for MLR use only) 5.0 Total Incurred Claims (Lines 2.1 + 2.2 - 2.3 + 3) (From Part 2, Line 2.15) 5.1 Net Assumed less Ceded reinsurance claims incurred 5.2 Other Adjustments due to MLR calculations - Claims 5.3 Rebates paid 5.4 Estimated rebates unpaid prior year 5.5 Estimated rebates unpaid current year 5.6 Fee for service and co-pay revenue 5.7 Net incurred claims after reinsurance (Lines 5.0 + 5.1 + 5.2 + 5.3 - 5.4 + 5.5 - 5.6) Improving Health Care Quality Expenses Incurred: 6.1 Improve health outcomes 6.2 Activities to prevent hospital readmissions 6.3 Improve patient safety and reduce medical errors 6.4 Wellness and health promotion activities 6.5 Health Information Technology expenses related to health improvement 6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5) Preliminary Medical Loss Ratio: MLR ((Lines 4 + 5.0 + 6.6 - Footnote 2.0)/Line 1.8 Claims Adjustment Expenses: 8.1 Cost containment expenses not included in quality of care expenses in Line 6.6 8.2 All other claims adjustment expenses 8.3 Total claims adjustment expenses (Lines 8.1 + 8.2) Claims Adjustment Expense Ratio (Line 8.3/Line 1.8) 2 Small Group Employer 3 Large Group Employer 4 5 Small Group Employer Individual Expatriate Plans 6 Large Group Employer 7 11 Government Business (excluded by statute) Other Health Business 9 8 Small Group 10 Student Health Plans Large Group 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 79413 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 1,985,651 0 (438) 50,932,085 0 (2,717) 323,035,079 0 (11,316) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 127,746,974 0 47,157 94,169,920 0 0 597,869,709 0 32,686 XXX XXX XXX 1,985,214 56,830 50,929,369 1,294,483 323,023,762 12,964,643 0 0 0 0 0 0 0 0 0 0 0 0 0 366,053 127,794,131 1,968,375 94,169,920 4,947,438 597,902,396 21,597,821 XXX 146,387 0 705 1,781,291 2,764 0 0 1,784,056 1,453,873 0 10,626 48,170,387 3,233 6,719 0 48,180,339 9,696,741 0 27,966 300,334,412 (44,820,104) 4,077 0 255,518,385 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 86,514 0 0 (452,567) 1,837,428 0 0 1,384,862 2,890,225 0 (19,213) 122,954,745 (1,284,034) 4,089 0 121,674,799 905,513 0 0 88,316,969 5,100 876,755 0 89,198,824 15,179,253 0 20,084 561,105,237 (44,255,613) 891,639 0 517,741,264 XXX XXX XXX XXX XXX 15,179,253 0 20,084 561,105,237 (44,255,613) 891,639 0 517,741,264 1,234,263 453,436 36,070 33,184,253 9,561,701 2,857,264 204,290,093 57,807,104 18,154,552 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 91,519,169 5,050,155 25,520 35,493,484 75,876,156 41,468,201 365,721,261 148,748,552 62,541,607 XXX XXX XXX 365,721,261 148,748,552 62,541,607 1 0 0 1,651,629 0 0 0 0 0 0 1,651,629 17,275 105,220 2,139 39,993,910 109,909 0 0 (57) (57) 0 40,103,819 34,368 1,446,656 97,922 245,389,300 (33,820,020) (8,757,202) 309,846 1,147,780 9,595,136 0 211,569,280 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 0 0 96,543,804 (657,452) 0 XXX XXX XXX 0 95,886,352 0 14,484 33 69,915,923 0 (6,885,350) 0 0 6,885,350 0 69,915,923 51,648 1,566,359 100,093 453,494,566 (34,367,563) (15,642,552) 309,846 1,147,722 16,480,428 0 419,127,003 XXX XXX 51,648 1,566,359 100,093 453,494,566 (34,367,563) (15,642,552) 309,846 1,147,722 16,480,428 0 419,127,003 15,885 0 0 0 0 407,457 0 0 0 0 2,584,281 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 15,885 0.936 407,457 0.839 2,584,281 0.826 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 14,873 30,110 44,984 0.025 640,087 971,858 1,611,945 0.033 3,655,400 5,092,928 8,748,328 0.029 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 XXX XXX XXX 0 0 19 16 5 3 6 236,231 91,110 81,364 643,824 67,032 342,200 155,159 294,009 275,053 265,227 3,586,073 246,286 375,378 918,880 332,265 50 1,119,561 XXX 1,331,648 0.807 5,458,882 XXX 388,472 2,073,411 2,461,883 0.020 1,448,269 4,419,228 5,867,497 0.066 6,147,128 12,587,554 18,734,682 XXX XXX 26 19 45 0.000 597,869,709 0 32,686 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 3,586,073 246,286 375,378 918,880 332,265 0 5,458,882 XXX 0 0 0 6,147,128 12,587,554 18,734,682 XXX XXX XXX 597,902,396 21,597,821 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 (Continued) Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 2 Small Group Employer Individual 10. General and Administrative (G&A) Expenses: 10.1 Direct sales salaries and benefits 10.2 Agents and brokers fees and commissions 10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below) 10.4 Other general and administrative expenses 10.4a Community Benefit Expenditures (informational only) 10.5 Total general and administrative (Lines 10.1 +10.2 + 10.3 + 10.4) 5,361 18,353 (2,162) 48,508 0 70,060 3 Large Group Employer 205,114 1,802,089 (16,039) 2,743,663 0 4,734,827 4 5 Small Group Employer Individual 1,442,547 11,910,345 317,248 8,904,171 0 22,574,311 0 0 0 0 0 0 Expatriate Plans 6 Large Group Employer 0 0 0 0 0 0 7 8 Small Group 0 0 0 0 0 0 Student Health Plans Large Group 0 0 0 0 0 0 10 11 Government Business (excluded by statute) Other Health Business 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 125 0 125 391,070 5,850,054 239,997 10,786,413 0 17,267,534 88,863 1,634,561 90,471 5,291,949 0 7,105,844 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 2,132,956 21,215,402 629,515 27,774,829 0 51,752,702 0 0 0 0 0 0 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) 12. Income from fees of uninsured plans XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 13. Net investment and other gain/(loss) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 14. Federal income taxes (excluding taxes on Line 1.5 above) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 15. Net gain or (loss) (Lines 11 + 12 + 13 - 14) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 16. ICD-10 Implementation Expenses (informational only; already included in general expenses and line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16. 16a ICD-10 Implementation Expenses (informational only; already included in line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,498 1,322,291 10,042,184 0 0 0 0 0 0 1,384,642 4,939,469 4,977,912 22,667,995 XXX 2,132,956 21,215,402 629,515 27,774,829 0 51,752,702 XXX 22,667,995 0 0 8,604,290 XXX XXX (2,744,369) XXX (2,744,369) XXX 34,016,653 XXX 34,016,653 8,604,290 OTHER INDICATORS: 216-2.LA 1. Number of certificates/policies 166 5,588 34,977 0 0 0 0 0 0 0 134,279 41,081 216,091 0 216,091 2. Number of Covered Lives 284 10,331 60,376 0 0 0 0 0 0 0 211,939 41,081 324,011 0 324,011 3. Number of Groups 662 670 0 0 0 0 0 0 1,670 0 3,002 0 3,002 4. Member Months 115,423 696,816 0 0 0 0 0 0 2,591,148 495,337 3,902,332 0 3,902,332 XXX 3,608 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ XXX 0 ] If yes, show the amount of premiums and claims included. Premiums $ 0 Claims $ 0 AFFORDABLE CARE ACT (ACA) RECEIPTS, PAYMENTS, RECEIVABLES and PAYABLES Current Year Prior Year Comprehensive Health Coverage Comprehensive Health Coverage 1 2 3 4 Small Group Small Group Employer Plans Employer Plans Individual Plans Individual Plans ACA Receivables and Payables 1. Permanent ACA Risk Adjustment Program 1.0 Premium adjustments receivable/(payable) 2. Transitional ACA Reinsurance Program 2.0 Total amounts recoverable for claims (paid & unpaid) 0 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 0 0 529 (274,124) XXX (34,085) 0 0 0 (1,456,159) XXX 0 0 0 0 ACA Receipts and Payments 4. Permanent ACA Risk Adjustment Program 4.0 Premium adjustments receipts/(payments) 5. Transitional ACA Reinsurance Program 5.0 Amounts received for claims 0 6. Temporary ACA Risk Corridors Program 6.1 Retrospective premium received 6.2 Rate credits or policy experience refunds paid 0 0 (9,218) (828,026) XXX (2,193) 0 0 0 0 0 (1,017,517) XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF 185 Asylum Street Hartford, CT 061033408 Louisiana DURING THE YEAR Comprehensive Health Coverage 1 2 3 Individual Small Group Employer Large Group Employer Small Group Employer Individual Expatriate Plans: 7 8 6 Large Group Employer Small Group 10 11 Government Business (excluded by statute) Other Health Business 9 Student Health Plans Large Group 79413 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.LA Health Premiums Earned: 1,975,114 50,934,486 1.1 Direct premiums written 77,862 9,810 1.2 Unearned premium prior year 67,325 5,491 1.3 Unearned premium current year 10,537 4,319 1.4 Change in unearned premium (Lines 1.2 - 1.3) (7,506) 0 1.5 Paid rate credits 0 (57) 1.6 Reserve for rate credits current year 0 (57) 1.7 Reserve for rate credits prior year 0 0 1.8 Change in reserve for rate credits (Lines 1.6 - 1.7) 0 6,719 1.9 Premium balances written off 0 0 1.10 Group conversion charge 1,985,651 50,932,085 1.11 Total direct premiums earned (Lines 1.1 + 1.4 - 1.9 + 1.10) 0 0 1.12 Assumed premiums earned from non-affiliates 2,764 3,233 1.13 Net Assumed less Ceded premiums earned from affiliates 0 0 1.14 Ceded premiums earned to non-affiliates 0 6,719 1.15 Other Adjustments due to MLR calculation - Premiums 1,995,922 50,942,037 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 1,775,505 37,641,723 2.1 Paid claims during the year 99,701 6,225,462 2.2 Direct claim liability current year 165,880 3,712,638 2.3 Direct claim liability prior year 10,034 124,875 2.4 Direct claim reserves current year 14,833 81,339 2.5 Direct claim reserves prior year 109,877 0 2.6 Direct contract reserves current year 158,879 0 2.7 Direct contract reserves prior year (7,506) 0 2.8 Paid rate credits 0 (57) 2.9 Reserve for rate credits current year 0 (57) 2.10 Reserve for rate credits prior year 0 105,220 2.11 Incurred medical incentive pools and bonuses (Lines 2.11a + 2.11b - 2.11c) 0 89,825 2.11a Paid medical incentive pools and bonuses current year 0 35,256 2.11b Accrued medical incentive pools and bonuses current year 0 19,861 2.11c Accrued medical incentive pools and bonuses prior year (3,610) 309,393 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 27,645 1,173,909 2.12a Healthcare receivables current year 31,255 864,516 2.12b Healthcare receivables prior year 0 0 2.13 Group conversion charge 0 0 2.14 Multi-option coverage blended rate adjustment 2.15 Total incurred claims (Lines 2.1 + 2.2 - 2.3 + 2.4 - 2.5 + 2.6 - 2.7 + 2.8 + 2.9 1,651,629 39,993,910 2.10 + 2.11 - 2.12 + 2.13 + 2.14) 0 0 2.16 Assumed incurred claims from non-affiliates 0 109,909 2.17 Net assumed less ceded incurred claims from affiliates 0 0 2.18 Ceded incurred claims to non-affiliates 0 0 2.19 Other adjustments due to MLR calculation - Claims 1,659,135 40,103,819 2.20 Net Incurred Claims (Lines 2.15 - 2.8 - 2.9 + 2.10 + 2.16 + 2.17 - 2.18 + 2.19) 3. Fraud and Abuse Recoveries that Reduced PAID Claims in Line 2.1 above 0 2,139 (informational only) 21,888,506 for stand-alone dental and $ (a) Column 13, Line 1.1 includes direct written premium of $ 4 Business Subject to MLR Mini-Med Plans 5 (LOCATION) NAIC Company Code 2018 323,044,779 25,264 30,887 (5,623) 308,029 9,707,379 1,260,023 8,447,357 4,077 0 323,035,079 0 42,294 44,862,399 4,077 269,463,666 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,837,428 0 0 1,837,428 127,766,934 19,908 35,780 (15,871) 957,922 444,035 429,982 14,053 4,089 0 127,746,974 0 0 1,284,034 4,089 125,495,054 95,046,675 0 0 0 1,283,982 6,527,508 1,074,080 5,453,427 876,755 0 94,169,920 0 5,100 0 876,755 88,314,365 598,767,987 132,844 139,482 (6,638) 2,542,426 16,678,864 2,764,028 13,914,837 891,639 0 597,869,709 0 1,890,820 46,146,433 891,639 538,048,473 232,949,977 28,610,282 26,484,694 610,912 629,167 0 0 308,029 9,707,379 1,260,023 1,446,656 627,674 1,570,893 751,911 (129,948) 7,215,204 7,345,152 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (1,194,149) 1,226,055 31,906 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 94,997,392 11,797,569 11,453,735 10,222,983 10,122,539 187,793 50,060 957,922 444,035 429,982 0 0 0 0 7,573 7,368 (205) 0 0 63,598,935 3,554,492 4,288,259 87,271 24,072 0 0 1,283,982 6,527,508 1,074,080 14,484 14,353 2,511 2,381 (235,663) 14,909,911 15,145,574 0 0 429,769,383 51,513,561 46,137,112 11,056,075 10,871,950 297,670 208,938 2,542,426 16,678,864 2,764,028 1,566,359 731,852 1,608,660 774,152 (52,255) 23,334,036 23,386,291 0 0 245,389,300 0 (138,691) 33,681,329 0 202,813,895 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 96,543,804 0 0 657,452 0 94,914,377 69,915,923 0 0 0 0 63,178,513 453,494,566 0 (28,782) 34,338,781 0 402,669,740 97,922 0 0 4,825,777 for stand-alone vision policies. 0 0 0 0 0 0 33 100,093 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF Louisiana DURING THE YEAR All Expenses 1 Improve Health Outcomes 1. Individual Comprehensive Coverage Expenses: 36,119 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 2,147 for affiliated services) 1.3 EDP Equipment and Software (incl $ 206 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 22 for affiliated services) 1.5 Accreditation and Certification (incl $ 59,532 for affiliated services) 1.6 Other Expenses (incl $ 1.7 Subtotal before Reimbursements and Taxes (Lines 1.1 to 1.6) 1.8 Reimbursements by uninsured plans and fiscal intermediaries 1.9 Taxes, Licenses and Fees (in total, for tying purposes) 1.10 Total (1.7 to 1.9) 1.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 2. 216-4.LA 3. 0 0 0 0 0 15,885 15,885 0 XXX Small Group Comprehensive Coverage Expenses: 3,293,914 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 233,585 for affiliated services) 2.3 EDP Equipment and Software (incl $ 22,421 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 2,435 for affiliated services) 2.5 Accreditation and Certification (incl $ 887,810 for affiliated services) 2.6 Other Expenses (incl $ 2.7 Subtotal before Reimbursements and Taxes (Lines 2.1 to 2.6) 2.8 Reimbursements by uninsured plans and fiscal intermediaries 2.9 Taxes, Licenses and Fees (in total, for tying purposes) 2.10 Total (2.7 to 2.9) 2.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Comprehensive Coverage Expenses: 5,335,003 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 354,331 for affiliated services) 3.3 EDP Equipment and Software (incl $ 34,012 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 3,693 for affiliated services) 3.5 Accreditation and Certification (incl $ 18,692,399 for affiliated services) 3.6 Other Expenses (incl $ 3.7 Subtotal before Reimbursements and Taxes (Lines 3.1 to 3.6) 3.8 Reimbursements by uninsured plans and fiscal intermediaries 3.9 Taxes, Licenses and Fees (in total, for tying purposes) 3.10 Total (3.7 to 3.9) 3.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 185 Asylum Street Hartford, CT 061033408 Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX Total (1 to 5) 0 0 0 0 0 15,885 15,885 0 XXX 0 0 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 0 0 0 0 0 0 0 XXX (LOCATION) NAIC Company Code 2018 XXX 2,979 4,630 249 24 3 6,663 14,547 0 XXX 9,692 711 657 63 7 18,243 29,373 0 XXX 15,885 0 0 0 0 0 0 0 0 0 15,885 0 14,547 394 29,373 0 0 0 0 0 0 407,457 407,457 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 407,457 407,457 0 420,382 72,995 35,104 3,370 366 88,751 620,967 0 670,983 76,896 56,030 5,378 584 141,629 951,500 0 XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX XXX XXX 407,457 0 0 0 0 0 0 0 0 0 407,457 0 620,967 165,730 951,500 0 0 0 0 0 0 2,584,281 2,584,281 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,584,281 2,584,281 0 720,179 224,183 60,138 5,773 627 2,535,078 3,545,978 0 1,056,365 121,062 88,211 8,467 919 3,721,700 4,996,724 0 2,584,281 0 XXX 3,545,978 1,008,531 XXX 4,996,724 0 XXX 2,584,281 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 79413 9 10 General Administrative Expenses Total Expenses (6 to 9) 23,448 1,700 1,242 111 13 45,484 71,996 0 146,220 218,216 0 36,119 7,040 2,147 198 22 86,275 131,801 0 146,220 278,021 394 2,202,549 218,988 142,451 13,674 1,485 2,157,210 4,736,356 0 1,502,449 6,238,805 0 3,293,914 368,879 233,585 22,421 2,435 2,795,046 6,716,279 0 1,502,449 8,218,728 165,730 3,558,459 357,809 205,981 19,772 2,147 18,017,964 22,162,130 0 10,342,514 32,504,644 0 5,335,003 703,053 354,331 34,012 3,693 26,859,022 33,289,113 0 10,342,514 43,631,627 1,008,531 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 4. 5. 216-5.LA 6. Individual Mini-Med Plans Expenses: 0 for affiliated services) 4.1 Salaries (including $ 4.2 Outsourced Services 0 for affiliated services) 4.3 EDP Equipment and Software (incl $ 0 for affiliated services) 4.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 4.5 Accreditation and Certification (incl $ 0 for affiliated services) 4.6 Other Expenses (incl $ 4.7 Subtotal before Reimbursements and Taxes (Lines 4.1 to 4.6) 4.8 Reimbursements by uninsured plans and fiscal intermediaries 4.9 Taxes, Licenses and Fees (in total, for tying purposes) 4.10 Total (4.7 to 4.9) 4.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Mini-Med Plans Expenses: 0 for affiliated services) 5.1 Salaries (including $ 5.2 Outsourced Services 0 for affiliated services) 5.3 EDP Equipment and Software (incl $ 0 for affiliated services) 5.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 5.5 Accreditation and Certification (incl $ 0 for affiliated services) 5.6 Other Expenses (incl $ 5.7 Subtotal before Reimbursements and Taxes (Lines 5.1 to 5.6) 5.8 Reimbursements by uninsured plans and fiscal intermediaries 5.9 Taxes, Licenses and Fees (in total, for tying purposes) 5.10 Total (5.7 to 5.9) 5.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Mini-Med Plans Expenses: 0 for affiliated services) 6.1 Salaries (including $ 6.2 Outsourced Services 0 for affiliated services) 6.3 EDP Equipment and Software (incl $ 0 for affiliated services) 6.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 6.5 Accreditation and Certification (incl $ 0 for affiliated services) 6.6 Other Expenses (incl $ 6.7 Subtotal before Reimbursements and Taxes (Lines 6.1 to 6.6) 6.8 Reimbursements by uninsured plans and fiscal intermediaries 6.9 Taxes, Licenses and Fees (in total, for tying purposes) 6.10 Total (6.7 to 6.9) 6.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 7. 8. 216-6.LA 9. Small Group Expatriate Plans Expenses: 0 for affiliated services) 7.1 Salaries (including $ 7.2 Outsourced Services 0 for affiliated services) 7.3 EDP Equipment and Software (incl $ 0 for affiliated services) 7.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 7.5 Accreditation and Certification (incl $ 0 for affiliated services) 7.6 Other Expenses (incl $ 7.7 Subtotal before Reimbursements and Taxes (Lines 7.1 to 7.6) 7.8 Reimbursements by uninsured plans and fiscal intermediaries 7.9 Taxes, Licenses and Fees (in total, for tying purposes) 7.10 Total (7.7 to 7.9) 7.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Expatriate Plans Expenses: 0 for affiliated services) 8.1 Salaries (including $ 8.2 Outsourced Services 0 for affiliated services) 8.3 EDP Equipment and Software (incl $ 0 for affiliated services) 8.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 8.5 Accreditation and Certification (incl $ 0 for affiliated services) 8.6 Other Expenses (incl $ 8.7 Subtotal before Reimbursements and Taxes (Lines 8.1 to 8.6) 8.8 Reimbursements by uninsured plans and fiscal intermediaries 8.9 Taxes, Licenses and Fees (in total, for tying purposes) 8.10 Total (8.7 to 8.9) 8.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Student Health Plans Expenses: 0 for affiliated services) 9.1 Salaries (including $ 9.2 Outsourced Services 0 for affiliated services) 9.3 EDP Equipment and Software (incl $ 0 for affiliated services) 9.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 9.5 Accreditation and Certification (incl $ 0 for affiliated services) 9.6 Other Expenses (incl $ 9.7 Subtotal before Reimbursements and Taxes (Lines 9.1 to 9.6) 9.8 Reimbursements by uninsured plans and fiscal intermediaries 9.9 Taxes, Licenses and Fees (in total, for tying purposes) 9.10 Total (9.7 to 9.9) 9.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 *79413201821620100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes - See Cautionary Statement at http://www.naic.org/documents/committees_e_app_blanks_related_shce_cautionary_statement.pdf) UnitedHealthcare Insurance Company 2. 185 Asylum Street Hartford, CT 061033408 (LOCATION) BUSINESS IN THE STATE OF Maine DURING THE YEAR 2018 NAIC Company Code Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 1. 216-1.ME 2. 3. 4. 5. 6. 7. 8. 9. Premium: 1.1 Health premiums earned (From Part 2, Line 1.11) 1.2 Federal high risk pools 1.3 State high risk pools 1.4 Premiums earned including state and federal high risk programs (Lines 1.1 + 1.2 + 1.3) 1.5 Federal taxes and federal assessments 1.6 State insurance, premium and other taxes (Similar local taxes of 14,166 ) $ 1.6a Community Benefit Expenditures (informational only) 1.7 Regulatory authority licenses and fees 1.8 Adjusted Premiums Earned (Lines 1.4 - 1.5 - 1.6 - 1.7) 1.9 Net Assumed less Ceded reinsurance premiums earned 1.10 Other Adjustments due to MLR calculations - Premiums 1.11 Risk Revenue 1.12 Net adjusted premiums earned after reinsurance (Lines 1.8 + 1.9 + 1.10 + 1.11) Claims: 2.1 Incurred claims excluding prescription drugs 2.2 Prescription drugs 2.3 Pharmaceutical rebates 2.4 State stop loss, market stabilization and claim/census based assessments (informational only) Incurred medical incentive pools and bonuses Deductible Fraud and Abuse Detection/Recovery Expenses (for MLR use only) 5.0 Total Incurred Claims (Lines 2.1 + 2.2 - 2.3 + 3) (From Part 2, Line 2.15) 5.1 Net Assumed less Ceded reinsurance claims incurred 5.2 Other Adjustments due to MLR calculations - Claims 5.3 Rebates paid 5.4 Estimated rebates unpaid prior year 5.5 Estimated rebates unpaid current year 5.6 Fee for service and co-pay revenue 5.7 Net incurred claims after reinsurance (Lines 5.0 + 5.1 + 5.2 + 5.3 - 5.4 + 5.5 - 5.6) Improving Health Care Quality Expenses Incurred: 6.1 Improve health outcomes 6.2 Activities to prevent hospital readmissions 6.3 Improve patient safety and reduce medical errors 6.4 Wellness and health promotion activities 6.5 Health Information Technology expenses related to health improvement 6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5) Preliminary Medical Loss Ratio: MLR ((Lines 4 + 5.0 + 6.6 - Footnote 2.0)/Line 1.8 Claims Adjustment Expenses: 8.1 Cost containment expenses not included in quality of care expenses in Line 6.6 8.2 All other claims adjustment expenses 8.3 Total claims adjustment expenses (Lines 8.1 + 8.2) Claims Adjustment Expense Ratio (Line 8.3/Line 1.8) 2 Small Group Employer 3 Large Group Employer 4 5 Small Group Employer Individual Expatriate Plans 6 Large Group Employer 7 11 Government Business (excluded by statute) Other Health Business 9 8 Small Group 10 Student Health Plans Large Group 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 79413 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 (22,549) 0 (2) 3,665,635 0 (306) 1,644,893 0 (66) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 95,093,833 0 55,848 53,670,960 0 0 154,052,771 0 55,475 XXX XXX XXX (22,551) (16,709) 3,665,329 181,151 1,644,827 158,820 0 0 0 0 0 0 0 0 0 0 0 0 0 0 95,149,681 635,804 53,670,960 1,458,649 154,108,246 2,417,715 XXX 16,758 0 12 (22,611) 0 0 0 (22,611) 82,845 0 1,438 3,399,895 0 0 0 3,399,896 39,030 0 225 1,446,752 (76,502) 0 0 1,370,250 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 992,422 0 (23,663) 93,545,118 (3,741) 0 0 93,541,377 32,142 0 0 52,180,169 (586) 2,129,614 0 54,309,197 1,163,197 0 (21,988) 150,549,322 (80,828) 2,129,615 0 152,598,108 XXX XXX XXX XXX XXX 1,163,197 0 (21,988) 150,549,322 (80,828) 2,129,615 0 152,598,108 15,352 30,272 7,864 2,068,526 294,382 97,322 648,922 175,412 90,173 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 75,810,018 64,777 17,400 4,695,497 83,642,610 47,954,758 83,238,316 84,207,453 48,167,517 XXX XXX XXX 83,238,316 84,207,453 48,167,517 0 0 0 37,760 0 0 0 0 0 0 37,760 8,001 1,266 4 2,266,852 0 0 0 0 0 0 2,266,852 13,770 2,457 13 736,617 66,960 0 0 0 0 0 803,577 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 110 0 0 75,857,396 (282) 0 XXX XXX XXX 0 75,857,114 0 143,937 998 40,527,287 0 0 0 0 0 0 40,527,287 21,882 147,661 1,014 119,425,912 66,678 0 0 0 0 0 119,492,590 XXX XXX 21,882 147,661 1,014 119,425,912 66,678 0 0 0 0 0 119,492,590 (180) 0 0 0 0 29,325 0 0 0 0 13,159 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (180) (1.662) 29,325 0.675 13,159 0.518 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 317 390 706 (0.031) 43,966 65,104 109,070 0.032 17,184 23,586 40,771 0.028 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 XXX XXX XXX 0 0 0 0 0 0 0 355,218 266,362 198,049 706,959 75,213 0 1,601,802 XXX 2,833,560 0.831 4,477,665 XXX 19,546 1,237,710 1,257,256 0.013 1,284,432 5,210,554 6,494,987 0.124 1,365,445 6,537,344 7,902,789 XXX XXX 0 0 0 0.000 2,354,842 29,989 260,772 (35,966) 223,924 154,052,771 0 55,475 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 2,752,364 296,351 458,821 670,993 299,137 0 0 0 0 0 2,752,364 296,351 458,821 670,993 299,137 0 4,477,665 XXX 0 0 0 1,365,445 6,537,344 7,902,789 XXX XXX XXX 154,108,246 2,417,715 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 (Continued) Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 2 Small Group Employer Individual 10. General and Administrative (G&A) Expenses: 10.1 Direct sales salaries and benefits 10.2 Agents and brokers fees and commissions 10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below) 10.4 Other general and administrative expenses 10.4a Community Benefit Expenditures (informational only) 10.5 Total general and administrative (Lines 10.1 +10.2 + 10.3 + 10.4) 91 741 (584) 2,081 0 2,330 3 Large Group Employer 15,364 108,510 16,200 176,288 0 316,362 4 5 Small Group Employer Individual 5,828 44,051 2,514 73,669 0 126,063 0 0 0 0 0 0 Expatriate Plans 6 Large Group Employer 0 0 0 0 0 0 7 8 Small Group 0 0 0 0 0 0 Student Health Plans Large Group 0 0 0 0 0 0 10 11 Government Business (excluded by statute) Other Health Business 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 103,690 3,151,792 148,037 8,876,101 0 12,279,620 97,734 381,522 116,510 5,439,499 0 6,035,266 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 222,708 3,686,617 282,677 14,567,638 0 18,759,640 0 0 0 0 0 0 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) 12. Income from fees of uninsured plans XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 13. Net investment and other gain/(loss) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 14. Federal income taxes (excluding taxes on Line 1.5 above) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 15. Net gain or (loss) (Lines 11 + 12 + 13 - 14) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 16. ICD-10 Implementation Expenses (informational only; already included in general expenses and line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16. 16a ICD-10 Implementation Expenses (informational only; already included in line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (63,226) 678,286 386,680 0 0 0 0 0 0 0 2,545,585 (1,581,901) 1,965,424 XXX 222,708 3,686,617 282,677 14,567,638 0 18,759,640 XXX 1,965,424 0 0 1,720,471 XXX XXX 102,741 XXX 102,741 XXX 3,583,153 XXX 3,583,153 1,720,471 OTHER INDICATORS: 216-2.ME 1. Number of certificates/policies 4 844 380 0 0 0 0 0 0 0 38,627 38,582 78,437 0 78,437 2. Number of Covered Lives 5 1,439 518 0 0 0 0 0 0 0 38,206 38,582 78,750 0 78,750 3. Number of Groups 124 23 0 0 0 0 0 0 32 0 179 0 179 4. Member Months 51 8,598 3,260 0 0 0 0 0 0 468,582 483,479 963,970 0 963,970 XXX Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ XXX 0 ] If yes, show the amount of premiums and claims included. Premiums $ 0 Claims $ 0 AFFORDABLE CARE ACT (ACA) RECEIPTS, PAYMENTS, RECEIVABLES and PAYABLES Current Year Prior Year Comprehensive Health Coverage Comprehensive Health Coverage 1 2 3 4 Small Group Small Group Employer Plans Employer Plans Individual Plans Individual Plans ACA Receivables and Payables 1. Permanent ACA Risk Adjustment Program 1.0 Premium adjustments receivable/(payable) 2. Transitional ACA Reinsurance Program 2.0 Total amounts recoverable for claims (paid & unpaid) 0 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 0 0 (76,132) (458,978) XXX (44,631) 0 116,855 XXX 0 0 0 0 0 0 190,299 0 21,880 ACA Receipts and Payments 4. Permanent ACA Risk Adjustment Program 4.0 Premium adjustments receipts/(payments) 5. Transitional ACA Reinsurance Program 5.0 Amounts received for claims 0 6. Temporary ACA Risk Corridors Program 6.1 Retrospective premium received 6.2 Rate credits or policy experience refunds paid 0 0 (22,587) XXX 0 0 0 0 0 XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF 185 Asylum Street Hartford, CT 061033408 Maine DURING THE YEAR Comprehensive Health Coverage 1 2 3 Individual Small Group Employer Large Group Employer Small Group Employer Individual Expatriate Plans: 7 8 6 Large Group Employer Small Group 10 11 Government Business (excluded by statute) Other Health Business 9 Student Health Plans Large Group 79413 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.ME Health Premiums Earned: (22,549) 3,665,782 1.1 Direct premiums written 0 0 1.2 Unearned premium prior year 0 147 1.3 Unearned premium current year 0 (147) 1.4 Change in unearned premium (Lines 1.2 - 1.3) 0 0 1.5 Paid rate credits 0 0 1.6 Reserve for rate credits current year 0 0 1.7 Reserve for rate credits prior year 0 0 1.8 Change in reserve for rate credits (Lines 1.6 - 1.7) 0 0 1.9 Premium balances written off 0 0 1.10 Group conversion charge (22,549) 3,665,635 1.11 Total direct premiums earned (Lines 1.1 + 1.4 - 1.9 + 1.10) 0 0 1.12 Assumed premiums earned from non-affiliates 0 0 1.13 Net Assumed less Ceded premiums earned from affiliates 0 0 1.14 Ceded premiums earned to non-affiliates 0 0 1.15 Other Adjustments due to MLR calculation - Premiums (22,549) 3,665,635 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 37,717 2,054,828 2.1 Paid claims during the year 184 327,021 2.2 Direct claim liability current year 141 63,045 2.3 Direct claim liability prior year 0 9,049 2.4 Direct claim reserves current year 0 555 2.5 Direct claim reserves prior year 0 0 2.6 Direct contract reserves current year 0 0 2.7 Direct contract reserves prior year 0 0 2.8 Paid rate credits 0 0 2.9 Reserve for rate credits current year 0 0 2.10 Reserve for rate credits prior year 0 1,266 2.11 Incurred medical incentive pools and bonuses (Lines 2.11a + 2.11b - 2.11c) 0 20 2.11a Paid medical incentive pools and bonuses current year 0 1,539 2.11b Accrued medical incentive pools and bonuses current year 0 293 2.11c Accrued medical incentive pools and bonuses prior year 0 61,713 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 0 67,063 2.12a Healthcare receivables current year 0 5,350 2.12b Healthcare receivables prior year 0 0 2.13 Group conversion charge 0 0 2.14 Multi-option coverage blended rate adjustment 2.15 Total incurred claims (Lines 2.1 + 2.2 - 2.3 + 2.4 - 2.5 + 2.6 - 2.7 + 2.8 + 2.9 37,760 2,266,852 2.10 + 2.11 - 2.12 + 2.13 + 2.14) 0 0 2.16 Assumed incurred claims from non-affiliates 0 0 2.17 Net assumed less ceded incurred claims from affiliates 0 0 2.18 Ceded incurred claims to non-affiliates 0 0 2.19 Other adjustments due to MLR calculation - Claims 37,760 2,266,852 2.20 Net Incurred Claims (Lines 2.15 - 2.8 - 2.9 + 2.10 + 2.16 + 2.17 - 2.18 + 2.19) 3. Fraud and Abuse Recoveries that Reduced PAID Claims in Line 2.1 above 0 4 (informational only) 99,091 for stand-alone dental and $ (a) Column 13, Line 1.1 includes direct written premium of $ 4 Business Subject to MLR Mini-Med Plans 5 (LOCATION) NAIC Company Code 2018 1,644,893 0 0 0 0 0 0 0 0 0 1,644,893 10,105 0 86,607 0 1,568,391 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 95,070,768 23,101 36 23,065 218,108 0 0 0 0 0 95,093,833 0 0 3,741 0 94,871,985 55,800,574 0 0 0 3,177,824 1,628,182 2,720,108 (1,091,926) 2,129,614 0 53,670,960 0 (586) 0 2,129,614 53,714,091 156,159,468 23,101 183 22,918 3,395,931 1,628,182 2,720,108 (1,091,926) 2,129,615 0 154,052,771 10,105 (586) 90,348 2,129,615 153,797,552 656,479 172,380 82,961 3,454 3,331 0 0 0 0 0 2,457 0 3,253 796 11,862 67,072 55,210 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 76,127,600 10,525,220 10,955,779 2,589,843 2,629,405 44,211 56,896 218,108 0 0 0 0 0 0 5,506 5,506 0 0 0 39,119,850 744,101 4,470,478 1,006 755 0 0 3,177,824 1,628,182 2,720,108 143,937 129,846 26,092 12,001 (2,903,727) 17,516,590 20,420,318 0 0 117,996,475 11,768,905 15,572,403 2,603,352 2,634,045 44,211 56,896 3,395,931 1,628,182 2,720,108 147,661 129,866 30,884 13,090 (2,824,647) 17,656,231 20,480,877 0 0 736,617 (85,316) 0 (152,275) 0 803,577 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 75,857,396 (427) 0 (146) 0 75,639,006 40,527,287 0 0 0 0 38,441,389 119,425,912 (85,743) 0 (152,421) 0 117,188,585 13 0 0 12,783 for stand-alone vision policies. 0 0 0 0 0 0 998 1,014 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF Maine DURING THE YEAR All Expenses 1 Individual Comprehensive Coverage Expenses: 758 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 56 for affiliated services) 1.3 EDP Equipment and Software (incl $ 5 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 1 for affiliated services) 1.5 Accreditation and Certification (incl $ 1,635 for affiliated services) 1.6 Other Expenses (incl $ 1.7 Subtotal before Reimbursements and Taxes (Lines 1.1 to 1.6) 1.8 Reimbursements by uninsured plans and fiscal intermediaries 1.9 Taxes, Licenses and Fees (in total, for tying purposes) 1.10 Total (1.7 to 1.9) 1.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 2. 216-4.ME 2.7 Subtotal before Reimbursements and Taxes (Lines 2.1 to 2.6) 2.8 Reimbursements by uninsured plans and fiscal intermediaries 2.9 Taxes, Licenses and Fees (in total, for tying purposes) 2.10 Total (2.7 to 2.9) 2.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 3. 0 0 0 0 0 (180) (180) 0 XXX XXX XXX 0 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 29,325 29,325 0 Large Group Comprehensive Coverage Expenses: 37,523 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 2,664 for affiliated services) 3.3 EDP Equipment and Software (incl $ 256 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 28 for affiliated services) 3.5 Accreditation and Certification (incl $ 83,904 for affiliated services) 3.6 Other Expenses (incl $ 3.7 Subtotal before Reimbursements and Taxes (Lines 3.1 to 3.6) 3.8 Reimbursements by uninsured plans and fiscal intermediaries 3.9 Taxes, Licenses and Fees (in total, for tying purposes) 3.10 Total (3.7 to 3.9) 3.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 0 0 0 0 (180) 0 Small Group Comprehensive Coverage Expenses: 93,813 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 6,597 for affiliated services) 2.3 EDP Equipment and Software (incl $ 633 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 69 for affiliated services) 2.5 Accreditation and Certification (incl $ 208,679 for affiliated services) 2.6 Other Expenses (incl $ Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions Improve Health Outcomes 1. 185 Asylum Street Hartford, CT 061033408 0 0 0 0 XXX 0 0 0 XXX Total (1 to 5) 0 0 0 0 0 (180) (180) 0 XXX 0 0 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 0 0 0 0 0 0 0 XXX (LOCATION) NAIC Company Code 2018 XXX 70 75 6 1 0 156 308 0 XXX 110 13 9 1 0 247 380 0 XXX 0 0 0 0 0 0 0 0 (180) 0 308 73 380 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 29,325 29,325 0 11,933 2,154 996 96 10 27,344 42,534 0 18,463 2,116 1,542 148 16 41,294 63,579 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX XXX XXX 29,325 0 0 0 0 0 0 0 0 0 29,325 0 42,534 12,360 63,579 0 0 0 0 0 0 13,159 13,159 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 13,159 13,159 0 4,502 1,255 376 36 4 10,468 16,641 0 6,682 766 558 54 6 14,944 23,008 0 XXX XXX XXX 0 0 0 XXX 13,159 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 13,159 0 XXX 16,641 4,688 23,008 0 79413 9 10 General Administrative Expenses Total Expenses (6 to 9) 577 96 41 4 0 2,188 2,907 0 16,210 19,116 0 758 184 56 5 1 2,411 3,415 0 16,210 19,624 73 63,417 6,047 4,059 390 42 225,121 299,076 0 104,526 403,602 0 93,813 10,318 6,597 633 69 323,084 434,514 0 104,526 539,040 12,360 26,339 3,280 1,730 166 18 91,603 123,136 0 43,302 166,439 0 37,523 5,301 2,664 256 28 130,174 175,945 0 43,302 219,248 4,688 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 4. 5. 216-5.ME 6. Individual Mini-Med Plans Expenses: 0 for affiliated services) 4.1 Salaries (including $ 4.2 Outsourced Services 0 for affiliated services) 4.3 EDP Equipment and Software (incl $ 0 for affiliated services) 4.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 4.5 Accreditation and Certification (incl $ 0 for affiliated services) 4.6 Other Expenses (incl $ 4.7 Subtotal before Reimbursements and Taxes (Lines 4.1 to 4.6) 4.8 Reimbursements by uninsured plans and fiscal intermediaries 4.9 Taxes, Licenses and Fees (in total, for tying purposes) 4.10 Total (4.7 to 4.9) 4.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Mini-Med Plans Expenses: 0 for affiliated services) 5.1 Salaries (including $ 5.2 Outsourced Services 0 for affiliated services) 5.3 EDP Equipment and Software (incl $ 0 for affiliated services) 5.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 5.5 Accreditation and Certification (incl $ 0 for affiliated services) 5.6 Other Expenses (incl $ 5.7 Subtotal before Reimbursements and Taxes (Lines 5.1 to 5.6) 5.8 Reimbursements by uninsured plans and fiscal intermediaries 5.9 Taxes, Licenses and Fees (in total, for tying purposes) 5.10 Total (5.7 to 5.9) 5.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Mini-Med Plans Expenses: 0 for affiliated services) 6.1 Salaries (including $ 6.2 Outsourced Services 0 for affiliated services) 6.3 EDP Equipment and Software (incl $ 0 for affiliated services) 6.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 6.5 Accreditation and Certification (incl $ 0 for affiliated services) 6.6 Other Expenses (incl $ 6.7 Subtotal before Reimbursements and Taxes (Lines 6.1 to 6.6) 6.8 Reimbursements by uninsured plans and fiscal intermediaries 6.9 Taxes, Licenses and Fees (in total, for tying purposes) 6.10 Total (6.7 to 6.9) 6.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 7. 8. 216-6.ME 9. Small Group Expatriate Plans Expenses: 0 for affiliated services) 7.1 Salaries (including $ 7.2 Outsourced Services 0 for affiliated services) 7.3 EDP Equipment and Software (incl $ 0 for affiliated services) 7.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 7.5 Accreditation and Certification (incl $ 0 for affiliated services) 7.6 Other Expenses (incl $ 7.7 Subtotal before Reimbursements and Taxes (Lines 7.1 to 7.6) 7.8 Reimbursements by uninsured plans and fiscal intermediaries 7.9 Taxes, Licenses and Fees (in total, for tying purposes) 7.10 Total (7.7 to 7.9) 7.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Expatriate Plans Expenses: 0 for affiliated services) 8.1 Salaries (including $ 8.2 Outsourced Services 0 for affiliated services) 8.3 EDP Equipment and Software (incl $ 0 for affiliated services) 8.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 8.5 Accreditation and Certification (incl $ 0 for affiliated services) 8.6 Other Expenses (incl $ 8.7 Subtotal before Reimbursements and Taxes (Lines 8.1 to 8.6) 8.8 Reimbursements by uninsured plans and fiscal intermediaries 8.9 Taxes, Licenses and Fees (in total, for tying purposes) 8.10 Total (8.7 to 8.9) 8.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Student Health Plans Expenses: 0 for affiliated services) 9.1 Salaries (including $ 9.2 Outsourced Services 0 for affiliated services) 9.3 EDP Equipment and Software (incl $ 0 for affiliated services) 9.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 9.5 Accreditation and Certification (incl $ 0 for affiliated services) 9.6 Other Expenses (incl $ 9.7 Subtotal before Reimbursements and Taxes (Lines 9.1 to 9.6) 9.8 Reimbursements by uninsured plans and fiscal intermediaries 9.9 Taxes, Licenses and Fees (in total, for tying purposes) 9.10 Total (9.7 to 9.9) 9.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 *79413201821621100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes - See Cautionary Statement at http://www.naic.org/documents/committees_e_app_blanks_related_shce_cautionary_statement.pdf) UnitedHealthcare Insurance Company 2. 185 Asylum Street Hartford, CT 061033408 (LOCATION) BUSINESS IN THE STATE OF Maryland DURING THE YEAR 2018 NAIC Company Code Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 1. 216-1.MD 2. 3. 4. 5. 6. 7. 8. 9. Premium: 1.1 Health premiums earned (From Part 2, Line 1.11) 1.2 Federal high risk pools 1.3 State high risk pools 1.4 Premiums earned including state and federal high risk programs (Lines 1.1 + 1.2 + 1.3) 1.5 Federal taxes and federal assessments 1.6 State insurance, premium and other taxes (Similar local taxes of 109,750 ) $ 1.6a Community Benefit Expenditures (informational only) 1.7 Regulatory authority licenses and fees 1.8 Adjusted Premiums Earned (Lines 1.4 - 1.5 - 1.6 - 1.7) 1.9 Net Assumed less Ceded reinsurance premiums earned 1.10 Other Adjustments due to MLR calculations - Premiums 1.11 Risk Revenue 1.12 Net adjusted premiums earned after reinsurance (Lines 1.8 + 1.9 + 1.10 + 1.11) Claims: 2.1 Incurred claims excluding prescription drugs 2.2 Prescription drugs 2.3 Pharmaceutical rebates 2.4 State stop loss, market stabilization and claim/census based assessments (informational only) Incurred medical incentive pools and bonuses Deductible Fraud and Abuse Detection/Recovery Expenses (for MLR use only) 5.0 Total Incurred Claims (Lines 2.1 + 2.2 - 2.3 + 3) (From Part 2, Line 2.15) 5.1 Net Assumed less Ceded reinsurance claims incurred 5.2 Other Adjustments due to MLR calculations - Claims 5.3 Rebates paid 5.4 Estimated rebates unpaid prior year 5.5 Estimated rebates unpaid current year 5.6 Fee for service and co-pay revenue 5.7 Net incurred claims after reinsurance (Lines 5.0 + 5.1 + 5.2 + 5.3 - 5.4 + 5.5 - 5.6) Improving Health Care Quality Expenses Incurred: 6.1 Improve health outcomes 6.2 Activities to prevent hospital readmissions 6.3 Improve patient safety and reduce medical errors 6.4 Wellness and health promotion activities 6.5 Health Information Technology expenses related to health improvement 6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5) Preliminary Medical Loss Ratio: MLR ((Lines 4 + 5.0 + 6.6 - Footnote 2.0)/Line 1.8 Claims Adjustment Expenses: 8.1 Cost containment expenses not included in quality of care expenses in Line 6.6 8.2 All other claims adjustment expenses 8.3 Total claims adjustment expenses (Lines 8.1 + 8.2) Claims Adjustment Expense Ratio (Line 8.3/Line 1.8) 2 Small Group Employer 3 Large Group Employer 4 5 Small Group Employer Individual Expatriate Plans 6 Large Group Employer 7 11 Government Business (excluded by statute) Other Health Business 9 8 Small Group 10 Student Health Plans Large Group 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 79413 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 1,179,664 0 (574) 142,335,339 0 (5,820) 427,591,653 0 (28,404) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 331,686,953 0 158,478 176,185,270 0 0 1,078,978,877 0 123,681 XXX XXX XXX 1,078,978,877 0 123,681 1,179,090 (12,429) 142,329,519 5,427,460 427,563,249 11,876,752 0 0 0 0 0 0 0 0 0 0 0 0 0 143,209 331,845,430 4,478,622 176,185,270 4,702,119 1,079,102,558 26,615,733 XXX 43,345 1,079,102,558 26,659,078 19,025 0 552 1,171,942 1,195 0 0 1,173,137 2,540,388 0 43,070 134,318,602 111,245 54,200 0 134,484,047 7,971,891 0 277,700 407,436,906 (54,306,746) 12,908 0 353,143,068 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (143,209) 712,411 0 0 569,201 5,171,349 0 (14,740) 322,210,200 (1,049,296) (237,933) 0 320,922,971 19,609 0 0 171,463,542 0 996,123 0 172,459,665 15,722,262 0 306,581 1,036,457,982 (54,531,190) 825,297 0 982,752,089 13 0 0 XXX XXX XXX XXX XXX 15,722,275 0 306,581 1,036,414,624 (54,531,190) 825,297 0 982,708,731 879,499 388,069 126,496 91,017,893 23,740,244 8,022,794 292,040,256 84,656,859 25,704,198 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (6,354) 0 0 255,931,077 4,895,613 97,909 70,871,918 175,713,742 97,895,448 710,734,290 289,394,527 131,846,846 XXX XXX XXX 710,734,290 289,394,527 131,846,846 127,226 112,676 4,080 106,848,018 242,014 (1,652,017) 1,652,017 0 0 0 107,090,032 556,008 414,541 41,766 351,407,457 (44,902,262) (7,273,264) 14,013,684 17,222,646 10,483,810 0 306,506,780 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (6,354) 0 0 XXX XXX XXX 0 (6,354) 172 0 0 260,728,781 (194,412) 144 XXX XXX XXX 0 260,534,513 0 8,632 386 148,698,844 0 0 0 0 0 0 148,698,844 683,410 535,849 46,232 868,817,819 (44,854,660) (8,925,137) 15,665,701 17,222,646 10,483,810 0 823,964,888 XXX XXX 683,410 535,849 46,232 868,817,819 (44,854,660) (8,925,137) 15,665,701 17,222,646 10,483,810 0 823,964,888 9,437 0 0 0 0 1,138,683 0 0 0 0 3,420,733 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 9,437 0.982 1,138,683 0.804 3,420,733 0.871 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 12,452 22,699 35,151 0.030 1,686,882 2,308,065 3,994,947 0.030 5,124,437 6,398,246 11,522,683 0.028 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 3 0 0 1,141,073 0 0 0 0 0 0 1,141,073 0 0 0 0 0 612,023 159,655 132,967 1,946,096 134,190 0 2,984,931 XXX 1,394,815 0.875 8,948,599 XXX 501,180 4,514,987 5,016,167 0.016 2,645,167 9,274,946 11,920,113 0.070 9,970,119 22,518,942 32,489,061 XXX XXX 0 0 0 0.000 376,551 117,147 471,935 (76,220) 505,402 5,557,427 276,802 604,902 1,869,876 639,591 0 XXX XXX XXX XXX XXX XXX XXX XXX 1,904 (16) 6,104 (2,218) 3,197 5,559,331 276,786 611,006 1,867,659 642,789 8,972 XXX 8,957,570 XXX 23,258 126,065 149,323 XXX 9,993,377 22,645,007 32,638,384 XXX SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 (Continued) Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 2 Small Group Employer Individual 10. General and Administrative (G&A) Expenses: 10.1 Direct sales salaries and benefits 10.2 Agents and brokers fees and commissions 10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below) 10.4 Other general and administrative expenses 10.4a Community Benefit Expenditures (informational only) 10.5 Total general and administrative (Lines 10.1 +10.2 + 10.3 + 10.4) 3,894 34,770 (1,434) 68,839 0 106,069 3 Large Group Employer 519,707 4,860,884 134,847 6,905,862 0 12,421,301 4 5 Small Group Employer Individual 1,925,368 16,576,256 225,771 12,308,053 0 31,035,448 0 0 0 0 0 0 Expatriate Plans 6 Large Group Employer 0 0 0 0 0 0 7 8 Small Group 0 0 0 0 0 0 Student Health Plans Large Group 0 0 0 0 0 0 10 11 Government Business (excluded by statute) Other Health Business 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 624,600 8,688,968 564,791 28,250,919 0 38,129,278 283,404 688,674 317,813 10,597,124 0 11,887,014 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 3,356,973 30,849,551 1,241,788 58,130,797 0 93,579,109 6,080 25 708 19,562 0 26,375 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) 14,258,083 (1,441,120) 23,770,432 12. Income from fees of uninsured plans XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 13. Net investment and other gain/(loss) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 14,745,909 14. Federal income taxes (excluding taxes on Line 1.5 above) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 15. Net gain or (loss) (Lines 11 + 12 + 13 - 14) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 16. ICD-10 Implementation Expenses (informational only; already included in general expenses and line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16. 16a ICD-10 Implementation Expenses (informational only; already included in line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (118,592) 9,839,084 657,423 0 0 0 0 0 0 575,555 XXX 3,363,052 30,849,577 1,242,496 58,150,359 0 93,605,484 23,542,404 402,230 (929,489) 39,445,831 XXX 402,230 14,745,909 XXX (929,489) XXX 39,620,033 OTHER INDICATORS: 216-2.MD 1. Number of certificates/policies 123 12,995 42,831 0 0 0 0 0 0 0 265,812 103,674 425,435 2,750 428,185 2. Number of Covered Lives 238 25,327 76,370 0 0 0 0 0 0 0 397,980 103,674 603,589 2,750 606,339 3. Number of Groups 2,129 952 0 0 0 0 0 0 5,473 7 8,561 1 8,562 4. Member Months 290,901 994,307 0 0 0 0 0 0 4,777,005 1,255,098 7,320,006 32,309 7,352,315 XXX 2,695 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ XXX 0 ] If yes, show the amount of premiums and claims included. Premiums $ 0 Claims $ 0 AFFORDABLE CARE ACT (ACA) RECEIPTS, PAYMENTS, RECEIVABLES and PAYABLES Current Year Prior Year Comprehensive Health Coverage Comprehensive Health Coverage 1 2 3 4 Small Group Small Group Employer Plans Employer Plans Individual Plans Individual Plans ACA Receivables and Payables 1. Permanent ACA Risk Adjustment Program 1.0 Premium adjustments receivable/(payable) 2. Transitional ACA Reinsurance Program 2.0 Total amounts recoverable for claims (paid & unpaid) 0 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 0 0 (156,828) 5,261,098 XXX (95,423) 0 0 0 (5,555,959) XXX 0 0 0 0 ACA Receipts and Payments 4. Permanent ACA Risk Adjustment Program 4.0 Premium adjustments receipts/(payments) 5. Transitional ACA Reinsurance Program 5.0 Amounts received for claims 0 6. Temporary ACA Risk Corridors Program 6.1 Retrospective premium received 6.2 Rate credits or policy experience refunds paid 0 0 (38,873) (1,603,816) XXX (33,012) 0 0 0 0 0 (1,389,181) XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF 185 Asylum Street Hartford, CT 061033408 Maryland DURING THE YEAR Comprehensive Health Coverage 1 2 3 Individual Small Group Employer Large Group Employer Small Group Employer Individual Expatriate Plans: 7 8 6 Large Group Employer Small Group 10 11 Government Business (excluded by statute) Other Health Business 9 Student Health Plans Large Group 79413 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.MD Health Premiums Earned: 1,179,664 142,395,486 1.1 Direct premiums written 0 11,200 1.2 Unearned premium prior year 0 17,148 1.3 Unearned premium current year 0 (5,948) 1.4 Change in unearned premium (Lines 1.2 - 1.3) 178,991 1,652,017 1.5 Paid rate credits 0 0 1.6 Reserve for rate credits current year 0 0 1.7 Reserve for rate credits prior year 0 0 1.8 Change in reserve for rate credits (Lines 1.6 - 1.7) 0 54,200 1.9 Premium balances written off 0 0 1.10 Group conversion charge 1,179,664 142,335,339 1.11 Total direct premiums earned (Lines 1.1 + 1.4 - 1.9 + 1.10) 0 0 1.12 Assumed premiums earned from non-affiliates 1,195 111,245 1.13 Net Assumed less Ceded premiums earned from affiliates 0 0 1.14 Ceded premiums earned to non-affiliates 0 54,200 1.15 Other Adjustments due to MLR calculation - Premiums 1,001,867 140,848,766 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 1,004,445 101,695,229 2.1 Paid claims during the year 14,329 13,651,499 2.2 Direct claim liability current year 8,484 9,714,607 2.3 Direct claim liability prior year 979 269,055 2.4 Direct claim reserves current year 1,162 211,560 2.5 Direct claim reserves prior year 209,484 0 2.6 Direct contract reserves current year 256,886 0 2.7 Direct contract reserves prior year 178,991 1,652,017 2.8 Paid rate credits 0 0 2.9 Reserve for rate credits current year 0 0 2.10 Reserve for rate credits prior year 0 112,676 2.11 Incurred medical incentive pools and bonuses (Lines 2.11a + 2.11b - 2.11c) 0 15,866 2.11a Paid medical incentive pools and bonuses current year 0 181,805 2.11b Accrued medical incentive pools and bonuses current year 0 84,995 2.11c Accrued medical incentive pools and bonuses prior year 624 606,291 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 624 3,458,864 2.12a Healthcare receivables current year 0 2,852,573 2.12b Healthcare receivables prior year 0 0 2.13 Group conversion charge 0 0 2.14 Multi-option coverage blended rate adjustment 2.15 Total incurred claims (Lines 2.1 + 2.2 - 2.3 + 2.4 - 2.5 + 2.6 - 2.7 + 2.8 + 2.9 1,141,073 106,848,018 2.10 + 2.11 - 2.12 + 2.13 + 2.14) 0 0 2.16 Assumed incurred claims from non-affiliates 0 242,014 2.17 Net assumed less ceded incurred claims from affiliates 0 0 2.18 Ceded incurred claims to non-affiliates 0 0 2.19 Other adjustments due to MLR calculation - Claims 962,081 105,438,015 2.20 Net Incurred Claims (Lines 2.15 - 2.8 - 2.9 + 2.10 + 2.16 + 2.17 - 2.18 + 2.19) 3. Fraud and Abuse Recoveries that Reduced PAID Claims in Line 2.1 above 0 4,080 (informational only) 22,966,368 for stand-alone dental and $ (a) Column 13, Line 1.1 includes direct written premium of $ 4 Business Subject to MLR Mini-Med Plans 5 (LOCATION) NAIC Company Code 2018 427,614,227 20,390 30,057 (9,666) 13,284,657 9,761,816 16,492,316 (6,730,499) 12,908 0 427,591,653 0 116,016 54,422,762 12,908 366,743,657 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 712,411 0 0 712,411 331,476,530 4,357 31,867 (27,510) (2,297,327) 795,253 667,004 128,249 (237,933) 0 331,686,953 0 0 1,049,296 (237,933) 332,568,802 177,181,393 0 0 0 6,861,460 4,061,485 7,964,493 (3,903,008) 996,123 0 176,185,270 0 0 0 996,123 174,222,941 1,079,847,299 35,947 79,071 (43,125) 19,679,798 14,618,554 25,123,813 (10,505,259) 825,297 0 1,078,978,877 0 940,867 55,472,058 825,297 1,016,098,445 343,647,337 34,237,052 33,779,997 796,989 816,414 0 0 13,284,657 9,761,816 16,492,316 414,541 68,736 775,281 429,476 (353,791) 9,609,883 9,963,674 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 566,628 (54,055) 518,926 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 259,084,646 35,301,890 31,136,751 14,737,524 15,203,319 197,963 55,922 (2,297,327) 795,253 667,004 0 0 0 0 28,171 28,311 140 0 0 151,155,043 2,307,567 8,490,486 0 0 0 0 6,861,460 4,061,485 7,964,493 8,632 7,810 822 0 (759,636) 31,678,196 32,437,832 0 0 857,153,327 85,458,282 83,649,251 15,804,546 16,232,454 407,447 312,809 19,679,798 14,618,554 25,123,813 535,849 92,412 957,907 514,471 (478,342) 44,775,877 45,254,219 0 0 351,407,457 508 (559,288) 44,343,483 0 299,951,038 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (6,354) 0 0 0 0 (6,354) 260,728,781 0 0 194,412 0 262,703,447 148,698,843 0 0 0 0 145,740,391 868,817,819 508 (317,274) 44,537,895 0 814,788,619 41,766 0 0 8,906,827 for stand-alone vision policies. 0 0 0 0 0 6,285 0 52,131 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF Maryland DURING THE YEAR All Expenses 1 Improve Health Outcomes 1. Individual Comprehensive Coverage Expenses: 35,334 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 2,018 for affiliated services) 1.3 EDP Equipment and Software (incl $ 194 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 21 for affiliated services) 1.5 Accreditation and Certification (incl $ 63,428 for affiliated services) 1.6 Other Expenses (incl $ 1.7 Subtotal before Reimbursements and Taxes (Lines 1.1 to 1.6) 1.8 Reimbursements by uninsured plans and fiscal intermediaries 1.9 Taxes, Licenses and Fees (in total, for tying purposes) 1.10 Total (1.7 to 1.9) 1.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 2. 216-4.MD Small Group Comprehensive Coverage Expenses: 3,376,140 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 240,086 for affiliated services) 2.3 EDP Equipment and Software (incl $ 23,045 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 2,502 for affiliated services) 2.5 Accreditation and Certification (incl $ 7,891,242 for affiliated services) 2.6 Other Expenses (incl $ 2.7 Subtotal before Reimbursements and Taxes (Lines 2.1 to 2.6) 2.8 Reimbursements by uninsured plans and fiscal intermediaries 2.9 Taxes, Licenses and Fees (in total, for tying purposes) 2.10 Total (2.7 to 2.9) 2.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 3. Large Group Comprehensive Coverage Expenses: 9,292,191 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 620,946 for affiliated services) 3.3 EDP Equipment and Software (incl $ 59,603 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 6,472 for affiliated services) 3.5 Accreditation and Certification (incl $ 21,554,233 for affiliated services) 3.6 Other Expenses (incl $ 3.7 Subtotal before Reimbursements and Taxes (Lines 3.1 to 3.6) 3.8 Reimbursements by uninsured plans and fiscal intermediaries 3.9 Taxes, Licenses and Fees (in total, for tying purposes) 3.10 Total (3.7 to 3.9) 3.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 185 Asylum Street Hartford, CT 061033408 0 0 0 0 0 9,437 9,437 0 XXX Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX Total (1 to 5) 0 0 0 0 0 9,437 9,437 0 XXX 0 0 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 0 0 0 0 0 0 0 XXX (LOCATION) NAIC Company Code 2018 XXX 3,511 402 293 28 3 7,852 12,089 0 XXX 8,042 641 456 44 5 13,125 22,312 0 XXX 9,437 0 0 0 0 0 0 0 0 0 9,437 0 12,089 3,145 22,312 0 0 0 0 0 0 1,138,683 1,138,683 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,138,683 1,138,683 0 426,885 189,837 35,647 3,422 372 982,189 1,638,352 0 655,244 75,178 54,716 5,252 570 1,465,496 2,256,455 0 XXX 1,138,683 0 0 0 0 0 0 3,420,733 3,420,733 0 XXX 3,420,733 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 1,138,683 0 XXX 1,638,352 420,937 XXX 2,256,455 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3,420,733 3,420,733 0 1,299,716 567,916 108,532 10,418 1,131 2,988,258 4,975,971 0 1,819,392 208,435 151,928 14,583 1,583 4,069,190 6,265,111 0 3,420,733 0 XXX 4,975,971 1,360,811 XXX 6,265,111 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 79413 9 10 General Administrative Expenses Total Expenses (6 to 9) 23,781 1,724 1,269 110 13 80,331 107,228 0 19,168 126,396 0 35,334 2,767 2,018 182 21 110,745 151,066 0 19,168 170,234 3,145 2,294,012 282,156 149,723 14,372 1,560 9,507,886 12,249,709 0 2,855,189 15,104,899 0 3,376,140 547,171 240,086 23,045 2,502 13,094,253 17,283,198 0 2,855,189 20,138,388 420,937 6,173,084 704,956 360,486 34,602 3,757 23,405,091 30,681,976 0 8,884,665 39,566,641 0 9,292,191 1,481,307 620,946 59,603 6,472 33,883,272 45,343,791 0 8,884,665 54,228,456 1,360,811 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 4. 5. 216-5.MD 6. Individual Mini-Med Plans Expenses: 0 for affiliated services) 4.1 Salaries (including $ 4.2 Outsourced Services 0 for affiliated services) 4.3 EDP Equipment and Software (incl $ 0 for affiliated services) 4.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 4.5 Accreditation and Certification (incl $ 0 for affiliated services) 4.6 Other Expenses (incl $ 4.7 Subtotal before Reimbursements and Taxes (Lines 4.1 to 4.6) 4.8 Reimbursements by uninsured plans and fiscal intermediaries 4.9 Taxes, Licenses and Fees (in total, for tying purposes) 4.10 Total (4.7 to 4.9) 4.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Mini-Med Plans Expenses: 0 for affiliated services) 5.1 Salaries (including $ 5.2 Outsourced Services 0 for affiliated services) 5.3 EDP Equipment and Software (incl $ 0 for affiliated services) 5.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 5.5 Accreditation and Certification (incl $ 0 for affiliated services) 5.6 Other Expenses (incl $ 5.7 Subtotal before Reimbursements and Taxes (Lines 5.1 to 5.6) 5.8 Reimbursements by uninsured plans and fiscal intermediaries 5.9 Taxes, Licenses and Fees (in total, for tying purposes) 5.10 Total (5.7 to 5.9) 5.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Mini-Med Plans Expenses: 0 for affiliated services) 6.1 Salaries (including $ 6.2 Outsourced Services 0 for affiliated services) 6.3 EDP Equipment and Software (incl $ 0 for affiliated services) 6.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 6.5 Accreditation and Certification (incl $ 0 for affiliated services) 6.6 Other Expenses (incl $ 6.7 Subtotal before Reimbursements and Taxes (Lines 6.1 to 6.6) 6.8 Reimbursements by uninsured plans and fiscal intermediaries 6.9 Taxes, Licenses and Fees (in total, for tying purposes) 6.10 Total (6.7 to 6.9) 6.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 7. 8. 216-6.MD 9. Small Group Expatriate Plans Expenses: 0 for affiliated services) 7.1 Salaries (including $ 7.2 Outsourced Services 0 for affiliated services) 7.3 EDP Equipment and Software (incl $ 0 for affiliated services) 7.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 7.5 Accreditation and Certification (incl $ 0 for affiliated services) 7.6 Other Expenses (incl $ 7.7 Subtotal before Reimbursements and Taxes (Lines 7.1 to 7.6) 7.8 Reimbursements by uninsured plans and fiscal intermediaries 7.9 Taxes, Licenses and Fees (in total, for tying purposes) 7.10 Total (7.7 to 7.9) 7.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Expatriate Plans Expenses: 0 for affiliated services) 8.1 Salaries (including $ 8.2 Outsourced Services 0 for affiliated services) 8.3 EDP Equipment and Software (incl $ 0 for affiliated services) 8.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 8.5 Accreditation and Certification (incl $ 0 for affiliated services) 8.6 Other Expenses (incl $ 8.7 Subtotal before Reimbursements and Taxes (Lines 8.1 to 8.6) 8.8 Reimbursements by uninsured plans and fiscal intermediaries 8.9 Taxes, Licenses and Fees (in total, for tying purposes) 8.10 Total (8.7 to 8.9) 8.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Student Health Plans Expenses: 0 for affiliated services) 9.1 Salaries (including $ 9.2 Outsourced Services 0 for affiliated services) 9.3 EDP Equipment and Software (incl $ 0 for affiliated services) 9.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 9.5 Accreditation and Certification (incl $ 0 for affiliated services) 9.6 Other Expenses (incl $ 9.7 Subtotal before Reimbursements and Taxes (Lines 9.1 to 9.6) 9.8 Reimbursements by uninsured plans and fiscal intermediaries 9.9 Taxes, Licenses and Fees (in total, for tying purposes) 9.10 Total (9.7 to 9.9) 9.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 *79413201821622100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes - See Cautionary Statement at http://www.naic.org/documents/committees_e_app_blanks_related_shce_cautionary_statement.pdf) UnitedHealthcare Insurance Company 2. 185 Asylum Street Hartford, CT 061033408 (LOCATION) BUSINESS IN THE STATE OF Massachusetts DURING THE YEAR 2018 NAIC Company Code Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 1. 216-1.MA 2. 3. 4. 5. 6. 7. 8. 9. Premium: 1.1 Health premiums earned (From Part 2, Line 1.11) 1.2 Federal high risk pools 1.3 State high risk pools 1.4 Premiums earned including state and federal high risk programs (Lines 1.1 + 1.2 + 1.3) 1.5 Federal taxes and federal assessments 1.6 State insurance, premium and other taxes (Similar local taxes of 157,907 ) $ 1.6a Community Benefit Expenditures (informational only) 1.7 Regulatory authority licenses and fees 1.8 Adjusted Premiums Earned (Lines 1.4 - 1.5 - 1.6 - 1.7) 1.9 Net Assumed less Ceded reinsurance premiums earned 1.10 Other Adjustments due to MLR calculations - Premiums 1.11 Risk Revenue 1.12 Net adjusted premiums earned after reinsurance (Lines 1.8 + 1.9 + 1.10 + 1.11) Claims: 2.1 Incurred claims excluding prescription drugs 2.2 Prescription drugs 2.3 Pharmaceutical rebates 2.4 State stop loss, market stabilization and claim/census based assessments (informational only) Incurred medical incentive pools and bonuses Deductible Fraud and Abuse Detection/Recovery Expenses (for MLR use only) 5.0 Total Incurred Claims (Lines 2.1 + 2.2 - 2.3 + 3) (From Part 2, Line 2.15) 5.1 Net Assumed less Ceded reinsurance claims incurred 5.2 Other Adjustments due to MLR calculations - Claims 5.3 Rebates paid 5.4 Estimated rebates unpaid prior year 5.5 Estimated rebates unpaid current year 5.6 Fee for service and co-pay revenue 5.7 Net incurred claims after reinsurance (Lines 5.0 + 5.1 + 5.2 + 5.3 - 5.4 + 5.5 - 5.6) Improving Health Care Quality Expenses Incurred: 6.1 Improve health outcomes 6.2 Activities to prevent hospital readmissions 6.3 Improve patient safety and reduce medical errors 6.4 Wellness and health promotion activities 6.5 Health Information Technology expenses related to health improvement 6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5) Preliminary Medical Loss Ratio: MLR ((Lines 4 + 5.0 + 6.6 - Footnote 2.0)/Line 1.8 Claims Adjustment Expenses: 8.1 Cost containment expenses not included in quality of care expenses in Line 6.6 8.2 All other claims adjustment expenses 8.3 Total claims adjustment expenses (Lines 8.1 + 8.2) Claims Adjustment Expense Ratio (Line 8.3/Line 1.8) 2 Small Group Employer 3 Large Group Employer 4 5 Small Group Employer Individual Expatriate Plans 6 Large Group Employer 7 11 Government Business (excluded by statute) Other Health Business 9 8 Small Group 10 Student Health Plans Large Group 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 79413 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 1,430,197 0 (71) 45,762,614 0 (2,815) 156,967,272 0 (2,845) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 410,827,064 0 0 123,858,935 0 41,948 491,447,067 0 0 1,230,293,148 0 36,217 XXX XXX XXX 1,230,293,148 0 36,217 1,430,126 (38,850) 45,759,798 2,277,186 156,964,427 6,467,569 0 0 0 0 0 0 0 0 0 0 0 0 410,827,064 2,270,534 123,900,883 1,434,396 491,447,067 14,973,753 1,230,329,365 27,384,588 XXX 125,831 1,230,329,365 27,510,420 19,165 0 667 1,449,144 0 27,624 0 1,476,768 851,063 0 22,383 42,609,166 0 14,421 0 42,623,587 2,757,454 0 100,204 147,639,200 (656,872) 25 0 146,982,353 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (79,463) 0 0 408,635,993 0 0 0 408,635,993 2,330,683 0 (13,466) 120,149,269 588,836 918 0 120,739,024 (15,046) 0 0 476,488,360 175,753 962,205 0 477,626,318 5,863,857 0 109,788 1,196,971,132 107,718 1,005,193 0 1,198,084,043 0 0 0 XXX XXX XXX XXX XXX 5,863,857 0 109,788 1,196,845,301 107,718 1,005,193 0 1,197,958,212 1,424,262 227,367 84,910 27,944,841 7,226,157 2,664,260 100,236,931 23,825,048 7,227,788 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 364,594,610 5,538,141 122,205 96,156,152 1,164,918 20,535 341,127,939 174,790,741 101,690,043 931,484,735 212,772,372 111,809,741 XXX XXX XXX 931,484,735 212,772,372 111,809,741 1,707 0 1 1,566,719 (7) 0 0 0 0 0 1,566,712 519,903 86,892 1,783 32,593,630 0 (299,791) 0 0 299,791 0 32,593,630 1,313,281 84,268 25,703 116,918,459 5,348,120 0 0 0 0 0 122,266,579 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (3,104) 2,211 370,007,443 0 0 XXX XXX XXX 0 370,007,443 125,550 0 0 97,300,534 234,385 0 XXX XXX XXX 0 97,534,919 0 2,325,618 32,303 416,554,255 0 (13,898,092) 25,425,819 22,792,081 11,264,354 0 416,554,255 1,960,440 2,493,674 62,000 1,034,941,040 5,582,498 (14,197,883) 25,425,819 22,792,081 11,564,145 0 1,040,523,537 XXX XXX 1,960,440 2,493,674 62,000 1,034,941,040 5,582,498 (14,197,883) 25,425,819 22,792,081 11,564,145 0 1,040,523,537 11,442 0 0 0 0 366,101 0 0 0 0 1,255,738 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5,840,746 3,278,221 2,805,314 2,380,000 593,142 169,617 15,966 16,496 685,704 41,000 5,373,237 2,645,926 2,275,157 1,739,682 1,005,202 13,016,880 5,940,113 5,096,967 4,805,386 1,639,344 11,442 1.088 366,101 0.774 1,255,738 0.801 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 14,897,423 XXX 928,782 XXX 13,039,203 0.902 30,498,689 XXX 9,790 15,105 24,895 0.017 532,804 701,429 1,234,233 0.029 1,635,778 1,731,668 3,367,446 0.023 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 5,747,628 5,054,691 10,802,319 0.026 215,002 1,727,149 1,942,152 0.016 5,074,303 7,768,366 12,842,669 0.027 13,215,305 16,998,409 30,213,713 XXX 0 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 13,016,880 5,940,113 5,096,967 4,805,386 1,639,344 0 30,498,689 XXX 0 0 0 13,215,305 16,998,409 30,213,713 XXX XXX XXX SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 (Continued) Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 2 Small Group Employer Individual 10. General and Administrative (G&A) Expenses: 10.1 Direct sales salaries and benefits 10.2 Agents and brokers fees and commissions 10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below) 10.4 Other general and administrative expenses 10.4a Community Benefit Expenditures (informational only) 10.5 Total general and administrative (Lines 10.1 +10.2 + 10.3 + 10.4) 3,481 23,340 (1,749) 76,623 0 101,695 3 Large Group Employer 167,211 961,785 27,289 1,943,306 0 3,099,591 4 5 Small Group Employer Individual 650,970 4,318,505 156,412 4,698,201 0 9,824,088 0 0 0 0 0 0 Expatriate Plans 6 Large Group Employer 0 0 0 0 0 0 7 8 Small Group 0 0 0 0 0 0 Student Health Plans Large Group 0 0 0 0 0 0 10 11 Government Business (excluded by statute) Other Health Business 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 9 0 0 0 0 0 0 0 0 0 0 0 0 2,394,861 14,085 419,119 12,970,568 0 15,798,633 256,887 4,873,885 221,038 10,619,530 0 15,971,340 2,095,670 2,315,297 611,129 18,004,029 0 23,026,124 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 5,569,080 12,506,896 1,433,238 48,312,257 0 67,821,471 0 0 0 0 0 0 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) 12,164,068 29,026,633 12. Income from fees of uninsured plans XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 13. Net investment and other gain/(loss) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 18,532,381 XXX 18,532,381 14. Federal income taxes (excluding taxes on Line 1.5 above) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX (1,869,899) XXX (1,869,899) 15. Net gain or (loss) (Lines 11 + 12 + 13 - 14) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 49,428,912 XXX 49,934,600 16. ICD-10 Implementation Expenses (informational only; already included in general expenses and line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16. 16a ICD-10 Implementation Expenses (informational only; already included in line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 91 4,611 13,930 0 0 0 0 0 0 1,856 131,133 94,843 246,464 0 246,464 154 8,901 27,761 0 0 0 0 0 0 1,856 213,634 94,843 347,149 0 347,149 947 189 0 0 0 0 0 1 850 1 1,988 0 1,988 93,574 311,180 0 0 0 0 0 22,167 2,425,354 1,146,481 4,000,704 0 4,000,704 (227,975) 5,330,032 10,268,503 0 0 0 0 0 0 (2,869,825) 4,361,830 XXX 5,569,080 12,506,896 1,433,238 48,312,257 0 67,821,471 28,900,801 631,519 631,519 OTHER INDICATORS: 216-2.MA 1. Number of certificates/policies 2. Number of Covered Lives 3. Number of Groups 4. Member Months XXX 1,948 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ XXX 0 ] If yes, show the amount of premiums and claims included. Premiums $ 0 Claims $ 0 AFFORDABLE CARE ACT (ACA) RECEIPTS, PAYMENTS, RECEIVABLES and PAYABLES Current Year Prior Year Comprehensive Health Coverage Comprehensive Health Coverage 1 2 3 4 Small Group Small Group Employer Plans Employer Plans Individual Plans Individual Plans ACA Receivables and Payables 1. Permanent ACA Risk Adjustment Program 1.0 Premium adjustments receivable/(payable) 2. Transitional ACA Reinsurance Program 2.0 Total amounts recoverable for claims (paid & unpaid) 1,378 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 0 0 (85,031) (4,326,312) XXX (99,737) 47,978 0 0 (2,376,045) XXX 0 0 0 0 ACA Receipts and Payments 4. Permanent ACA Risk Adjustment Program 4.0 Premium adjustments receipts/(payments) 5. Transitional ACA Reinsurance Program 5.0 Amounts received for claims 6. Temporary ACA Risk Corridors Program 6.1 Retrospective premium received 6.2 Rate credits or policy experience refunds paid 225,063 46,600 0 0 (1,340,142) XXX 0 259,472 0 0 0 0 (2,000,204) XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF 185 Asylum Street Hartford, CT 061033408 Massachusetts DURING THE YEAR Comprehensive Health Coverage 1 2 3 Individual Small Group Employer Large Group Employer Small Group Employer Individual Expatriate Plans: 7 8 6 Large Group Employer Small Group 10 11 Government Business (excluded by statute) Other Health Business 9 Student Health Plans Large Group 79413 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.MA Health Premiums Earned: 1,457,821 45,761,056 1.1 Direct premiums written 0 25,513 1.2 Unearned premium prior year 0 9,535 1.3 Unearned premium current year 0 15,979 1.4 Change in unearned premium (Lines 1.2 - 1.3) 0 0 1.5 Paid rate credits 0 299,791 1.6 Reserve for rate credits current year 0 0 1.7 Reserve for rate credits prior year 0 299,791 1.8 Change in reserve for rate credits (Lines 1.6 - 1.7) 27,624 14,421 1.9 Premium balances written off 0 0 1.10 Group conversion charge 1,430,197 45,762,614 1.11 Total direct premiums earned (Lines 1.1 + 1.4 - 1.9 + 1.10) 0 0 1.12 Assumed premiums earned from non-affiliates 0 0 1.13 Net Assumed less Ceded premiums earned from affiliates 0 0 1.14 Ceded premiums earned to non-affiliates 27,624 14,421 1.15 Other Adjustments due to MLR calculation - Premiums 1,457,821 45,477,244 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 1,567,970 33,408,999 2.1 Paid claims during the year (392) 4,028,972 2.2 Direct claim liability current year 2,346 5,055,179 2.3 Direct claim liability prior year 0 69,884 2.4 Direct claim reserves current year 0 115,659 2.5 Direct claim reserves prior year 0 0 2.6 Direct contract reserves current year 0 0 2.7 Direct contract reserves prior year 0 0 2.8 Paid rate credits 0 299,791 2.9 Reserve for rate credits current year 0 0 2.10 Reserve for rate credits prior year 0 86,892 2.11 Incurred medical incentive pools and bonuses (Lines 2.11a + 2.11b - 2.11c) 0 36,619 2.11a Paid medical incentive pools and bonuses current year 0 77,967 2.11b Accrued medical incentive pools and bonuses current year 0 27,694 2.11c Accrued medical incentive pools and bonuses prior year (1,486) 130,069 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 0 1,144,068 2.12a Healthcare receivables current year 1,486 1,013,999 2.12b Healthcare receivables prior year 0 0 2.13 Group conversion charge 0 0 2.14 Multi-option coverage blended rate adjustment 2.15 Total incurred claims (Lines 2.1 + 2.2 - 2.3 + 2.4 - 2.5 + 2.6 - 2.7 + 2.8 + 2.9 1,566,719 32,593,630 2.10 + 2.11 - 2.12 + 2.13 + 2.14) 0 0 2.16 Assumed incurred claims from non-affiliates (7) 0 2.17 Net assumed less ceded incurred claims from affiliates 0 0 2.18 Ceded incurred claims to non-affiliates 0 0 2.19 Other adjustments due to MLR calculation - Claims 1,566,712 32,293,839 2.20 Net Incurred Claims (Lines 2.15 - 2.8 - 2.9 + 2.10 + 2.16 + 2.17 - 2.18 + 2.19) 3. Fraud and Abuse Recoveries that Reduced PAID Claims in Line 2.1 above 1 1,783 (informational only) 7,247,340 for stand-alone dental and $ (a) Column 13, Line 1.1 includes direct written premium of $ 4 Business Subject to MLR Mini-Med Plans 5 (LOCATION) NAIC Company Code 2018 156,967,297 0 0 0 81,307 0 6,172 (6,172) 25 0 156,967,272 85,764,733 0 86,421,605 25 156,235,291 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 410,827,064 0 0 0 0 0 0 0 0 0 410,827,064 0 0 0 0 410,827,064 123,892,347 36,070 68,564 (32,494) 56,586 910,989 936,234 (25,245) 918 0 123,858,935 1,081,683 0 492,846 918 124,417,349 492,409,272 0 0 0 25,443,921 9,118,954 23,319,126 (14,200,172) 962,205 0 491,447,067 0 175,753 0 962,205 481,341,276 1,231,314,857 61,583 78,099 (16,515) 25,581,814 10,329,734 24,261,532 (13,931,799) 1,005,193 0 1,230,293,148 86,846,415 175,753 86,914,451 1,005,193 1,219,756,045 120,411,797 13,827,674 17,405,830 333,897 346,937 0 0 81,307 0 6,172 84,268 38,129 91,750 45,611 61,546 2,981,609 2,920,063 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 371,137,323 4,008,971 4,797,031 2,007 2,051 0 0 0 0 0 (3,104) (3,104) 0 0 338,672 1,164,713 826,042 0 0 96,418,728 13,186,082 12,560,285 8,770,787 8,494,324 75,489 123,099 56,586 910,989 936,234 0 0 0 0 4,184 6,141 1,957 0 0 400,422,306 54,141,957 57,548,700 37,496 35,380 0 5 25,443,921 9,118,954 23,319,126 2,325,618 1,812,892 1,453,928 941,202 (5,967,212) 36,596,815 42,564,027 0 0 1,023,367,123 89,193,264 97,369,370 9,214,071 8,994,350 75,489 123,104 25,581,814 10,329,734 24,261,532 2,493,674 1,884,536 1,623,645 1,014,508 (5,434,229) 41,893,346 47,327,575 0 0 116,918,459 74,229,851 0 68,881,731 0 122,191,444 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 370,007,443 0 0 0 0 370,007,443 97,300,534 413,325 0 178,940 0 97,503,579 416,554,255 0 0 0 0 405,310,506 1,034,941,040 74,643,177 (7) 69,060,671 0 1,028,873,523 25,703 0 0 6,192,975 for stand-alone vision policies. 0 0 0 0 2,211 0 32,303 62,000 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF Massachusetts DURING THE YEAR All Expenses 1 Improve Health Outcomes 1. Individual Comprehensive Coverage Expenses: 25,224 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 1,826 for affiliated services) 1.3 EDP Equipment and Software (incl $ 175 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 19 for affiliated services) 1.5 Accreditation and Certification (incl $ 56,488 for affiliated services) 1.6 Other Expenses (incl $ 1.7 Subtotal before Reimbursements and Taxes (Lines 1.1 to 1.6) 1.8 Reimbursements by uninsured plans and fiscal intermediaries 1.9 Taxes, Licenses and Fees (in total, for tying purposes) 1.10 Total (1.7 to 1.9) 1.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 2. 216-4.MA 3. 0 0 0 0 0 11,442 11,442 0 XXX Small Group Comprehensive Coverage Expenses: 1,029,629 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 72,518 for affiliated services) 2.3 EDP Equipment and Software (incl $ 6,961 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 756 for affiliated services) 2.5 Accreditation and Certification (incl $ 2,323,557 for affiliated services) 2.6 Other Expenses (incl $ 2.7 Subtotal before Reimbursements and Taxes (Lines 2.1 to 2.6) 2.8 Reimbursements by uninsured plans and fiscal intermediaries 2.9 Taxes, Licenses and Fees (in total, for tying purposes) 2.10 Total (2.7 to 2.9) 2.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Comprehensive Coverage Expenses: 2,887,874 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 188,747 for affiliated services) 3.3 EDP Equipment and Software (incl $ 18,117 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 1,967 for affiliated services) 3.5 Accreditation and Certification (incl $ 6,328,465 for affiliated services) 3.6 Other Expenses (incl $ 3.7 Subtotal before Reimbursements and Taxes (Lines 3.1 to 3.6) 3.8 Reimbursements by uninsured plans and fiscal intermediaries 3.9 Taxes, Licenses and Fees (in total, for tying purposes) 3.10 Total (3.7 to 3.9) 3.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 185 Asylum Street Hartford, CT 061033408 Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX Total (1 to 5) 0 0 0 0 0 11,442 11,442 0 XXX 0 0 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 0 0 0 0 0 0 0 XXX (LOCATION) NAIC Company Code 2018 XXX 2,751 308 230 22 2 6,152 9,465 0 XXX 4,286 491 358 34 4 9,586 14,759 0 XXX 11,442 0 0 0 0 0 0 0 0 0 11,442 0 9,465 2,801 14,759 0 0 0 0 0 0 366,101 366,101 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 366,101 366,101 0 131,115 71,685 10,949 1,051 114 302,303 517,217 0 198,874 22,791 16,607 1,594 173 444,795 684,834 0 XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX XXX XXX 366,101 0 0 0 0 0 0 0 0 0 366,101 0 517,217 134,594 684,834 0 0 0 0 0 0 1,255,738 1,255,738 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,255,738 1,255,738 0 398,611 235,228 33,286 3,195 347 917,364 1,588,032 0 491,152 56,287 41,013 3,937 427 1,098,494 1,691,310 0 1,255,738 0 XXX 1,588,032 441,401 XXX 1,691,310 0 XXX 1,255,738 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 79413 9 10 General Administrative Expenses Total Expenses (6 to 9) 18,187 1,700 1,238 119 13 81,941 103,198 0 18,999 122,197 0 25,224 2,499 1,826 175 19 109,121 138,864 0 18,999 157,863 2,801 699,640 88,366 44,962 4,316 469 2,222,724 3,060,477 0 944,743 4,005,220 0 1,029,629 182,842 72,518 6,961 756 3,335,923 4,628,629 0 944,743 5,573,372 134,594 1,998,111 259,822 114,447 10,986 1,193 7,240,727 9,625,285 0 3,144,565 12,769,850 0 2,887,874 551,337 188,747 18,117 1,967 10,512,323 14,160,365 0 3,144,565 17,304,930 441,401 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 4. 5. 216-5.MA 6. Individual Mini-Med Plans Expenses: 0 for affiliated services) 4.1 Salaries (including $ 4.2 Outsourced Services 0 for affiliated services) 4.3 EDP Equipment and Software (incl $ 0 for affiliated services) 4.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 4.5 Accreditation and Certification (incl $ 0 for affiliated services) 4.6 Other Expenses (incl $ 4.7 Subtotal before Reimbursements and Taxes (Lines 4.1 to 4.6) 4.8 Reimbursements by uninsured plans and fiscal intermediaries 4.9 Taxes, Licenses and Fees (in total, for tying purposes) 4.10 Total (4.7 to 4.9) 4.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Mini-Med Plans Expenses: 0 for affiliated services) 5.1 Salaries (including $ 5.2 Outsourced Services 0 for affiliated services) 5.3 EDP Equipment and Software (incl $ 0 for affiliated services) 5.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 5.5 Accreditation and Certification (incl $ 0 for affiliated services) 5.6 Other Expenses (incl $ 5.7 Subtotal before Reimbursements and Taxes (Lines 5.1 to 5.6) 5.8 Reimbursements by uninsured plans and fiscal intermediaries 5.9 Taxes, Licenses and Fees (in total, for tying purposes) 5.10 Total (5.7 to 5.9) 5.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Mini-Med Plans Expenses: 0 for affiliated services) 6.1 Salaries (including $ 6.2 Outsourced Services 0 for affiliated services) 6.3 EDP Equipment and Software (incl $ 0 for affiliated services) 6.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 6.5 Accreditation and Certification (incl $ 0 for affiliated services) 6.6 Other Expenses (incl $ 6.7 Subtotal before Reimbursements and Taxes (Lines 6.1 to 6.6) 6.8 Reimbursements by uninsured plans and fiscal intermediaries 6.9 Taxes, Licenses and Fees (in total, for tying purposes) 6.10 Total (6.7 to 6.9) 6.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 7. 8. 216-6.MA 9. Small Group Expatriate Plans Expenses: 0 for affiliated services) 7.1 Salaries (including $ 7.2 Outsourced Services 0 for affiliated services) 7.3 EDP Equipment and Software (incl $ 0 for affiliated services) 7.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 7.5 Accreditation and Certification (incl $ 0 for affiliated services) 7.6 Other Expenses (incl $ 7.7 Subtotal before Reimbursements and Taxes (Lines 7.1 to 7.6) 7.8 Reimbursements by uninsured plans and fiscal intermediaries 7.9 Taxes, Licenses and Fees (in total, for tying purposes) 7.10 Total (7.7 to 7.9) 7.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Expatriate Plans Expenses: 0 for affiliated services) 8.1 Salaries (including $ 8.2 Outsourced Services 0 for affiliated services) 8.3 EDP Equipment and Software (incl $ 0 for affiliated services) 8.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 8.5 Accreditation and Certification (incl $ 0 for affiliated services) 8.6 Other Expenses (incl $ 8.7 Subtotal before Reimbursements and Taxes (Lines 8.1 to 8.6) 8.8 Reimbursements by uninsured plans and fiscal intermediaries 8.9 Taxes, Licenses and Fees (in total, for tying purposes) 8.10 Total (8.7 to 8.9) 8.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Student Health Plans Expenses: 0 for affiliated services) 9.1 Salaries (including $ 9.2 Outsourced Services 0 for affiliated services) 9.3 EDP Equipment and Software (incl $ 0 for affiliated services) 9.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 9.5 Accreditation and Certification (incl $ 0 for affiliated services) 9.6 Other Expenses (incl $ 9.7 Subtotal before Reimbursements and Taxes (Lines 9.1 to 9.6) 9.8 Reimbursements by uninsured plans and fiscal intermediaries 9.9 Taxes, Licenses and Fees (in total, for tying purposes) 9.10 Total (9.7 to 9.9) 9.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 *79413201821623100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes - See Cautionary Statement at http://www.naic.org/documents/committees_e_app_blanks_related_shce_cautionary_statement.pdf) UnitedHealthcare Insurance Company 2. 185 Asylum Street Hartford, CT 061033408 (LOCATION) BUSINESS IN THE STATE OF Michigan DURING THE YEAR 2018 NAIC Company Code Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 1. 216-1.MI 2. 3. 4. 5. 6. 7. 8. 9. Premium: 1.1 Health premiums earned (From Part 2, Line 1.11) 1.2 Federal high risk pools 1.3 State high risk pools 1.4 Premiums earned including state and federal high risk programs (Lines 1.1 + 1.2 + 1.3) 1.5 Federal taxes and federal assessments 1.6 State insurance, premium and other taxes (Similar local taxes of 97,894 ) $ 1.6a Community Benefit Expenditures (informational only) 1.7 Regulatory authority licenses and fees 1.8 Adjusted Premiums Earned (Lines 1.4 - 1.5 - 1.6 - 1.7) 1.9 Net Assumed less Ceded reinsurance premiums earned 1.10 Other Adjustments due to MLR calculations - Premiums 1.11 Risk Revenue 1.12 Net adjusted premiums earned after reinsurance (Lines 1.8 + 1.9 + 1.10 + 1.11) Claims: 2.1 Incurred claims excluding prescription drugs 2.2 Prescription drugs 2.3 Pharmaceutical rebates 2.4 State stop loss, market stabilization and claim/census based assessments (informational only) Incurred medical incentive pools and bonuses Deductible Fraud and Abuse Detection/Recovery Expenses (for MLR use only) 5.0 Total Incurred Claims (Lines 2.1 + 2.2 - 2.3 + 3) (From Part 2, Line 2.15) 5.1 Net Assumed less Ceded reinsurance claims incurred 5.2 Other Adjustments due to MLR calculations - Claims 5.3 Rebates paid 5.4 Estimated rebates unpaid prior year 5.5 Estimated rebates unpaid current year 5.6 Fee for service and co-pay revenue 5.7 Net incurred claims after reinsurance (Lines 5.0 + 5.1 + 5.2 + 5.3 - 5.4 + 5.5 - 5.6) Improving Health Care Quality Expenses Incurred: 6.1 Improve health outcomes 6.2 Activities to prevent hospital readmissions 6.3 Improve patient safety and reduce medical errors 6.4 Wellness and health promotion activities 6.5 Health Information Technology expenses related to health improvement 6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5) Preliminary Medical Loss Ratio: MLR ((Lines 4 + 5.0 + 6.6 - Footnote 2.0)/Line 1.8 Claims Adjustment Expenses: 8.1 Cost containment expenses not included in quality of care expenses in Line 6.6 8.2 All other claims adjustment expenses 8.3 Total claims adjustment expenses (Lines 8.1 + 8.2) Claims Adjustment Expense Ratio (Line 8.3/Line 1.8) 2 Small Group Employer 3 Large Group Employer 4 5 Small Group Employer Individual Expatriate Plans 6 Large Group Employer 7 11 Government Business (excluded by statute) Other Health Business 9 8 Small Group 10 Student Health Plans Large Group 573,181 0 (41) 149,593,627 0 (5,772) 266,084,899 0 (27,311) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 573,140 (56,684) 149,587,855 8,344,090 266,057,588 7,838,370 0 0 0 0 0 0 0 0 0 0 0 0 15,931 0 338 613,555 0 0 0 613,555 2,376,339 0 46,925 138,820,501 955 12,857 0 138,834,312 4,197,351 0 37,031 253,984,836 (31,796,535) 1,126,679 0 223,314,980 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 755,941 100,167 37,343 94,270,397 20,056,122 7,409,013 192,154,183 43,196,514 14,742,111 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (44) 0 0 1 0 0 818,765 0 0 0 0 0 0 818,765 804,784 53,466 2,206 106,970,972 83,136 (6,133,709) 5,885,306 5,790,251 6,038,848 0 107,054,302 1,346,612 81,625 64,614 220,690,211 (26,652,312) 0 0 0 (194) 0 194,037,705 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (44) 8,656,675 0 XXX XXX XXX 0 8,656,631 4,585 0 0 0 0 1,196,749 0 0 0 0 2,128,679 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4,585 1.342 1,196,749 0.779 2,128,679 0.878 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 13,342 29,977 43,319 0.071 1,994,987 2,768,447 4,763,434 0.034 3,321,813 4,471,000 7,792,813 0.031 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 (837,115) 0 0 0 837,115 4,455,177 0 0 5,292,291 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 294,280,223 0 147,884 104,123,897 0 0 814,655,826 0 114,760 XXX XXX XXX 294,428,107 2,747,504 104,123,897 4,477,277 814,770,586 22,513,444 XXX 4,781,026 0 (52,147) 286,951,724 (474,565) (240,375) 0 286,236,784 13,220 0 0 99,633,399 0 1,402,151 0 101,035,550 11,383,867 0 32,146 780,841,129 (27,814,969) 2,301,313 0 755,327,473 XXX XXX XXX XXX XXX 11,383,867 0 32,146 780,841,129 (27,814,969) 2,301,313 0 755,327,473 227,569,777 219,873 49,478 2,287,625 163,668,567 90,922,875 517,037,878 227,241,242 113,160,819 XXX XXX XXX 517,037,878 227,241,242 113,160,819 1,326,692 0 0 227,740,171 (486,408) 0 XXX XXX XXX 0 227,253,763 0 0 97 75,033,317 0 0 0 0 0 0 75,033,317 3,478,090 135,091 66,918 631,253,393 (18,398,908) (6,133,709) 5,885,306 5,790,251 6,038,653 0 612,854,484 XXX XXX 3,478,090 135,091 66,918 631,253,393 (18,398,908) (6,133,709) 5,885,306 5,790,251 6,038,653 0 612,854,484 0 0 0 0 0 753,979 339,210 259,638 2,229,001 164,718 157,267 42,492 336,591 (81,620) 315,214 4,241,260 381,702 596,228 2,147,380 479,932 0 3,746,545 XXX 769,943 0.761 7,846,502 XXX 506,797 4,928,836 5,435,633 0.019 2,560,909 7,056,319 9,617,229 0.097 8,397,848 19,254,580 27,652,428 XXX XXX 0 0 0 0.000 79413 13 814,655,826 0 114,760 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 4,241,260 381,702 596,228 2,147,380 479,932 0 7,846,502 XXX 0 0 0 8,397,848 19,254,580 27,652,428 XXX XXX XXX 814,770,586 22,513,444 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 (Continued) Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 2 Small Group Employer Individual 10. General and Administrative (G&A) Expenses: 10.1 Direct sales salaries and benefits 10.2 Agents and brokers fees and commissions 10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below) 10.4 Other general and administrative expenses 10.4a Community Benefit Expenditures (informational only) 10.5 Total general and administrative (Lines 10.1 +10.2 + 10.3 + 10.4) 4,571 30,500 (1,766) 62,302 0 95,607 3 Large Group Employer 641,130 4,576,554 113,626 8,363,113 0 13,694,423 4 5 Small Group Employer Individual 1,314,578 1,245,187 389,229 10,544,517 0 13,493,511 0 0 0 0 0 0 Expatriate Plans 6 Large Group Employer 0 0 0 0 0 0 7 8 Small Group 0 0 0 0 0 0 Student Health Plans Large Group 0 0 0 0 0 0 10 11 Government Business (excluded by statute) Other Health Business 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 613,492 11,640,947 593,426 28,910,267 0 41,758,132 234,958 962,852 223,622 7,782,745 0 9,204,176 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 2,808,729 18,456,040 1,318,137 55,662,943 0 78,245,848 0 0 0 0 0 0 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) 12. Income from fees of uninsured plans XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 13. Net investment and other gain/(loss) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 10,781,261 14. Federal income taxes (excluding taxes on Line 1.5 above) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 15. Net gain or (loss) (Lines 11 + 12 + 13 - 14) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 16. ICD-10 Implementation Expenses (informational only; already included in general expenses and line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16. 16a ICD-10 Implementation Expenses (informational only; already included in line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (348,722) 12,125,404 5,862,272 0 0 0 0 0 0 (3,364,340) 8,042,711 6,410,885 28,728,210 XXX 2,808,729 18,456,040 1,318,137 55,662,943 0 78,245,848 28,728,210 0 (622,296) 40,131,767 XXX 0 10,781,261 XXX (622,296) XXX 40,131,767 OTHER INDICATORS: 216-2.MI 1. Number of certificates/policies 105 15,461 28,867 0 0 0 0 0 0 0 250,134 102,214 396,781 0 396,781 2. Number of Covered Lives 219 29,709 54,780 0 0 0 0 0 0 0 375,829 102,214 562,751 0 562,751 3. Number of Groups 2,899 700 0 0 0 0 0 0 2,578 0 6,177 0 6,177 4. Member Months 358,875 652,630 0 0 0 0 0 0 4,577,389 1,247,927 6,839,379 0 6,839,379 XXX 2,558 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ XXX 0 ] If yes, show the amount of premiums and claims included. Premiums $ 0 Claims $ 0 AFFORDABLE CARE ACT (ACA) RECEIPTS, PAYMENTS, RECEIVABLES and PAYABLES Current Year Prior Year Comprehensive Health Coverage Comprehensive Health Coverage 1 2 3 4 Small Group Small Group Employer Plans Employer Plans Individual Plans Individual Plans ACA Receivables and Payables 1. Permanent ACA Risk Adjustment Program 1.0 Premium adjustments receivable/(payable) 2. Transitional ACA Reinsurance Program 2.0 Total amounts recoverable for claims (paid & unpaid) 0 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 0 0 0 0 272,103 356,654 (368,893) (3,446,426) XXX 416,367 0 (972,847) XXX 0 0 0 0 ACA Receipts and Payments 4. Permanent ACA Risk Adjustment Program 4.0 Premium adjustments receipts/(payments) 5. Transitional ACA Reinsurance Program 5.0 Amounts received for claims 0 6. Temporary ACA Risk Corridors Program 6.1 Retrospective premium received 6.2 Rate credits or policy experience refunds paid 0 0 XXX (53,486) 0 0 0 0 0 (1,884,438) XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF 185 Asylum Street Hartford, CT 061033408 Michigan DURING THE YEAR Comprehensive Health Coverage 1 2 3 Individual Small Group Employer Small Group Employer Individual Expatriate Plans: 7 8 6 Large Group Employer Small Group 10 11 Government Business (excluded by statute) Other Health Business 9 Student Health Plans Large Group 79413 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.MI Health Premiums Earned: 573,181 149,546,293 1.1 Direct premiums written 0 72,997 1.2 Unearned premium prior year 0 12,806 1.3 Unearned premium current year 0 60,191 1.4 Change in unearned premium (Lines 1.2 - 1.3) 129 5,885,112 1.5 Paid rate credits 0 6,038,848 1.6 Reserve for rate credits current year 0 5,790,251 1.7 Reserve for rate credits prior year 0 248,597 1.8 Change in reserve for rate credits (Lines 1.6 - 1.7) 0 12,857 1.9 Premium balances written off 0 0 1.10 Group conversion charge 573,181 149,593,627 1.11 Total direct premiums earned (Lines 1.1 + 1.4 - 1.9 + 1.10) 0 0 1.12 Assumed premiums earned from non-affiliates 0 955 1.13 Net Assumed less Ceded premiums earned from affiliates 0 0 1.14 Ceded premiums earned to non-affiliates 0 12,857 1.15 Other Adjustments due to MLR calculation - Premiums 573,052 143,473,730 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 818,639 102,423,104 2.1 Paid claims during the year 5 14,377,640 2.2 Direct claim liability current year 7 16,379,265 2.3 Direct claim liability prior year 0 268,724 2.4 Direct claim reserves current year 0 333,400 2.5 Direct claim reserves prior year 0 0 2.6 Direct contract reserves current year 0 0 2.7 Direct contract reserves prior year 129 5,885,112 2.8 Paid rate credits 0 6,038,848 2.9 Reserve for rate credits current year 0 5,790,251 2.10 Reserve for rate credits prior year 0 53,466 2.11 Incurred medical incentive pools and bonuses (Lines 2.11a + 2.11b - 2.11c) 0 19,043 2.11a Paid medical incentive pools and bonuses current year 0 82,956 2.11b Accrued medical incentive pools and bonuses current year 0 48,533 2.11c Accrued medical incentive pools and bonuses prior year 0 (426,995) 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 0 3,091,113 2.12a Healthcare receivables current year 0 3,518,107 2.12b Healthcare receivables prior year 0 0 2.13 Group conversion charge 0 0 2.14 Multi-option coverage blended rate adjustment 2.15 Total incurred claims (Lines 2.1 + 2.2 - 2.3 + 2.4 - 2.5 + 2.6 - 2.7 + 2.8 + 2.9 818,765 106,970,972 2.10 + 2.11 - 2.12 + 2.13 + 2.14) 0 0 2.16 Assumed incurred claims from non-affiliates 0 83,136 2.17 Net assumed less ceded incurred claims from affiliates 0 0 2.18 Ceded incurred claims to non-affiliates 0 0 2.19 Other adjustments due to MLR calculation - Claims 818,636 100,920,399 2.20 Net Incurred Claims (Lines 2.15 - 2.8 - 2.9 + 2.10 + 2.16 + 2.17 - 2.18 + 2.19) 3. Fraud and Abuse Recoveries that Reduced PAID Claims in Line 2.1 above 0 2,206 (informational only) 11,481,828 for stand-alone dental and $ (a) Column 13, Line 1.1 includes direct written premium of $ Large Group Employer 4 Business Subject to MLR Mini-Med Plans 5 (LOCATION) NAIC Company Code 2018 267,141,544 34 (70,000) 70,034 65 (194) 0 (194) 1,126,679 0 266,084,899 0 (125) 31,796,410 1,126,679 235,415,172 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4,455,177 0 0 4,455,177 217,902,062 30,121,530 27,097,006 642,728 531,686 0 0 65 (194) 0 81,625 49,401 194,895 162,670 428,913 5,865,959 5,437,046 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (42,522) (3,515) (45,948) 0 0 0 0 0 0 0 0 0 0 0 (44) 0 44 0 0 220,690,211 0 (190,161) 26,462,151 0 194,038,028 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (44) 0 8,656,675 0 0 8,656,631 64,614 0 0 18,722,429 for stand-alone vision policies. 0 0 0 0 0 294,068,494 593,701 622,347 (28,646) (2,147,892) 257,318 259,553 (2,235) (240,375) 0 294,280,223 0 0 474,565 (240,375) 295,715,410 105,526,048 0 0 0 5,830,852 2,160,183 5,801,933 (3,641,750) 1,402,151 0 104,123,897 0 0 0 1,402,151 103,336,946 816,855,560 666,733 565,153 101,579 9,568,266 8,456,155 11,851,738 (3,395,583) 2,301,313 0 814,655,826 0 4,456,006 32,270,975 2,301,313 782,969,487 227,617,739 31,300,080 30,305,176 9,031,090 8,003,654 411,724 146,347 (2,147,892) 257,318 259,553 0 0 0 0 15,158 15,152 (6) 0 0 74,920,058 2,805,804 6,761,981 0 0 0 0 5,830,852 2,160,183 5,801,933 0 0 1,509,392 1,509,392 (1,880,334) 30,971,078 32,851,413 0 0 623,639,080 78,601,545 80,497,487 9,942,541 8,868,741 411,724 146,347 9,568,266 8,456,155 11,851,738 135,091 68,444 1,787,243 1,720,595 (1,863,302) 39,943,302 41,806,605 0 0 227,740,171 0 0 486,408 0 229,403,891 75,033,317 0 0 0 0 72,844,216 631,253,393 0 8,549,650 26,948,558 0 606,681,801 0 239,115 305,935 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF Michigan DURING THE YEAR All Expenses 1 Improve Health Outcomes 1. Individual Comprehensive Coverage Expenses: 32,726 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 2,365 for affiliated services) 1.3 EDP Equipment and Software (incl $ 227 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 25 for affiliated services) 1.5 Accreditation and Certification (incl $ 74,205 for affiliated services) 1.6 Other Expenses (incl $ 1.7 Subtotal before Reimbursements and Taxes (Lines 1.1 to 1.6) 1.8 Reimbursements by uninsured plans and fiscal intermediaries 1.9 Taxes, Licenses and Fees (in total, for tying purposes) 1.10 Total (1.7 to 1.9) 1.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 2. 216-4.MI Small Group Comprehensive Coverage Expenses: 4,163,749 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 296,080 for affiliated services) 2.3 EDP Equipment and Software (incl $ 28,420 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 3,086 for affiliated services) 2.5 Accreditation and Certification (incl $ 9,512,615 for affiliated services) 2.6 Other Expenses (incl $ 2.7 Subtotal before Reimbursements and Taxes (Lines 2.1 to 2.6) 2.8 Reimbursements by uninsured plans and fiscal intermediaries 2.9 Taxes, Licenses and Fees (in total, for tying purposes) 2.10 Total (2.7 to 2.9) 2.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 3. Large Group Comprehensive Coverage Expenses: 6,711,446 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 454,611 for affiliated services) 3.3 EDP Equipment and Software (incl $ 43,637 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 4,738 for affiliated services) 3.5 Accreditation and Certification (incl $ 15,130,234 for affiliated services) 3.6 Other Expenses (incl $ 3.7 Subtotal before Reimbursements and Taxes (Lines 3.1 to 3.6) 3.8 Reimbursements by uninsured plans and fiscal intermediaries 3.9 Taxes, Licenses and Fees (in total, for tying purposes) 3.10 Total (3.7 to 3.9) 3.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 185 Asylum Street Hartford, CT 061033408 0 0 0 0 0 4,585 4,585 0 XXX Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX Total (1 to 5) 0 0 0 0 0 4,585 4,585 0 XXX 0 0 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 0 0 0 0 0 0 0 XXX (LOCATION) NAIC Company Code 2018 XXX 3,751 430 313 30 3 8,389 12,916 0 XXX 8,573 983 716 69 7 19,175 29,523 0 XXX 4,585 0 0 0 0 0 0 0 0 0 4,585 0 12,916 3,692 29,523 0 0 0 0 0 0 1,196,749 1,196,749 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,196,749 1,196,749 0 522,619 160,572 43,641 4,189 455 1,203,710 1,935,186 0 785,468 90,016 65,590 6,296 684 1,756,751 2,704,805 0 XXX 1,196,749 0 0 0 0 0 0 2,128,679 2,128,679 0 XXX 2,128,679 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 1,196,749 0 XXX 1,935,186 518,461 XXX 2,704,805 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,128,679 2,128,679 0 899,762 168,800 75,134 7,212 783 2,066,972 3,218,663 0 1,271,021 145,662 106,136 10,188 1,106 2,842,723 4,376,836 0 2,128,679 0 XXX 3,218,663 940,379 XXX 4,376,836 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 79413 9 10 General Administrative Expenses Total Expenses (6 to 9) 20,401 1,833 1,336 128 14 73,338 97,050 0 15,706 112,756 0 32,726 3,245 2,365 227 25 105,487 144,074 0 15,706 159,780 3,692 2,855,663 316,642 186,849 17,935 1,947 10,156,425 13,535,461 0 2,705,669 16,241,131 0 4,163,749 567,230 296,080 28,420 3,086 14,313,635 19,372,201 0 2,705,669 22,077,870 518,461 4,540,663 418,279 273,341 26,237 2,849 7,755,423 13,016,792 0 4,908,414 17,925,207 0 6,711,446 732,741 454,611 43,637 4,738 14,793,797 22,740,971 0 4,908,414 27,649,385 940,379 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 4. 5. 216-5.MI 6. Individual Mini-Med Plans Expenses: 0 for affiliated services) 4.1 Salaries (including $ 4.2 Outsourced Services 0 for affiliated services) 4.3 EDP Equipment and Software (incl $ 0 for affiliated services) 4.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 4.5 Accreditation and Certification (incl $ 0 for affiliated services) 4.6 Other Expenses (incl $ 4.7 Subtotal before Reimbursements and Taxes (Lines 4.1 to 4.6) 4.8 Reimbursements by uninsured plans and fiscal intermediaries 4.9 Taxes, Licenses and Fees (in total, for tying purposes) 4.10 Total (4.7 to 4.9) 4.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Mini-Med Plans Expenses: 0 for affiliated services) 5.1 Salaries (including $ 5.2 Outsourced Services 0 for affiliated services) 5.3 EDP Equipment and Software (incl $ 0 for affiliated services) 5.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 5.5 Accreditation and Certification (incl $ 0 for affiliated services) 5.6 Other Expenses (incl $ 5.7 Subtotal before Reimbursements and Taxes (Lines 5.1 to 5.6) 5.8 Reimbursements by uninsured plans and fiscal intermediaries 5.9 Taxes, Licenses and Fees (in total, for tying purposes) 5.10 Total (5.7 to 5.9) 5.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Mini-Med Plans Expenses: 0 for affiliated services) 6.1 Salaries (including $ 6.2 Outsourced Services 0 for affiliated services) 6.3 EDP Equipment and Software (incl $ 0 for affiliated services) 6.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 6.5 Accreditation and Certification (incl $ 0 for affiliated services) 6.6 Other Expenses (incl $ 6.7 Subtotal before Reimbursements and Taxes (Lines 6.1 to 6.6) 6.8 Reimbursements by uninsured plans and fiscal intermediaries 6.9 Taxes, Licenses and Fees (in total, for tying purposes) 6.10 Total (6.7 to 6.9) 6.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 7. 8. 216-6.MI 9. Small Group Expatriate Plans Expenses: 0 for affiliated services) 7.1 Salaries (including $ 7.2 Outsourced Services 0 for affiliated services) 7.3 EDP Equipment and Software (incl $ 0 for affiliated services) 7.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 7.5 Accreditation and Certification (incl $ 0 for affiliated services) 7.6 Other Expenses (incl $ 7.7 Subtotal before Reimbursements and Taxes (Lines 7.1 to 7.6) 7.8 Reimbursements by uninsured plans and fiscal intermediaries 7.9 Taxes, Licenses and Fees (in total, for tying purposes) 7.10 Total (7.7 to 7.9) 7.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Expatriate Plans Expenses: 0 for affiliated services) 8.1 Salaries (including $ 8.2 Outsourced Services 0 for affiliated services) 8.3 EDP Equipment and Software (incl $ 0 for affiliated services) 8.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 8.5 Accreditation and Certification (incl $ 0 for affiliated services) 8.6 Other Expenses (incl $ 8.7 Subtotal before Reimbursements and Taxes (Lines 8.1 to 8.6) 8.8 Reimbursements by uninsured plans and fiscal intermediaries 8.9 Taxes, Licenses and Fees (in total, for tying purposes) 8.10 Total (8.7 to 8.9) 8.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Student Health Plans Expenses: 0 for affiliated services) 9.1 Salaries (including $ 9.2 Outsourced Services 0 for affiliated services) 9.3 EDP Equipment and Software (incl $ 0 for affiliated services) 9.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 9.5 Accreditation and Certification (incl $ 0 for affiliated services) 9.6 Other Expenses (incl $ 9.7 Subtotal before Reimbursements and Taxes (Lines 9.1 to 9.6) 9.8 Reimbursements by uninsured plans and fiscal intermediaries 9.9 Taxes, Licenses and Fees (in total, for tying purposes) 9.10 Total (9.7 to 9.9) 9.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 *79413201821624100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes - See Cautionary Statement at http://www.naic.org/documents/committees_e_app_blanks_related_shce_cautionary_statement.pdf) UnitedHealthcare Insurance Company 2. 185 Asylum Street Hartford, CT 061033408 (LOCATION) BUSINESS IN THE STATE OF Minnesota DURING THE YEAR 2018 NAIC Company Code Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 1. 216-1.MN 2. 3. 4. 5. 6. 7. 8. 9. Premium: 1.1 Health premiums earned (From Part 2, Line 1.11) 1.2 Federal high risk pools 1.3 State high risk pools 1.4 Premiums earned including state and federal high risk programs (Lines 1.1 + 1.2 + 1.3) 1.5 Federal taxes and federal assessments 1.6 State insurance, premium and other taxes (Similar local taxes of 27,329 ) $ 1.6a Community Benefit Expenditures (informational only) 1.7 Regulatory authority licenses and fees 1.8 Adjusted Premiums Earned (Lines 1.4 - 1.5 - 1.6 - 1.7) 1.9 Net Assumed less Ceded reinsurance premiums earned 1.10 Other Adjustments due to MLR calculations - Premiums 1.11 Risk Revenue 1.12 Net adjusted premiums earned after reinsurance (Lines 1.8 + 1.9 + 1.10 + 1.11) Claims: 2.1 Incurred claims excluding prescription drugs 2.2 Prescription drugs 2.3 Pharmaceutical rebates 2.4 State stop loss, market stabilization and claim/census based assessments (informational only) Incurred medical incentive pools and bonuses Deductible Fraud and Abuse Detection/Recovery Expenses (for MLR use only) 5.0 Total Incurred Claims (Lines 2.1 + 2.2 - 2.3 + 3) (From Part 2, Line 2.15) 5.1 Net Assumed less Ceded reinsurance claims incurred 5.2 Other Adjustments due to MLR calculations - Claims 5.3 Rebates paid 5.4 Estimated rebates unpaid prior year 5.5 Estimated rebates unpaid current year 5.6 Fee for service and co-pay revenue 5.7 Net incurred claims after reinsurance (Lines 5.0 + 5.1 + 5.2 + 5.3 - 5.4 + 5.5 - 5.6) Improving Health Care Quality Expenses Incurred: 6.1 Improve health outcomes 6.2 Activities to prevent hospital readmissions 6.3 Improve patient safety and reduce medical errors 6.4 Wellness and health promotion activities 6.5 Health Information Technology expenses related to health improvement 6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5) Preliminary Medical Loss Ratio: MLR ((Lines 4 + 5.0 + 6.6 - Footnote 2.0)/Line 1.8 Claims Adjustment Expenses: 8.1 Cost containment expenses not included in quality of care expenses in Line 6.6 8.2 All other claims adjustment expenses 8.3 Total claims adjustment expenses (Lines 8.1 + 8.2) Claims Adjustment Expense Ratio (Line 8.3/Line 1.8) 2 Small Group Employer 3 Large Group Employer 4 5 Small Group Employer Individual Expatriate Plans 6 Large Group Employer 7 11 Government Business (excluded by statute) Other Health Business 9 8 Small Group 10 Student Health Plans Large Group 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 79413 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 0 0 0 352,399 0 (1,934) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 81,265,032 0 16,907 16,111,101 0 0 97,893,543 0 14,973 XXX XXX XXX 165,011 (302,808) 0 8,035 350,465 (4,179,422) 0 0 0 0 0 0 0 0 0 0 0 0 0 (3) 81,281,939 2,468,797 16,111,101 (370,359) 97,908,516 (2,375,761) XXX 1,029,853 0 0 (562,033) 0 0 0 (562,033) (34) 0 0 (8,001) 0 0 0 (8,001) (112) 0 2,030 4,527,970 494,536 0 0 5,022,506 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 18 (14) 0 0 0 (14) 1,513,797 0 26,757 77,272,588 (51,119) 24,058 0 77,245,527 3,495 0 0 16,477,965 0 267,820 0 16,745,785 2,546,999 0 28,804 97,708,474 443,417 291,878 0 98,443,770 XXX XXX XXX XXX XXX 2,546,999 0 28,804 97,708,474 443,417 291,878 0 98,443,770 165,011 0 0 97,893,543 0 14,973 0 0 0 0 97,908,516 (2,375,761) 539,058 0 0 (94) 0 0 2,975,181 29,566 5,887 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 57,236,401 747,947 4,150 (238,013) 39,429,649 22,530,786 60,512,533 40,207,162 22,540,823 XXX XXX XXX 60,512,533 40,207,162 22,540,823 13 0 0 539,058 0 0 0 0 0 0 539,058 0 0 0 (94) 0 0 0 0 0 0 (94) 0 489 0 2,999,349 (36,117) (2,753,798) 0 0 2,753,798 0 2,963,232 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 18 16,660,849 0 0 0 0 0 0 16,660,849 122 489 18 78,179,361 40,401 (2,753,798) 0 0 2,753,798 0 78,219,762 XXX XXX 0 0 109 0 0 57,980,198 76,519 0 XXX XXX XXX 0 58,056,717 122 489 18 78,179,361 40,401 (2,753,798) 0 0 2,753,798 0 78,219,762 0 0 0 0 0 108,549 47,423 36,019 297,032 20,653 0 509,674 XXX 168,412 1.021 682,226 XXX 363,259 1,863,313 2,226,571 0.029 (62,433) 202,798 140,365 0.009 308,845 2,085,166 2,394,010 XXX 1,320 0 0 0 0 0 0 0 0 0 2,819 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,320 (0.961) 0 0.012 2,819 0.663 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 4,161 3,209 7,370 (0.013) 0 0 0 0.000 3,857 15,846 19,704 0.004 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 XXX XXX XXX XXX 0 0 0 0.000 133,427 9,667 5,457 (4,110) 23,972 0 XXX XXX XXX XXX XXX XXX XXX XXX 246,115 57,089 41,475 292,921 44,625 0 0 0 0 0 246,115 57,089 41,475 292,921 44,625 0 682,226 XXX 0 0 0 308,845 2,085,166 2,394,010 XXX XXX XXX SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 (Continued) Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 2 Small Group Employer Individual 10. General and Administrative (G&A) Expenses: 10.1 Direct sales salaries and benefits 10.2 Agents and brokers fees and commissions 10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below) 10.4 Other general and administrative expenses 10.4a Community Benefit Expenditures (informational only) 10.5 Total general and administrative (Lines 10.1 +10.2 + 10.3 + 10.4) 963 0 (2,067) 129,805 0 128,701 3 Large Group Employer 4 5 Small Group Employer Individual 0 0 (40,178) 0 0 (40,178) 1,138 98,967 288 21,493,186 0 21,593,579 32,271 (19,556,828) 0 0 0 0 0 0 Expatriate Plans 6 Large Group Employer 0 0 0 0 0 0 7 8 Small Group 0 0 0 0 0 0 Student Health Plans Large Group 0 0 0 0 0 0 10 11 Government Business (excluded by statute) Other Health Business 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 413,607 1,103,893 182,439 7,048,631 0 8,748,571 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 53,500 322,425 34,192 1,161,911 0 1,572,027 469,209 1,525,285 174,674 29,833,533 0 32,002,700 0 0 0 0 0 0 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) (1,238,483) (1,795,869) (14,854,929) 12. Income from fees of uninsured plans XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 13. Net investment and other gain/(loss) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 14. Federal income taxes (excluding taxes on Line 1.5 above) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX (498,275) XXX (498,275) 15. Net gain or (loss) (Lines 11 + 12 + 13 - 14) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX (13,098,791) XXX (13,098,791) 16. ICD-10 Implementation Expenses (informational only; already included in general expenses and line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16. 16a ICD-10 Implementation Expenses (informational only; already included in line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (14) 7,703,994 XXX 469,209 1,525,285 174,674 29,833,533 0 32,002,700 (14,854,929) 0 1,257,863 XXX 0 1,257,863 OTHER INDICATORS: 216-2.MN 1. Number of certificates/policies 21 0 278 0 0 0 0 0 0 0 236,166 23,808 260,273 0 260,273 2. Number of Covered Lives 43 0 367 0 0 0 0 0 0 0 393,853 23,808 418,071 0 418,071 3. Number of Groups 0 0 0 0 0 0 262 1 272 0 272 4. Member Months 0 0 0 0 0 0 4,815,815 284,017 5,106,914 0 5,106,914 XXX 539 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ 0 9 0 6,543 XXX 0 ] If yes, show the amount of premiums and claims included. Premiums $ 0 Claims $ 0 AFFORDABLE CARE ACT (ACA) RECEIPTS, PAYMENTS, RECEIVABLES and PAYABLES Current Year Prior Year Comprehensive Health Coverage Comprehensive Health Coverage 1 2 3 4 Small Group Small Group Employer Plans Employer Plans Individual Plans Individual Plans ACA Receivables and Payables 1. Permanent ACA Risk Adjustment Program 1.0 Premium adjustments receivable/(payable) 0 2. Transitional ACA Reinsurance Program 2.0 Total amounts recoverable for claims (paid & unpaid) 0 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 0 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 XXX ACA Receipts and Payments 4. Permanent ACA Risk Adjustment Program 4.0 Premium adjustments receipts/(payments) 0 5. Transitional ACA Reinsurance Program 5.0 Amounts received for claims 0 6. Temporary ACA Risk Corridors Program 6.1 Retrospective premium received 6.2 Rate credits or policy experience refunds paid 0 0 XXX 0 0 0 0 0 XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF 185 Asylum Street Hartford, CT 061033408 Minnesota DURING THE YEAR Comprehensive Health Coverage 1 2 3 Individual Small Group Employer Small Group Employer Individual Expatriate Plans: 7 8 6 Large Group Employer Small Group 10 11 Government Business (excluded by statute) Other Health Business 9 Student Health Plans Large Group 79413 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.MN Health Premiums Earned: 165,011 1.1 Direct premiums written 0 1.2 Unearned premium prior year 0 1.3 Unearned premium current year 0 1.4 Change in unearned premium (Lines 1.2 - 1.3) 112 1.5 Paid rate credits 0 1.6 Reserve for rate credits current year 0 1.7 Reserve for rate credits prior year 0 1.8 Change in reserve for rate credits (Lines 1.6 - 1.7) 0 1.9 Premium balances written off 0 1.10 Group conversion charge 165,011 1.11 Total direct premiums earned (Lines 1.1 + 1.4 - 1.9 + 1.10) 0 1.12 Assumed premiums earned from non-affiliates 0 1.13 Net Assumed less Ceded premiums earned from affiliates 0 1.14 Ceded premiums earned to non-affiliates 0 1.15 Other Adjustments due to MLR calculation - Premiums 164,900 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 554,165 2.1 Paid claims during the year 89,967 2.2 Direct claim liability current year 105,186 2.3 Direct claim liability prior year 0 2.4 Direct claim reserves current year 0 2.5 Direct claim reserves prior year 0 2.6 Direct contract reserves current year 0 2.7 Direct contract reserves prior year 112 2.8 Paid rate credits 0 2.9 Reserve for rate credits current year 0 2.10 Reserve for rate credits prior year 0 2.11 Incurred medical incentive pools and bonuses (Lines 2.11a + 2.11b - 2.11c) 0 2.11a Paid medical incentive pools and bonuses current year 0 2.11b Accrued medical incentive pools and bonuses current year 0 2.11c Accrued medical incentive pools and bonuses prior year 0 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 0 2.12a Healthcare receivables current year 0 2.12b Healthcare receivables prior year 0 2.13 Group conversion charge 0 2.14 Multi-option coverage blended rate adjustment 2.15 Total incurred claims (Lines 2.1 + 2.2 - 2.3 + 2.4 - 2.5 + 2.6 - 2.7 + 2.8 + 2.9 539,058 2.10 + 2.11 - 2.12 + 2.13 + 2.14) 0 2.16 Assumed incurred claims from non-affiliates 0 2.17 Net assumed less ceded incurred claims from affiliates 0 2.18 Ceded incurred claims to non-affiliates 0 2.19 Other adjustments due to MLR calculation - Claims 538,947 2.20 Net Incurred Claims (Lines 2.15 - 2.8 - 2.9 + 2.10 + 2.16 + 2.17 - 2.18 + 2.19) 3. Fraud and Abuse Recoveries that Reduced PAID Claims in Line 2.1 above 0 (informational only) 1,207,840 for stand-alone dental and $ (a) Column 13, Line 1.1 includes direct written premium of $ Large Group Employer 4 Business Subject to MLR Mini-Med Plans 5 (LOCATION) NAIC Company Code 2018 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 352,399 0 0 0 (112) 2,753,798 0 2,753,798 0 0 352,399 0 0 (494,536) 0 (1,906,751) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 81,283,603 74,898 69,411 5,486 (1,248,856) 202,101 146,732 55,369 24,058 0 81,265,032 0 0 51,119 24,058 82,431,458 16,378,921 0 0 0 0 1,072,018 1,254,127 (182,109) 267,820 0 16,111,101 0 0 0 267,820 16,561,031 98,179,935 74,898 69,411 5,486 (1,248,856) 4,027,917 1,400,859 2,627,058 291,878 0 97,893,543 0 0 (443,417) 291,878 97,250,637 (94) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 120,673 144,474 15,732 1,645 0 0 0 (112) 2,753,798 0 489 489 0 0 5,887 5,887 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 57,146,419 10,217,884 8,232,676 3,988,657 3,889,732 115,946 171,488 (1,248,856) 202,101 146,732 0 0 27 27 1,325 1,325 0 0 0 10,230,491 1,192,288 476,705 0 0 0 0 0 1,072,018 1,254,127 0 0 0 0 (5,896,885) 5,884,618 11,781,503 0 0 68,051,654 11,644,613 8,830,299 3,990,303 3,889,732 115,946 171,488 (1,248,856) 4,027,917 1,400,859 489 489 27 27 (5,889,674) 5,891,829 11,781,503 0 0 (94) 0 0 0 0 (94) 2,999,349 0 0 36,117 0 209,545 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 57,980,198 0 0 (76,519) 0 59,250,204 16,660,849 0 0 0 0 16,842,959 78,179,361 0 0 (40,401) 0 76,841,560 0 0 0 21,219,959 for stand-alone vision policies. 0 0 0 0 0 0 0 1,844 1,844 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF Minnesota DURING THE YEAR All Expenses 1 Individual Comprehensive Coverage Expenses: 39,638 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 3,232 for affiliated services) 1.3 EDP Equipment and Software (incl $ 310 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 34 for affiliated services) 1.5 Accreditation and Certification (incl $ 87,305 for affiliated services) 1.6 Other Expenses (incl $ 1.7 Subtotal before Reimbursements and Taxes (Lines 1.1 to 1.6) 1.8 Reimbursements by uninsured plans and fiscal intermediaries 1.9 Taxes, Licenses and Fees (in total, for tying purposes) 1.10 Total (1.7 to 1.9) 1.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 2. 216-4.MN 3. Small Group Comprehensive Coverage Expenses: 0 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 0 for affiliated services) 2.3 EDP Equipment and Software (incl $ 0 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 2.5 Accreditation and Certification (incl $ 0 for affiliated services) 2.6 Other Expenses (incl $ 2.7 Subtotal before Reimbursements and Taxes (Lines 2.1 to 2.6) 2.8 Reimbursements by uninsured plans and fiscal intermediaries 2.9 Taxes, Licenses and Fees (in total, for tying purposes) 2.10 Total (2.7 to 2.9) 2.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 0 0 0 0 0 1,320 1,320 0 XXX 3.7 Subtotal before Reimbursements and Taxes (Lines 3.1 to 3.6) 3.8 Reimbursements by uninsured plans and fiscal intermediaries 3.9 Taxes, Licenses and Fees (in total, for tying purposes) 3.10 Total (3.7 to 3.9) 3.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX Total (1 to 5) 0 0 0 0 0 1,320 1,320 0 XXX 0 0 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 0 0 0 0 0 0 0 XXX (LOCATION) NAIC Company Code 2018 XXX 701 1,739 59 6 1 1,567 4,072 0 XXX 904 104 76 7 1 2,022 3,113 0 XXX 1,320 0 0 0 0 0 0 0 0 0 1,320 0 4,072 775 3,113 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX Large Group Comprehensive Coverage Expenses: 6,233,463 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 520,432 for affiliated services) 3.3 EDP Equipment and Software (incl $ 49,955 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 5,424 for affiliated services) 3.5 Accreditation and Certification (incl $ 13,942,671 for affiliated services) 3.6 Other Expenses (incl $ Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions Improve Health Outcomes 1. 185 Asylum Street Hartford, CT 061033408 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,819 2,819 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,819 2,819 0 1,081 124 90 9 1 2,464 3,769 0 4,576 524 382 37 4 10,234 15,756 0 XXX XXX XXX 0 0 0 XXX 2,819 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 2,819 0 XXX 3,769 805 15,756 0 79413 9 10 General Administrative Expenses Total Expenses (6 to 9) 38,033 6,839 3,098 297 32 82,400 130,700 0 1,028,039 1,158,739 0 0 0 0 0 0 0 0 0 (40,211) (40,211) 0 6,227,807 713,593 519,959 49,910 5,419 14,076,487 21,593,176 0 2,499 21,595,675 0 39,638 8,682 3,232 310 34 87,309 139,205 0 1,028,039 1,167,244 775 0 0 0 0 0 0 0 0 (40,211) (40,211) 0 6,233,463 714,242 520,432 49,955 5,424 14,092,004 21,615,520 0 2,499 21,618,019 805 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 4. 5. 216-5.MN 6. Individual Mini-Med Plans Expenses: 0 for affiliated services) 4.1 Salaries (including $ 4.2 Outsourced Services 0 for affiliated services) 4.3 EDP Equipment and Software (incl $ 0 for affiliated services) 4.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 4.5 Accreditation and Certification (incl $ 0 for affiliated services) 4.6 Other Expenses (incl $ 4.7 Subtotal before Reimbursements and Taxes (Lines 4.1 to 4.6) 4.8 Reimbursements by uninsured plans and fiscal intermediaries 4.9 Taxes, Licenses and Fees (in total, for tying purposes) 4.10 Total (4.7 to 4.9) 4.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Mini-Med Plans Expenses: 0 for affiliated services) 5.1 Salaries (including $ 5.2 Outsourced Services 0 for affiliated services) 5.3 EDP Equipment and Software (incl $ 0 for affiliated services) 5.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 5.5 Accreditation and Certification (incl $ 0 for affiliated services) 5.6 Other Expenses (incl $ 5.7 Subtotal before Reimbursements and Taxes (Lines 5.1 to 5.6) 5.8 Reimbursements by uninsured plans and fiscal intermediaries 5.9 Taxes, Licenses and Fees (in total, for tying purposes) 5.10 Total (5.7 to 5.9) 5.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Mini-Med Plans Expenses: 0 for affiliated services) 6.1 Salaries (including $ 6.2 Outsourced Services 0 for affiliated services) 6.3 EDP Equipment and Software (incl $ 0 for affiliated services) 6.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 6.5 Accreditation and Certification (incl $ 0 for affiliated services) 6.6 Other Expenses (incl $ 6.7 Subtotal before Reimbursements and Taxes (Lines 6.1 to 6.6) 6.8 Reimbursements by uninsured plans and fiscal intermediaries 6.9 Taxes, Licenses and Fees (in total, for tying purposes) 6.10 Total (6.7 to 6.9) 6.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 7. 8. 216-6.MN 9. Small Group Expatriate Plans Expenses: 0 for affiliated services) 7.1 Salaries (including $ 7.2 Outsourced Services 0 for affiliated services) 7.3 EDP Equipment and Software (incl $ 0 for affiliated services) 7.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 7.5 Accreditation and Certification (incl $ 0 for affiliated services) 7.6 Other Expenses (incl $ 7.7 Subtotal before Reimbursements and Taxes (Lines 7.1 to 7.6) 7.8 Reimbursements by uninsured plans and fiscal intermediaries 7.9 Taxes, Licenses and Fees (in total, for tying purposes) 7.10 Total (7.7 to 7.9) 7.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Expatriate Plans Expenses: 0 for affiliated services) 8.1 Salaries (including $ 8.2 Outsourced Services 0 for affiliated services) 8.3 EDP Equipment and Software (incl $ 0 for affiliated services) 8.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 8.5 Accreditation and Certification (incl $ 0 for affiliated services) 8.6 Other Expenses (incl $ 8.7 Subtotal before Reimbursements and Taxes (Lines 8.1 to 8.6) 8.8 Reimbursements by uninsured plans and fiscal intermediaries 8.9 Taxes, Licenses and Fees (in total, for tying purposes) 8.10 Total (8.7 to 8.9) 8.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Student Health Plans Expenses: 0 for affiliated services) 9.1 Salaries (including $ 9.2 Outsourced Services 0 for affiliated services) 9.3 EDP Equipment and Software (incl $ 0 for affiliated services) 9.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 9.5 Accreditation and Certification (incl $ 0 for affiliated services) 9.6 Other Expenses (incl $ 9.7 Subtotal before Reimbursements and Taxes (Lines 9.1 to 9.6) 9.8 Reimbursements by uninsured plans and fiscal intermediaries 9.9 Taxes, Licenses and Fees (in total, for tying purposes) 9.10 Total (9.7 to 9.9) 9.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 *79413201821625100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes - See Cautionary Statement at http://www.naic.org/documents/committees_e_app_blanks_related_shce_cautionary_statement.pdf) UnitedHealthcare Insurance Company 2. 185 Asylum Street Hartford, CT 061033408 (LOCATION) BUSINESS IN THE STATE OF Mississippi DURING THE YEAR 2018 NAIC Company Code Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 1. 216-1.MS 2. 3. 4. 5. 6. 7. 8. 9. Premium: 1.1 Health premiums earned (From Part 2, Line 1.11) 1.2 Federal high risk pools 1.3 State high risk pools 1.4 Premiums earned including state and federal high risk programs (Lines 1.1 + 1.2 + 1.3) 1.5 Federal taxes and federal assessments 1.6 State insurance, premium and other taxes (Similar local taxes of 1,194,150 ) $ 1.6a Community Benefit Expenditures (informational only) 1.7 Regulatory authority licenses and fees 1.8 Adjusted Premiums Earned (Lines 1.4 - 1.5 - 1.6 - 1.7) 1.9 Net Assumed less Ceded reinsurance premiums earned 1.10 Other Adjustments due to MLR calculations - Premiums 1.11 Risk Revenue 1.12 Net adjusted premiums earned after reinsurance (Lines 1.8 + 1.9 + 1.10 + 1.11) Claims: 2.1 Incurred claims excluding prescription drugs 2.2 Prescription drugs 2.3 Pharmaceutical rebates 2.4 State stop loss, market stabilization and claim/census based assessments (informational only) Incurred medical incentive pools and bonuses Deductible Fraud and Abuse Detection/Recovery Expenses (for MLR use only) 5.0 Total Incurred Claims (Lines 2.1 + 2.2 - 2.3 + 3) (From Part 2, Line 2.15) 5.1 Net Assumed less Ceded reinsurance claims incurred 5.2 Other Adjustments due to MLR calculations - Claims 5.3 Rebates paid 5.4 Estimated rebates unpaid prior year 5.5 Estimated rebates unpaid current year 5.6 Fee for service and co-pay revenue 5.7 Net incurred claims after reinsurance (Lines 5.0 + 5.1 + 5.2 + 5.3 - 5.4 + 5.5 - 5.6) Improving Health Care Quality Expenses Incurred: 6.1 Improve health outcomes 6.2 Activities to prevent hospital readmissions 6.3 Improve patient safety and reduce medical errors 6.4 Wellness and health promotion activities 6.5 Health Information Technology expenses related to health improvement 6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5) Preliminary Medical Loss Ratio: MLR ((Lines 4 + 5.0 + 6.6 - Footnote 2.0)/Line 1.8 Claims Adjustment Expenses: 8.1 Cost containment expenses not included in quality of care expenses in Line 6.6 8.2 All other claims adjustment expenses 8.3 Total claims adjustment expenses (Lines 8.1 + 8.2) Claims Adjustment Expense Ratio (Line 8.3/Line 1.8) 2 Small Group Employer 3 Large Group Employer 4 5 Small Group Employer Individual Expatriate Plans 6 Large Group Employer 7 11 Government Business (excluded by statute) Other Health Business 9 8 Small Group 10 Student Health Plans Large Group 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 79413 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 191,731 0 (305) 27,601,243 0 (140) 123,582,475 0 (5,135) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 83,555,333 0 42,199 72,062,325 0 0 306,993,107 0 36,619 XXX XXX XXX 191,426 9,378 27,601,103 589,895 123,577,340 4,563,315 0 0 0 0 0 0 0 0 0 0 0 0 0 174,852 83,597,532 1,066,965 72,062,325 3,261,761 307,029,726 9,666,166 XXX 2,688 0 144 179,215 0 0 0 179,215 733,784 0 2,854 26,274,570 (40) 1,409 0 26,275,939 3,279,307 0 13,438 115,721,280 (18,393,707) 4 0 97,327,576 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 32,169 0 0 (207,020) 0 0 0 (207,020) 1,603,422 0 (16,836) 80,943,980 (233,477) 16,198 0 80,726,701 438,181 0 0 68,362,383 0 1,371,165 0 69,733,547 6,089,552 0 (400) 291,274,408 (18,627,224) 1,388,775 0 274,035,959 XXX XXX XXX XXX XXX 6,089,552 0 (400) 291,274,408 (18,627,224) 1,388,775 0 274,035,959 149,174 20,274 3,592 18,484,981 5,576,373 1,942,803 83,129,815 23,058,810 7,786,458 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (860,073) (18,330) (826) 62,982,950 44,515 14,196 19,482,278 76,823,484 43,443,379 183,369,126 105,505,126 53,189,603 XXX XXX XXX 183,369,126 105,505,126 53,189,603 0 0 0 165,856 0 0 0 0 0 0 165,856 1,350 20,848 2,801 22,139,398 13,071 (9,457) 27,558 18,082 0 0 22,152,489 5,054 230,950 21,677 98,633,117 (15,311,975) (1,707,769) 4,031,934 4,606,777 2,282,970 0 83,321,500 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (877,577) 0 0 XXX XXX XXX 0 (877,577) 0 0 0 63,013,269 (380,605) 34 XXX XXX XXX 0 62,632,698 0 12,482 0 52,874,865 0 (2,767,887) 0 0 2,767,887 0 52,874,865 6,404 264,280 24,478 235,948,929 (15,679,509) (4,485,078) 4,059,492 4,624,859 5,050,857 0 220,269,831 XXX XXX 6,404 264,280 24,478 235,948,929 (15,679,509) (4,485,078) 4,059,492 4,624,859 5,050,857 0 220,269,831 1,534 0 0 0 0 220,810 0 0 0 0 988,660 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,534 0.934 220,810 0.851 988,660 0.861 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 2,307 5,855 8,162 0.046 379,276 610,842 990,118 0.038 1,415,209 2,100,743 3,515,951 0.030 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0 0 253,354 156,165 119,075 560,118 55,615 0 XXX 0 0 0 0.000 195,960 71,888 237,975 (1,339) 203,908 1,660,317 228,054 357,050 558,780 259,523 1,144,327 XXX 708,392 0.784 3,063,723 XXX 123,309 1,270,609 1,393,918 0.017 1,492,713 4,054,727 5,547,440 0.081 3,412,813 8,042,777 11,455,590 XXX 306,993,107 0 36,619 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 1,660,317 228,054 357,050 558,780 259,523 0 3,063,723 XXX 0 0 0 3,412,813 8,042,777 11,455,590 XXX XXX XXX 307,029,726 9,666,166 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 (Continued) Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 2 Small Group Employer Individual 10. General and Administrative (G&A) Expenses: 10.1 Direct sales salaries and benefits 10.2 Agents and brokers fees and commissions 10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below) 10.4 Other general and administrative expenses 10.4a Community Benefit Expenditures (informational only) 10.5 Total general and administrative (Lines 10.1 +10.2 + 10.3 + 10.4) 563 4,576 (1,132) 17,969 0 21,975 3 Large Group Employer 121,783 857,338 9,643 1,569,618 0 2,558,382 4 5 Small Group Employer Individual 607,403 1,537,687 43,007 3,514,259 0 5,702,357 0 0 0 0 0 0 Expatriate Plans 6 Large Group Employer 0 0 0 0 0 0 7 8 Small Group 0 0 0 0 0 0 Student Health Plans Large Group 0 0 0 0 0 0 10 11 Government Business (excluded by statute) Other Health Business 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 162,135 3,775,106 155,614 8,030,496 0 12,123,351 97,466 1,005,216 99,643 5,133,814 0 6,336,139 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 989,349 7,179,924 306,775 18,266,156 0 26,742,204 0 0 0 0 0 0 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) 12. Income from fees of uninsured plans XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 13. Net investment and other gain/(loss) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 14. Federal income taxes (excluding taxes on Line 1.5 above) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 15. Net gain or (loss) (Lines 11 + 12 + 13 - 14) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 16. ICD-10 Implementation Expenses (informational only; already included in general expenses and line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16. 16a ICD-10 Implementation Expenses (informational only; already included in line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (18,312) 354,141 3,799,108 0 0 0 0 0 0 670,556 3,432,407 4,266,711 12,504,611 XXX 989,349 7,179,924 306,775 18,266,156 0 26,742,204 XXX 12,504,611 0 4,235,649 (663,424) 17,403,684 XXX 0 4,235,649 XXX (663,424) XXX 17,403,684 OTHER INDICATORS: 216-2.MS 1. Number of certificates/policies 39 4,592 17,566 0 0 0 0 0 0 0 74,345 42,576 139,118 0 139,118 2. Number of Covered Lives 51 7,461 26,111 0 0 0 0 0 0 0 102,828 42,576 179,027 0 179,027 3. Number of Groups 645 203 0 0 0 0 0 0 812 0 1,660 0 1,660 4. Member Months 88,879 291,650 0 0 0 0 0 0 1,255,657 506,291 2,143,018 0 2,143,018 XXX 541 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ XXX 0 ] If yes, show the amount of premiums and claims included. Premiums $ 0 Claims $ 0 AFFORDABLE CARE ACT (ACA) RECEIPTS, PAYMENTS, RECEIVABLES and PAYABLES Current Year Prior Year Comprehensive Health Coverage Comprehensive Health Coverage 1 2 3 4 Small Group Small Group Employer Plans Employer Plans Individual Plans Individual Plans ACA Receivables and Payables 1. Permanent ACA Risk Adjustment Program 1.0 Premium adjustments receivable/(payable) 2. Transitional ACA Reinsurance Program 2.0 Total amounts recoverable for claims (paid & unpaid) 0 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 0 0 (46,113) (943,716) XXX 321,537 0 0 0 (81,153) XXX 0 0 0 0 ACA Receipts and Payments 4. Permanent ACA Risk Adjustment Program 4.0 Premium adjustments receipts/(payments) 5. Transitional ACA Reinsurance Program 5.0 Amounts received for claims 0 6. Temporary ACA Risk Corridors Program 6.1 Retrospective premium received 6.2 Rate credits or policy experience refunds paid 0 0 276,356 (391,589) XXX (62,212) 0 0 0 0 0 606,537 XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF 185 Asylum Street Hartford, CT 061033408 Mississippi DURING THE YEAR Comprehensive Health Coverage 1 2 3 Individual Small Group Employer Large Group Employer Small Group Employer Individual Expatriate Plans: 7 8 6 Large Group Employer Small Group 10 11 Government Business (excluded by statute) Other Health Business 9 Student Health Plans Large Group 79413 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.MS Health Premiums Earned: 191,731 27,593,409 1.1 Direct premiums written 0 18,146 1.2 Unearned premium prior year 0 8,903 1.3 Unearned premium current year 0 9,243 1.4 Change in unearned premium (Lines 1.2 - 1.3) 29,285 27,538 1.5 Paid rate credits 0 0 1.6 Reserve for rate credits current year 0 18,082 1.7 Reserve for rate credits prior year 0 (18,082) 1.8 Change in reserve for rate credits (Lines 1.6 - 1.7) 0 1,409 1.9 Premium balances written off 0 0 1.10 Group conversion charge 191,731 27,601,243 1.11 Total direct premiums earned (Lines 1.1 + 1.4 - 1.9 + 1.10) 0 0 1.12 Assumed premiums earned from non-affiliates 0 (40) 1.13 Net Assumed less Ceded premiums earned from affiliates 0 0 1.14 Ceded premiums earned to non-affiliates 0 1,409 1.15 Other Adjustments due to MLR calculation - Premiums 162,446 27,593,156 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 154,944 20,940,335 2.1 Paid claims during the year 6,041 3,096,971 2.2 Direct claim liability current year 2,636 1,722,608 2.3 Direct claim liability prior year 985 91,447 2.4 Direct claim reserves current year 556 37,286 2.5 Direct claim reserves prior year 68,468 0 2.6 Direct contract reserves current year 89,965 0 2.7 Direct contract reserves prior year 29,285 27,538 2.8 Paid rate credits 0 0 2.9 Reserve for rate credits current year 0 18,082 2.10 Reserve for rate credits prior year 0 20,848 2.11 Incurred medical incentive pools and bonuses (Lines 2.11a + 2.11b - 2.11c) 0 17,273 2.11a Paid medical incentive pools and bonuses current year 0 9,172 2.11b Accrued medical incentive pools and bonuses current year 0 5,597 2.11c Accrued medical incentive pools and bonuses prior year 710 259,764 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 710 769,373 2.12a Healthcare receivables current year 0 509,609 2.12b Healthcare receivables prior year 0 0 2.13 Group conversion charge 0 0 2.14 Multi-option coverage blended rate adjustment 2.15 Total incurred claims (Lines 2.1 + 2.2 - 2.3 + 2.4 - 2.5 + 2.6 - 2.7 + 2.8 + 2.9 165,856 22,139,398 2.10 + 2.11 - 2.12 + 2.13 + 2.14) 0 0 2.16 Assumed incurred claims from non-affiliates 0 13,071 2.17 Net assumed less ceded incurred claims from affiliates 0 0 2.18 Ceded incurred claims to non-affiliates 0 0 2.19 Other adjustments due to MLR calculation - Claims 136,571 22,143,013 2.20 Net Incurred Claims (Lines 2.15 - 2.8 - 2.9 + 2.10 + 2.16 + 2.17 - 2.18 + 2.19) 3. Fraud and Abuse Recoveries that Reduced PAID Claims in Line 2.1 above 0 2,801 (informational only) 4,837,469 for stand-alone dental and $ (a) Column 13, Line 1.1 includes direct written premium of $ 4 Business Subject to MLR Mini-Med Plans 5 (LOCATION) NAIC Company Code 2018 123,582,479 0 0 0 4,030,324 2,282,970 4,606,777 (2,323,807) 4 0 123,582,475 0 473 18,394,180 4 103,482,254 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 94,556,934 12,423,117 10,315,318 267,062 236,464 0 0 4,030,324 2,282,970 4,606,777 230,950 99,362 141,999 10,410 (319) 3,133,230 3,133,549 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (1,682,321) 920,401 202,517 0 0 0 0 0 0 0 0 0 0 0 (86,861) (71,564) 15,297 0 0 98,633,117 0 (10,808) 15,301,167 0 81,614,625 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (877,577) 0 0 0 0 (877,577) 21,677 0 0 2,809,918 for stand-alone vision policies. 0 0 0 0 0 83,570,723 1,355 548 807 (2,086,002) 167,753 129,729 38,024 16,198 0 83,555,333 0 0 233,477 16,198 85,386,032 73,433,489 0 0 0 3,406,860 4,048,939 3,393,617 655,323 1,371,165 0 72,062,325 0 0 0 1,371,165 69,371,307 308,371,831 19,502 9,451 10,050 5,408,005 6,499,663 8,148,205 (1,648,543) 1,388,775 0 306,993,107 0 433 18,627,657 1,388,775 285,995,195 64,717,919 8,694,850 8,656,468 3,550,379 3,131,560 47,096 157,048 (2,086,002) 167,753 129,729 0 0 0 0 3,921 3,921 0 0 0 48,723,112 3,588,070 3,435,488 60,602 9,063 0 0 3,406,860 4,048,939 3,393,617 12,482 12,297 185 0 127,033 15,909,284 15,782,251 0 0 227,410,923 28,729,450 24,335,034 3,970,473 3,414,929 115,564 247,013 5,408,005 6,499,663 8,148,205 264,280 128,932 151,356 16,008 304,249 19,744,955 19,440,706 0 0 63,013,269 0 0 380,605 0 64,680,642 52,874,865 0 0 0 0 48,812,683 235,948,929 0 2,263 15,681,772 0 216,509,957 0 0 24,478 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF Mississippi DURING THE YEAR All Expenses 1 Improve Health Outcomes 1. Individual Comprehensive Coverage Expenses: 9,188 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 396 for affiliated services) 1.3 EDP Equipment and Software (incl $ 38 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 4 for affiliated services) 1.5 Accreditation and Certification (incl $ 11,507 for affiliated services) 1.6 Other Expenses (incl $ 1.7 Subtotal before Reimbursements and Taxes (Lines 1.1 to 1.6) 1.8 Reimbursements by uninsured plans and fiscal intermediaries 1.9 Taxes, Licenses and Fees (in total, for tying purposes) 1.10 Total (1.7 to 1.9) 1.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 2. 216-4.MS 3. 0 0 0 0 0 1,534 1,534 0 XXX Small Group Comprehensive Coverage Expenses: 796,488 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 56,707 for affiliated services) 2.3 EDP Equipment and Software (incl $ 5,443 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 591 for affiliated services) 2.5 Accreditation and Certification (incl $ 1,856,510 for affiliated services) 2.6 Other Expenses (incl $ 2.7 Subtotal before Reimbursements and Taxes (Lines 2.1 to 2.6) 2.8 Reimbursements by uninsured plans and fiscal intermediaries 2.9 Taxes, Licenses and Fees (in total, for tying purposes) 2.10 Total (2.7 to 2.9) 2.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX Total (1 to 5) 0 0 0 0 0 1,534 1,534 0 XXX 0 0 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 0 0 0 0 0 0 0 XXX (LOCATION) NAIC Company Code 2018 XXX 624 177 52 5 1 1,395 2,254 0 XXX 2,509 136 96 9 1 3,049 5,800 0 XXX 1,534 0 0 0 0 0 0 0 0 0 1,534 0 2,254 455 5,800 0 0 0 0 0 0 220,810 220,810 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 220,810 220,810 0 101,324 24,024 8,461 812 88 233,214 367,923 0 173,877 19,927 14,520 1,394 151 388,887 598,755 0 XXX Large Group Comprehensive Coverage Expenses: 2,988,739 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 200,677 for affiliated services) 3.3 EDP Equipment and Software (incl $ 19,263 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 2,092 for affiliated services) 3.5 Accreditation and Certification (incl $ 6,670,105 for affiliated services) 3.6 Other Expenses (incl $ 3.7 Subtotal before Reimbursements and Taxes (Lines 3.1 to 3.6) 3.8 Reimbursements by uninsured plans and fiscal intermediaries 3.9 Taxes, Licenses and Fees (in total, for tying purposes) 3.10 Total (3.7 to 3.9) 3.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 185 Asylum Street Hartford, CT 061033408 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX XXX XXX 220,810 0 0 0 0 0 0 0 0 0 220,810 0 367,923 98,405 598,755 0 0 0 0 0 0 988,660 988,660 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 988,660 988,660 0 401,422 8,105 33,521 3,218 349 923,422 1,370,036 0 598,778 68,621 50,001 4,799 521 1,339,206 2,061,926 0 988,660 0 XXX 1,370,036 419,035 XXX 2,061,926 0 XXX XXX XXX 0 0 0 XXX 988,660 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 79413 9 10 General Administrative Expenses Total Expenses (6 to 9) 6,056 331 248 18 3 16,413 23,067 0 1,849 24,916 0 9,188 645 396 32 4 22,391 32,655 0 1,849 34,504 455 521,288 52,698 33,726 3,237 352 1,928,820 2,540,120 0 778,340 3,318,460 0 796,488 96,648 56,707 5,443 591 2,771,731 3,727,608 0 778,340 4,505,948 98,405 1,988,540 196,955 117,155 11,246 1,221 3,304,528 5,619,645 0 3,459,447 9,079,092 0 2,988,739 273,681 200,677 19,263 2,092 6,555,815 10,040,266 0 3,459,447 13,499,713 419,035 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 4. 5. 216-5.MS 6. Individual Mini-Med Plans Expenses: 0 for affiliated services) 4.1 Salaries (including $ 4.2 Outsourced Services 0 for affiliated services) 4.3 EDP Equipment and Software (incl $ 0 for affiliated services) 4.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 4.5 Accreditation and Certification (incl $ 0 for affiliated services) 4.6 Other Expenses (incl $ 4.7 Subtotal before Reimbursements and Taxes (Lines 4.1 to 4.6) 4.8 Reimbursements by uninsured plans and fiscal intermediaries 4.9 Taxes, Licenses and Fees (in total, for tying purposes) 4.10 Total (4.7 to 4.9) 4.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Mini-Med Plans Expenses: 0 for affiliated services) 5.1 Salaries (including $ 5.2 Outsourced Services 0 for affiliated services) 5.3 EDP Equipment and Software (incl $ 0 for affiliated services) 5.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 5.5 Accreditation and Certification (incl $ 0 for affiliated services) 5.6 Other Expenses (incl $ 5.7 Subtotal before Reimbursements and Taxes (Lines 5.1 to 5.6) 5.8 Reimbursements by uninsured plans and fiscal intermediaries 5.9 Taxes, Licenses and Fees (in total, for tying purposes) 5.10 Total (5.7 to 5.9) 5.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Mini-Med Plans Expenses: 0 for affiliated services) 6.1 Salaries (including $ 6.2 Outsourced Services 0 for affiliated services) 6.3 EDP Equipment and Software (incl $ 0 for affiliated services) 6.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 6.5 Accreditation and Certification (incl $ 0 for affiliated services) 6.6 Other Expenses (incl $ 6.7 Subtotal before Reimbursements and Taxes (Lines 6.1 to 6.6) 6.8 Reimbursements by uninsured plans and fiscal intermediaries 6.9 Taxes, Licenses and Fees (in total, for tying purposes) 6.10 Total (6.7 to 6.9) 6.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 7. 8. 216-6.MS 9. Small Group Expatriate Plans Expenses: 0 for affiliated services) 7.1 Salaries (including $ 7.2 Outsourced Services 0 for affiliated services) 7.3 EDP Equipment and Software (incl $ 0 for affiliated services) 7.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 7.5 Accreditation and Certification (incl $ 0 for affiliated services) 7.6 Other Expenses (incl $ 7.7 Subtotal before Reimbursements and Taxes (Lines 7.1 to 7.6) 7.8 Reimbursements by uninsured plans and fiscal intermediaries 7.9 Taxes, Licenses and Fees (in total, for tying purposes) 7.10 Total (7.7 to 7.9) 7.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Expatriate Plans Expenses: 0 for affiliated services) 8.1 Salaries (including $ 8.2 Outsourced Services 0 for affiliated services) 8.3 EDP Equipment and Software (incl $ 0 for affiliated services) 8.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 8.5 Accreditation and Certification (incl $ 0 for affiliated services) 8.6 Other Expenses (incl $ 8.7 Subtotal before Reimbursements and Taxes (Lines 8.1 to 8.6) 8.8 Reimbursements by uninsured plans and fiscal intermediaries 8.9 Taxes, Licenses and Fees (in total, for tying purposes) 8.10 Total (8.7 to 8.9) 8.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Student Health Plans Expenses: 0 for affiliated services) 9.1 Salaries (including $ 9.2 Outsourced Services 0 for affiliated services) 9.3 EDP Equipment and Software (incl $ 0 for affiliated services) 9.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 9.5 Accreditation and Certification (incl $ 0 for affiliated services) 9.6 Other Expenses (incl $ 9.7 Subtotal before Reimbursements and Taxes (Lines 9.1 to 9.6) 9.8 Reimbursements by uninsured plans and fiscal intermediaries 9.9 Taxes, Licenses and Fees (in total, for tying purposes) 9.10 Total (9.7 to 9.9) 9.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 *79413201821626100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes - See Cautionary Statement at http://www.naic.org/documents/committees_e_app_blanks_related_shce_cautionary_statement.pdf) UnitedHealthcare Insurance Company 2. 185 Asylum Street Hartford, CT 061033408 (LOCATION) BUSINESS IN THE STATE OF Missouri DURING THE YEAR 2018 NAIC Company Code Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 1. 216-1.MO 2. 3. 4. 5. 6. 7. 8. 9. Premium: 1.1 Health premiums earned (From Part 2, Line 1.11) 1.2 Federal high risk pools 1.3 State high risk pools 1.4 Premiums earned including state and federal high risk programs (Lines 1.1 + 1.2 + 1.3) 1.5 Federal taxes and federal assessments 1.6 State insurance, premium and other taxes (Similar local taxes of 172,664 ) $ 1.6a Community Benefit Expenditures (informational only) 1.7 Regulatory authority licenses and fees 1.8 Adjusted Premiums Earned (Lines 1.4 - 1.5 - 1.6 - 1.7) 1.9 Net Assumed less Ceded reinsurance premiums earned 1.10 Other Adjustments due to MLR calculations - Premiums 1.11 Risk Revenue 1.12 Net adjusted premiums earned after reinsurance (Lines 1.8 + 1.9 + 1.10 + 1.11) Claims: 2.1 Incurred claims excluding prescription drugs 2.2 Prescription drugs 2.3 Pharmaceutical rebates 2.4 State stop loss, market stabilization and claim/census based assessments (informational only) Incurred medical incentive pools and bonuses Deductible Fraud and Abuse Detection/Recovery Expenses (for MLR use only) 5.0 Total Incurred Claims (Lines 2.1 + 2.2 - 2.3 + 3) (From Part 2, Line 2.15) 5.1 Net Assumed less Ceded reinsurance claims incurred 5.2 Other Adjustments due to MLR calculations - Claims 5.3 Rebates paid 5.4 Estimated rebates unpaid prior year 5.5 Estimated rebates unpaid current year 5.6 Fee for service and co-pay revenue 5.7 Net incurred claims after reinsurance (Lines 5.0 + 5.1 + 5.2 + 5.3 - 5.4 + 5.5 - 5.6) Improving Health Care Quality Expenses Incurred: 6.1 Improve health outcomes 6.2 Activities to prevent hospital readmissions 6.3 Improve patient safety and reduce medical errors 6.4 Wellness and health promotion activities 6.5 Health Information Technology expenses related to health improvement 6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5) Preliminary Medical Loss Ratio: MLR ((Lines 4 + 5.0 + 6.6 - Footnote 2.0)/Line 1.8 Claims Adjustment Expenses: 8.1 Cost containment expenses not included in quality of care expenses in Line 6.6 8.2 All other claims adjustment expenses 8.3 Total claims adjustment expenses (Lines 8.1 + 8.2) Claims Adjustment Expense Ratio (Line 8.3/Line 1.8) 2 Small Group Employer 3 Large Group Employer 4 5 Small Group Employer Individual Expatriate Plans 6 Large Group Employer 7 11 Government Business (excluded by statute) Other Health Business 9 8 Small Group 10 Student Health Plans Large Group 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 79413 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 4,706,016 0 (835) 439,170,371 0 (11,148) 652,982,074 0 (60,936) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 252,159,334 0 106,916 210,272,444 0 0 1,559,290,239 0 33,997 XXX XXX XXX 1,559,290,239 0 33,997 4,705,181 73,517 439,159,223 23,793,081 652,921,138 21,957,425 0 0 0 0 0 0 0 0 0 0 0 0 0 2,639,926 252,266,250 4,306,528 210,272,444 6,821,622 1,559,324,235 59,592,099 XXX 285,821 1,559,324,235 59,877,920 10,867 0 355 4,620,441 10,754 0 0 4,631,195 1,179,683 0 4,759 414,181,700 0 128,881 0 414,310,581 2,396,764 0 19,163 628,547,786 (80,831,629) 474,867 0 548,191,024 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (6,702) 0 0 (2,633,223) 317,900,563 0 0 315,267,340 3,759,641 0 (45,951) 244,246,032 (274,423) 10,869 0 243,982,478 22,778 0 0 203,428,044 3,341,596 1,974,521 0 208,744,162 7,363,030 0 (21,674) 1,492,390,780 240,146,861 2,589,139 0 1,735,126,781 0 0 0 XXX XXX XXX XXX XXX 7,363,030 0 (21,674) 1,492,104,959 240,146,861 2,589,139 0 1,734,840,959 3,021,727 1,382,970 428,495 261,461,021 82,422,836 26,718,539 459,700,479 118,551,352 40,155,115 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 179,679,647 12,546,589 179,493 101,964,612 145,627,737 79,719,326 1,005,827,485 360,531,484 147,200,968 XXX XXX XXX 1,005,827,485 360,531,484 147,200,968 5 0 1 3,976,202 230 0 0 0 0 0 3,976,431 99,315 83,412 13,231 317,248,729 (15) (17,523,218) 7,850,128 3,661,798 13,334,887 0 317,248,713 199,369 245,800 101,928 538,342,516 (67,290,282) 0 0 0 0 0 471,052,234 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 272,183,054 0 XXX XXX XXX 0 272,183,054 98 0 0 192,046,744 995,458 0 XXX XXX XXX 0 193,042,202 0 1,407,019 4,757 169,280,041 (241,244) 0 0 0 0 0 169,038,798 298,787 1,736,230 119,916 1,220,894,231 205,647,201 (17,523,218) 7,850,128 3,661,798 13,334,887 0 1,426,541,432 XXX XXX 298,787 1,736,230 119,916 1,220,894,231 205,647,201 (17,523,218) 7,850,128 3,661,798 13,334,887 0 1,426,541,432 37,648 0 0 0 0 3,513,363 0 0 0 0 5,223,857 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 506,759 235,673 184,029 1,443,459 116,193 969,592 277,857 481,878 363,542 681,153 10,251,219 513,530 665,907 1,807,001 797,346 37,648 0.869 3,513,363 0.774 5,223,857 0.865 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 2,486,113 XXX 2,774,022 0.846 14,035,003 XXX 47,757 84,010 131,767 0.029 4,881,813 7,210,053 12,091,867 0.029 7,925,307 10,560,287 18,485,594 0.029 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 316,218 3,149,148 3,465,367 0.014 2,686,050 8,085,613 10,771,663 0.053 15,857,145 29,089,112 44,946,257 XXX XXX 0 0 0 0.000 0 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 10,251,219 513,530 665,907 1,807,001 797,346 0 14,035,003 XXX 0 0 0 15,857,145 29,089,112 44,946,257 XXX XXX XXX SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 (Continued) Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 2 Small Group Employer Individual 10. General and Administrative (G&A) Expenses: 10.1 Direct sales salaries and benefits 10.2 Agents and brokers fees and commissions 10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below) 10.4 Other general and administrative expenses 10.4a Community Benefit Expenditures (informational only) 10.5 Total general and administrative (Lines 10.1 +10.2 + 10.3 + 10.4) 16,316 129,159 (539) 266,332 0 411,268 3 Large Group Employer 1,617,283 13,541,917 502,007 23,231,789 0 38,892,996 4 5 Small Group Employer Individual 3,126,750 3,141,891 826,604 23,408,808 0 30,504,053 0 0 0 0 0 0 Expatriate Plans 6 Large Group Employer 0 0 0 0 0 0 7 8 Small Group 0 0 0 0 0 0 Student Health Plans Large Group 0 0 0 0 0 0 10 11 Government Business (excluded by statute) Other Health Business 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 32,474,499 0 32,474,499 417,147 8,838,662 416,204 21,311,404 0 30,983,417 392,144 3,481,075 323,655 14,225,797 0 18,422,670 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 5,569,639 29,132,704 2,067,931 114,918,628 0 151,688,903 0 0 0 0 0 0 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) 42,563,642 22,925,287 10,609,787 14,005,380 12. Income from fees of uninsured plans XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 13. Net investment and other gain/(loss) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 24,015,214 XXX 14. Federal income taxes (excluding taxes on Line 1.5 above) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX (2,322,119) XXX 15. Net gain or (loss) (Lines 11 + 12 + 13 - 14) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 16. ICD-10 Implementation Expenses (informational only; already included in general expenses and line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16. 16a ICD-10 Implementation Expenses (informational only; already included in line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 74,080 0 0 0 0 0 0 7,737,010 97,915,186 XXX 5,569,639 29,132,704 2,067,931 114,918,629 0 151,688,903 97,629,364 0 124,252,519 0 24,015,214 (2,322,119) XXX 123,966,698 OTHER INDICATORS: 216-2.MO 1. Number of certificates/policies 473 45,121 81,387 0 0 0 0 0 0 0 183,064 84,588 394,633 0 394,633 2. Number of Covered Lives 841 75,245 136,639 0 0 0 0 0 0 0 261,435 84,588 558,748 0 558,748 3. Number of Groups 7,822 1,364 0 0 0 0 0 0 4,657 5 13,848 0 13,848 4. Member Months 9,751 905,727 1,609,118 0 0 0 0 0 0 3,181,411 1,031,038 6,737,045 0 6,737,045 XXX Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ XXX 0 ] If yes, show the amount of premiums and claims included. Premiums $ 0 Claims $ 0 AFFORDABLE CARE ACT (ACA) RECEIPTS, PAYMENTS, RECEIVABLES and PAYABLES Current Year Prior Year Comprehensive Health Coverage Comprehensive Health Coverage 1 2 3 4 Small Group Small Group Employer Plans Employer Plans Individual Plans Individual Plans ACA Receivables and Payables 1. Permanent ACA Risk Adjustment Program 1.0 Premium adjustments receivable/(payable) 2. Transitional ACA Reinsurance Program 2.0 Total amounts recoverable for claims (paid & unpaid) 0 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 0 0 (298,755) (402,839) XXX (710,453) 0 0 0 601,322 XXX 0 0 0 0 ACA Receipts and Payments 4. Permanent ACA Risk Adjustment Program 4.0 Premium adjustments receipts/(payments) 5. Transitional ACA Reinsurance Program 5.0 Amounts received for claims 0 6. Temporary ACA Risk Corridors Program 6.1 Retrospective premium received 6.2 Rate credits or policy experience refunds paid 0 0 (589,792) 3,885,379 XXX (492,755) 0 0 0 0 0 6,818,482 XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF 185 Asylum Street Hartford, CT 061033408 Missouri DURING THE YEAR Comprehensive Health Coverage 1 2 3 Individual Small Group Employer Large Group Employer Small Group Employer Individual Expatriate Plans: 7 8 6 Large Group Employer Small Group 10 11 Government Business (excluded by statute) Other Health Business 9 Student Health Plans Large Group 79413 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.MO Health Premiums Earned: 4,706,016 439,228,911 1.1 Direct premiums written 0 114,783 1.2 Unearned premium prior year 0 44,441 1.3 Unearned premium current year 0 70,342 1.4 Change in unearned premium (Lines 1.2 - 1.3) (3,218) 7,850,128 1.5 Paid rate credits 0 13,334,887 1.6 Reserve for rate credits current year 0 3,661,798 1.7 Reserve for rate credits prior year 0 9,673,089 1.8 Change in reserve for rate credits (Lines 1.6 - 1.7) 0 128,881 1.9 Premium balances written off 0 0 1.10 Group conversion charge 4,706,016 439,170,371 1.11 Total direct premiums earned (Lines 1.1 + 1.4 - 1.9 + 1.10) 0 0 1.12 Assumed premiums earned from non-affiliates 10,754 0 1.13 Net Assumed less Ceded premiums earned from affiliates 0 0 1.14 Ceded premiums earned to non-affiliates 0 128,881 1.15 Other Adjustments due to MLR calculation - Premiums 4,719,988 421,776,035 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 4,073,035 299,371,246 2.1 Paid claims during the year 64,241 39,557,601 2.2 Direct claim liability current year 50,401 37,820,679 2.3 Direct claim liability prior year 6,153 924,327 2.4 Direct claim reserves current year 5,731 796,842 2.5 Direct claim reserves prior year 337,270 0 2.6 Direct contract reserves current year 440,048 0 2.7 Direct contract reserves prior year (3,218) 7,850,128 2.8 Paid rate credits 0 13,334,887 2.9 Reserve for rate credits current year 0 3,661,798 2.10 Reserve for rate credits prior year 0 83,412 2.11 Incurred medical incentive pools and bonuses (Lines 2.11a + 2.11b - 2.11c) 0 89,651 2.11a Paid medical incentive pools and bonuses current year 0 261,761 2.11b Accrued medical incentive pools and bonuses current year 0 268,000 2.11c Accrued medical incentive pools and bonuses prior year 5,098 1,593,554 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 5,098 11,572,234 2.12a Healthcare receivables current year 0 9,978,680 2.12b Healthcare receivables prior year 0 0 2.13 Group conversion charge 0 0 2.14 Multi-option coverage blended rate adjustment 2.15 Total incurred claims (Lines 2.1 + 2.2 - 2.3 + 2.4 - 2.5 + 2.6 - 2.7 + 2.8 + 2.9 3,976,202 317,248,729 2.10 + 2.11 - 2.12 + 2.13 + 2.14) 0 0 2.16 Assumed incurred claims from non-affiliates 230 (15) 2.17 Net assumed less ceded incurred claims from affiliates 0 0 2.18 Ceded incurred claims to non-affiliates 0 0 2.19 Other adjustments due to MLR calculation - Claims 3,979,650 299,725,496 2.20 Net Incurred Claims (Lines 2.15 - 2.8 - 2.9 + 2.10 + 2.16 + 2.17 - 2.18 + 2.19) 3. Fraud and Abuse Recoveries that Reduced PAID Claims in Line 2.1 above 1 13,231 (informational only) 14,692,323 for stand-alone dental and $ (a) Column 13, Line 1.1 includes direct written premium of $ 4 Business Subject to MLR Mini-Med Plans 5 (LOCATION) NAIC Company Code 2018 653,436,492 10,325 (10,125) 20,449 528,885 287,199 415,789 (128,590) 474,867 0 652,982,074 0 0 80,831,629 474,867 572,225,017 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 317,900,563 0 0 317,900,563 531,359,870 62,743,935 56,703,311 1,616,899 1,414,477 0 0 528,885 287,199 415,789 245,800 241,141 930,322 925,663 (93,504) 15,734,847 15,828,351 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 538,342,516 10,379 (57,366) 67,243,295 0 470,651,939 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 272,183,054 0 0 272,183,054 101,928 0 0 5,224,693 for stand-alone vision policies. 0 0 0 0 0 (562,367) 606,076 43,709 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 252,796,578 (17,447) 608,928 (626,375) 2,520,420 1,140,875 1,292,593 (151,718) 10,869 0 252,159,334 0 0 274,423 10,869 249,527,078 212,246,965 0 0 0 5,735,453 833,183 5,808,286 (4,975,103) 1,974,521 0 210,272,444 0 3,341,596 0 1,974,521 214,828,211 1,562,414,962 107,661 643,245 (535,584) 16,631,667 15,596,145 11,178,466 4,417,679 2,589,139 0 1,559,290,239 0 321,252,913 81,106,052 2,589,139 1,780,976,893 188,138,756 23,825,573 24,487,563 10,311,438 12,389,607 66,835,659 62,529,855 2,520,420 1,140,875 1,292,593 0 1,667 0 1,667 26,359 77,462 51,103 0 0 167,217,328 18,105,474 17,666,819 21,727 15,164 0 0 5,735,453 833,183 5,808,286 1,407,019 993,777 803,373 390,131 549,872 28,845,133 28,295,261 0 0 1,189,597,867 144,902,901 136,772,482 12,880,543 14,621,821 67,172,929 62,969,903 16,631,667 15,596,145 11,178,466 1,736,230 1,326,235 1,995,456 1,585,461 2,081,379 56,234,774 54,153,395 0 0 192,046,744 49 0 (995,409) 0 190,673,499 169,280,041 0 (241,244) 0 0 168,278,447 1,220,894,231 10,428 271,884,659 66,247,887 0 1,405,492,085 0 4,757 119,916 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF Missouri DURING THE YEAR All Expenses 1 Improve Health Outcomes 1. Individual Comprehensive Coverage Expenses: 127,161 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 8,409 for affiliated services) 1.3 EDP Equipment and Software (incl $ 807 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 88 for affiliated services) 1.5 Accreditation and Certification (incl $ 261,319 for affiliated services) 1.6 Other Expenses (incl $ 1.7 Subtotal before Reimbursements and Taxes (Lines 1.1 to 1.6) 1.8 Reimbursements by uninsured plans and fiscal intermediaries 1.9 Taxes, Licenses and Fees (in total, for tying purposes) 1.10 Total (1.7 to 1.9) 1.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 2. 216-4.MO Small Group Comprehensive Coverage Expenses: 10,804,666 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 772,046 for affiliated services) 2.3 EDP Equipment and Software (incl $ 74,107 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 8,047 for affiliated services) 2.5 Accreditation and Certification (incl $ 24,649,549 for affiliated services) 2.6 Other Expenses (incl $ 2.7 Subtotal before Reimbursements and Taxes (Lines 2.1 to 2.6) 2.8 Reimbursements by uninsured plans and fiscal intermediaries 2.9 Taxes, Licenses and Fees (in total, for tying purposes) 2.10 Total (2.7 to 2.9) 2.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 3. Large Group Comprehensive Coverage Expenses: 14,887,248 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 991,446 for affiliated services) 3.3 EDP Equipment and Software (incl $ 95,167 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 10,333 for affiliated services) 3.5 Accreditation and Certification (incl $ 33,233,123 for affiliated services) 3.6 Other Expenses (incl $ 3.7 Subtotal before Reimbursements and Taxes (Lines 3.1 to 3.6) 3.8 Reimbursements by uninsured plans and fiscal intermediaries 3.9 Taxes, Licenses and Fees (in total, for tying purposes) 3.10 Total (3.7 to 3.9) 3.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 185 Asylum Street Hartford, CT 061033408 0 0 0 0 0 37,648 37,648 0 XXX Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX Total (1 to 5) 0 0 0 0 0 37,648 37,648 0 XXX 0 0 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 0 0 0 0 0 0 0 XXX (LOCATION) NAIC Company Code 2018 XXX 13,417 1,571 1,120 108 12 30,009 46,236 0 XXX 26,191 2,586 1,875 180 20 51,539 82,391 0 XXX 37,648 0 0 0 0 0 0 0 0 0 37,648 0 46,236 13,124 82,391 0 0 0 0 0 0 3,513,363 3,513,363 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3,513,363 3,513,363 0 1,277,246 391,758 106,656 10,238 1,112 2,944,072 4,731,081 0 2,047,183 234,611 170,949 16,409 1,782 4,578,661 7,049,595 0 XXX 4,731,081 1,301,590 XXX 7,049,595 0 XXX 3,513,363 0 0 0 0 0 0 5,223,857 5,223,857 0 XXX 5,223,857 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 3,513,363 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5,223,857 5,223,857 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 5,223,857 0 2,059,912 687,690 172,012 16,511 1,793 4,742,507 7,680,425 (1,502) XXX 7,678,923 2,252,277 3,002,892 344,137 250,756 24,070 2,613 6,716,167 10,340,635 64 XXX 10,340,699 0 79413 9 10 General Administrative Expenses Total Expenses (6 to 9) 87,553 7,404 5,414 502 56 309,724 410,653 0 14,977 425,630 0 127,161 11,561 8,409 790 88 428,920 576,928 0 14,977 591,906 13,124 7,480,236 803,254 494,441 47,460 5,153 29,446,074 38,276,618 0 2,112,010 40,388,628 0 10,804,666 1,429,623 772,046 74,107 8,047 40,482,169 53,570,657 0 2,112,010 55,682,668 1,301,590 9,824,444 1,092,855 568,678 54,586 5,927 17,921,433 29,467,925 84 3,917,943 33,385,951 0 14,887,248 2,124,683 991,446 95,167 10,333 34,603,964 52,712,841 (1,354) 3,917,943 56,629,430 2,252,277 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 4. 5. 216-5.MO 6. Individual Mini-Med Plans Expenses: 0 for affiliated services) 4.1 Salaries (including $ 4.2 Outsourced Services 0 for affiliated services) 4.3 EDP Equipment and Software (incl $ 0 for affiliated services) 4.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 4.5 Accreditation and Certification (incl $ 0 for affiliated services) 4.6 Other Expenses (incl $ 4.7 Subtotal before Reimbursements and Taxes (Lines 4.1 to 4.6) 4.8 Reimbursements by uninsured plans and fiscal intermediaries 4.9 Taxes, Licenses and Fees (in total, for tying purposes) 4.10 Total (4.7 to 4.9) 4.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Mini-Med Plans Expenses: 0 for affiliated services) 5.1 Salaries (including $ 5.2 Outsourced Services 0 for affiliated services) 5.3 EDP Equipment and Software (incl $ 0 for affiliated services) 5.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 5.5 Accreditation and Certification (incl $ 0 for affiliated services) 5.6 Other Expenses (incl $ 5.7 Subtotal before Reimbursements and Taxes (Lines 5.1 to 5.6) 5.8 Reimbursements by uninsured plans and fiscal intermediaries 5.9 Taxes, Licenses and Fees (in total, for tying purposes) 5.10 Total (5.7 to 5.9) 5.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Mini-Med Plans Expenses: 0 for affiliated services) 6.1 Salaries (including $ 6.2 Outsourced Services 0 for affiliated services) 6.3 EDP Equipment and Software (incl $ 0 for affiliated services) 6.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 6.5 Accreditation and Certification (incl $ 0 for affiliated services) 6.6 Other Expenses (incl $ 6.7 Subtotal before Reimbursements and Taxes (Lines 6.1 to 6.6) 6.8 Reimbursements by uninsured plans and fiscal intermediaries 6.9 Taxes, Licenses and Fees (in total, for tying purposes) 6.10 Total (6.7 to 6.9) 6.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 7. 8. 216-6.MO 9. Small Group Expatriate Plans Expenses: 0 for affiliated services) 7.1 Salaries (including $ 7.2 Outsourced Services 0 for affiliated services) 7.3 EDP Equipment and Software (incl $ 0 for affiliated services) 7.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 7.5 Accreditation and Certification (incl $ 0 for affiliated services) 7.6 Other Expenses (incl $ 7.7 Subtotal before Reimbursements and Taxes (Lines 7.1 to 7.6) 7.8 Reimbursements by uninsured plans and fiscal intermediaries 7.9 Taxes, Licenses and Fees (in total, for tying purposes) 7.10 Total (7.7 to 7.9) 7.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Expatriate Plans Expenses: 0 for affiliated services) 8.1 Salaries (including $ 8.2 Outsourced Services 0 for affiliated services) 8.3 EDP Equipment and Software (incl $ 0 for affiliated services) 8.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 8.5 Accreditation and Certification (incl $ 0 for affiliated services) 8.6 Other Expenses (incl $ 8.7 Subtotal before Reimbursements and Taxes (Lines 8.1 to 8.6) 8.8 Reimbursements by uninsured plans and fiscal intermediaries 8.9 Taxes, Licenses and Fees (in total, for tying purposes) 8.10 Total (8.7 to 8.9) 8.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Student Health Plans Expenses: 0 for affiliated services) 9.1 Salaries (including $ 9.2 Outsourced Services 0 for affiliated services) 9.3 EDP Equipment and Software (incl $ 0 for affiliated services) 9.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 9.5 Accreditation and Certification (incl $ 0 for affiliated services) 9.6 Other Expenses (incl $ 9.7 Subtotal before Reimbursements and Taxes (Lines 9.1 to 9.6) 9.8 Reimbursements by uninsured plans and fiscal intermediaries 9.9 Taxes, Licenses and Fees (in total, for tying purposes) 9.10 Total (9.7 to 9.9) 9.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 *79413201821627100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes - See Cautionary Statement at http://www.naic.org/documents/committees_e_app_blanks_related_shce_cautionary_statement.pdf) UnitedHealthcare Insurance Company 2. 185 Asylum Street Hartford, CT 061033408 (LOCATION) BUSINESS IN THE STATE OF Montana DURING THE YEAR 2018 NAIC Company Code Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 1. 216-1.MT 2. 3. 4. 5. 6. 7. 8. 9. Premium: 1.1 Health premiums earned (From Part 2, Line 1.11) 1.2 Federal high risk pools 1.3 State high risk pools 1.4 Premiums earned including state and federal high risk programs (Lines 1.1 + 1.2 + 1.3) 1.5 Federal taxes and federal assessments 1.6 State insurance, premium and other taxes (Similar local taxes of 4,229 ) $ 1.6a Community Benefit Expenditures (informational only) 1.7 Regulatory authority licenses and fees 1.8 Adjusted Premiums Earned (Lines 1.4 - 1.5 - 1.6 - 1.7) 1.9 Net Assumed less Ceded reinsurance premiums earned 1.10 Other Adjustments due to MLR calculations - Premiums 1.11 Risk Revenue 1.12 Net adjusted premiums earned after reinsurance (Lines 1.8 + 1.9 + 1.10 + 1.11) Claims: 2.1 Incurred claims excluding prescription drugs 2.2 Prescription drugs 2.3 Pharmaceutical rebates 2.4 State stop loss, market stabilization and claim/census based assessments (informational only) Incurred medical incentive pools and bonuses Deductible Fraud and Abuse Detection/Recovery Expenses (for MLR use only) 5.0 Total Incurred Claims (Lines 2.1 + 2.2 - 2.3 + 3) (From Part 2, Line 2.15) 5.1 Net Assumed less Ceded reinsurance claims incurred 5.2 Other Adjustments due to MLR calculations - Claims 5.3 Rebates paid 5.4 Estimated rebates unpaid prior year 5.5 Estimated rebates unpaid current year 5.6 Fee for service and co-pay revenue 5.7 Net incurred claims after reinsurance (Lines 5.0 + 5.1 + 5.2 + 5.3 - 5.4 + 5.5 - 5.6) Improving Health Care Quality Expenses Incurred: 6.1 Improve health outcomes 6.2 Activities to prevent hospital readmissions 6.3 Improve patient safety and reduce medical errors 6.4 Wellness and health promotion activities 6.5 Health Information Technology expenses related to health improvement 6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5) Preliminary Medical Loss Ratio: MLR ((Lines 4 + 5.0 + 6.6 - Footnote 2.0)/Line 1.8 Claims Adjustment Expenses: 8.1 Cost containment expenses not included in quality of care expenses in Line 6.6 8.2 All other claims adjustment expenses 8.3 Total claims adjustment expenses (Lines 8.1 + 8.2) Claims Adjustment Expense Ratio (Line 8.3/Line 1.8) 2 Small Group Employer 3 Large Group Employer 4 5 Small Group Employer Individual Expatriate Plans 6 Large Group Employer 7 11 Government Business (excluded by statute) Other Health Business 9 8 Small Group 10 Student Health Plans Large Group 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 79413 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 49,212 0 35 334,649 0 214 618,080 0 (872) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 28,582,584 0 16,775 11,941,567 0 0 41,526,092 0 16,151 XXX XXX XXX 49,247 2,109 334,863 47,043 617,208 4,182 0 0 0 0 0 0 0 0 0 0 0 0 0 0 28,599,359 183,490 11,941,567 718,725 41,542,243 955,548 XXX 8,269 0 (2) 38,871 0 0 0 38,871 (4,769) 0 (12) 292,601 82 0 0 292,683 9,690 0 0 603,337 (101,592) 0 0 501,745 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 478,629 0 (7,108) 27,944,347 (3,983) 10 0 27,940,374 1,522 0 0 11,221,320 0 80,781 0 11,302,101 493,340 0 (7,122) 40,100,477 (105,493) 80,790 0 40,075,774 XXX XXX XXX XXX XXX 493,340 0 (7,122) 40,100,477 (105,493) 80,790 0 40,075,774 25,139 3,953 817 67,772 69,576 32,389 688,919 93,671 40,260 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 21,600,768 20,159 5,970 3,132,328 11,748,585 6,960,381 25,514,927 11,935,945 7,039,817 XXX XXX XXX 25,514,927 11,935,945 7,039,817 1 0 0 28,275 0 0 0 0 0 0 28,275 0 149 3 105,107 (116) 0 0 0 0 0 104,992 0 0 2 742,331 (146,311) 0 0 0 0 0 596,020 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7,920,533 0 0 0 0 0 0 7,920,533 1 149 5 30,411,203 85,693 0 0 0 0 0 30,496,896 XXX XXX 0 0 0 0 0 21,614,957 232,119 0 XXX XXX XXX 0 21,847,077 1 149 5 30,411,203 85,693 0 0 0 0 0 30,496,896 0 0 0 0 0 187,470 177,143 131,649 244,804 40,510 0 781,576 XXX 394 0 0 0 0 2,677 0 0 0 0 4,945 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 394 0.738 2,677 0.368 4,945 1.239 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 722 876 1,599 0.041 3,388 4,076 7,463 0.026 7,830 9,478 17,308 0.029 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 XXX XXX XXX XXX 0 0 0 0.000 5,602 441,647 447,248 0.016 28,051 10,769 6,860 (3,560) 20,861 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 223,537 187,911 138,509 241,245 61,371 62,981 0.711 852,573 XXX (12,166) 132,036 119,870 0.011 5,375 588,113 593,488 XXX 41,526,092 0 16,151 0 0 0 0 0 223,537 187,911 138,509 241,245 61,371 0 852,573 XXX 0 0 0 5,375 588,113 593,488 XXX XXX XXX 41,542,243 955,548 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 (Continued) Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 2 Small Group Employer Individual 10. General and Administrative (G&A) Expenses: 10.1 Direct sales salaries and benefits 10.2 Agents and brokers fees and commissions 10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below) 10.4 Other general and administrative expenses 10.4a Community Benefit Expenditures (informational only) 10.5 Total general and administrative (Lines 10.1 +10.2 + 10.3 + 10.4) 214 (237) (1,224) 1,908 0 661 3 Large Group Employer 1,071 (1,461) (1,179) 10,883 0 9,314 4 5 Small Group Employer Individual 3,326 6,980 818 20,054 0 31,178 0 0 0 0 0 0 Expatriate Plans 6 Large Group Employer 0 0 0 0 0 0 7 8 Small Group 0 0 0 0 0 0 Student Health Plans Large Group 0 0 0 0 0 0 10 11 Government Business (excluded by statute) Other Health Business 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 37,043 1,092,769 54,303 2,937,519 0 4,121,634 29,445 97,568 22,879 642,802 0 792,693 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 71,100 1,195,619 75,596 3,613,165 0 4,955,480 0 0 0 0 0 0 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) 12. Income from fees of uninsured plans XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 13. Net investment and other gain/(loss) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 14. Federal income taxes (excluding taxes on Line 1.5 above) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 15. Net gain or (loss) (Lines 11 + 12 + 13 - 14) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 16. ICD-10 Implementation Expenses (informational only; already included in general expenses and line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16. 16a ICD-10 Implementation Expenses (informational only; already included in line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 37 10 0 0 0 0 0 0 0 14,492 10,374 24,917 0 24,917 11 67 11 0 0 0 0 0 0 0 14,466 10,374 24,929 0 24,929 8 3 0 0 0 0 0 0 20 0 31 0 31 598 1,545 0 0 0 0 0 0 172,138 124,744 299,145 0 299,145 7,943 168,237 (147,706) 0 0 0 0 0 0 0 742,839 2,406,024 3,177,336 XXX 71,100 1,195,619 75,596 3,613,165 0 4,955,480 XXX 3,177,336 0 0 458,277 XXX XXX 26,666 XXX 26,666 XXX 3,608,947 XXX 3,608,947 458,277 OTHER INDICATORS: 216-2.MT 1. Number of certificates/policies 2. Number of Covered Lives 3. Number of Groups 4. Member Months XXX 120 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ XXX 0 ] If yes, show the amount of premiums and claims included. Premiums $ 0 Claims $ 0 AFFORDABLE CARE ACT (ACA) RECEIPTS, PAYMENTS, RECEIVABLES and PAYABLES Current Year Prior Year Comprehensive Health Coverage Comprehensive Health Coverage 1 2 3 4 Small Group Small Group Employer Plans Employer Plans Individual Plans Individual Plans ACA Receivables and Payables 1. Permanent ACA Risk Adjustment Program 1.0 Premium adjustments receivable/(payable) 0 2. Transitional ACA Reinsurance Program 2.0 Total amounts recoverable for claims (paid & unpaid) 0 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 0 0 0 0 0 0 0 0 82,328 0 182,823 2,654 XXX 0 0 31,003 XXX ACA Receipts and Payments 4. Permanent ACA Risk Adjustment Program 4.0 Premium adjustments receipts/(payments) 0 5. Transitional ACA Reinsurance Program 5.0 Amounts received for claims 0 6. Temporary ACA Risk Corridors Program 6.1 Retrospective premium received 6.2 Rate credits or policy experience refunds paid 0 0 XXX 0 0 0 0 0 XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF 185 Asylum Street Hartford, CT 061033408 Montana DURING THE YEAR Comprehensive Health Coverage 1 2 3 Individual Small Group Employer Large Group Employer Small Group Employer Individual Expatriate Plans: 7 8 6 Large Group Employer Small Group 10 11 Government Business (excluded by statute) Other Health Business 9 Student Health Plans Large Group 79413 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.MT Health Premiums Earned: 49,212 1.1 Direct premiums written 0 1.2 Unearned premium prior year 0 1.3 Unearned premium current year 0 1.4 Change in unearned premium (Lines 1.2 - 1.3) 208 1.5 Paid rate credits 0 1.6 Reserve for rate credits current year 0 1.7 Reserve for rate credits prior year 0 1.8 Change in reserve for rate credits (Lines 1.6 - 1.7) 0 1.9 Premium balances written off 0 1.10 Group conversion charge 49,212 1.11 Total direct premiums earned (Lines 1.1 + 1.4 - 1.9 + 1.10) 0 1.12 Assumed premiums earned from non-affiliates 0 1.13 Net Assumed less Ceded premiums earned from affiliates 0 1.14 Ceded premiums earned to non-affiliates 0 1.15 Other Adjustments due to MLR calculation - Premiums 49,004 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 27,169 2.1 Paid claims during the year 1,166 2.2 Direct claim liability current year 268 2.3 Direct claim liability prior year 0 2.4 Direct claim reserves current year 0 2.5 Direct claim reserves prior year 0 2.6 Direct contract reserves current year 0 2.7 Direct contract reserves prior year 208 2.8 Paid rate credits 0 2.9 Reserve for rate credits current year 0 2.10 Reserve for rate credits prior year 0 2.11 Incurred medical incentive pools and bonuses (Lines 2.11a + 2.11b - 2.11c) 0 2.11a Paid medical incentive pools and bonuses current year 0 2.11b Accrued medical incentive pools and bonuses current year 0 2.11c Accrued medical incentive pools and bonuses prior year 0 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 0 2.12a Healthcare receivables current year 0 2.12b Healthcare receivables prior year 0 2.13 Group conversion charge 0 2.14 Multi-option coverage blended rate adjustment 2.15 Total incurred claims (Lines 2.1 + 2.2 - 2.3 + 2.4 - 2.5 + 2.6 - 2.7 + 2.8 + 2.9 28,275 2.10 + 2.11 - 2.12 + 2.13 + 2.14) 0 2.16 Assumed incurred claims from non-affiliates 0 2.17 Net assumed less ceded incurred claims from affiliates 0 2.18 Ceded incurred claims to non-affiliates 0 2.19 Other adjustments due to MLR calculation - Claims 28,067 2.20 Net Incurred Claims (Lines 2.15 - 2.8 - 2.9 + 2.10 + 2.16 + 2.17 - 2.18 + 2.19) 3. Fraud and Abuse Recoveries that Reduced PAID Claims in Line 2.1 above 0 (informational only) 20,759 for stand-alone dental and $ (a) Column 13, Line 1.1 includes direct written premium of $ 4 Business Subject to MLR Mini-Med Plans 5 (LOCATION) NAIC Company Code 2018 335,108 0 459 (459) 0 0 0 0 0 0 334,649 0 82 0 0 334,731 618,080 0 0 0 (208) 0 0 0 0 0 618,080 0 0 101,592 0 516,695 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 28,582,641 0 47 (47) (1,813,344) 0 0 0 10 0 28,582,584 0 0 3,983 10 30,391,954 12,022,348 0 0 0 0 316,561 619,606 (303,045) 80,781 0 11,941,567 0 0 0 80,781 12,325,393 41,607,389 0 506 (506) (1,813,344) 316,561 619,606 (303,045) 80,790 0 41,526,092 0 82 105,576 80,790 43,617,778 137,989 29,569 61,659 4 1,230 0 0 0 0 0 149 149 0 0 (286) 12,135 12,421 0 0 737,679 30,535 38,617 3,108 374 0 0 (208) 0 0 0 0 0 0 (10,209) 3,830 14,039 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 23,377,279 3,896,259 3,631,214 845,854 1,049,792 10,904 19,094 (1,813,344) 0 0 0 0 0 0 1,894 1,894 0 0 0 5,980,732 1,332,957 1,057,592 728 608 0 0 0 316,561 619,606 0 0 1,609 1,609 (1,967,362) 2,119,111 4,086,473 0 0 30,260,848 5,290,485 4,789,351 849,694 1,052,005 10,904 19,094 (1,813,344) 316,561 619,606 149 149 1,609 1,609 (1,975,962) 2,136,970 4,112,933 0 0 105,107 0 (116) 0 0 104,992 742,331 0 (650) 145,660 0 596,228 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 21,614,957 0 0 (232,119) 0 23,660,420 7,920,533 0 0 0 0 8,223,578 30,411,203 0 (766) (86,459) 0 32,613,285 2 0 0 8,911 for stand-alone vision policies. 0 0 0 0 0 3 0 0 5 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF Montana DURING THE YEAR All Expenses 1 Individual Comprehensive Coverage Expenses: 1,132 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 77 for affiliated services) 1.3 EDP Equipment and Software (incl $ 7 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 1 for affiliated services) 1.5 Accreditation and Certification (incl $ 2,583 for affiliated services) 1.6 Other Expenses (incl $ 1.7 Subtotal before Reimbursements and Taxes (Lines 1.1 to 1.6) 1.8 Reimbursements by uninsured plans and fiscal intermediaries 1.9 Taxes, Licenses and Fees (in total, for tying purposes) 1.10 Total (1.7 to 1.9) 1.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 2. 216-4.MT 2.7 Subtotal before Reimbursements and Taxes (Lines 2.1 to 2.6) 2.8 Reimbursements by uninsured plans and fiscal intermediaries 2.9 Taxes, Licenses and Fees (in total, for tying purposes) 2.10 Total (2.7 to 2.9) 2.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 3. 0 0 0 0 0 394 394 0 XXX Small Group Comprehensive Coverage Expenses: 6,129 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 426 for affiliated services) 2.3 EDP Equipment and Software (incl $ 41 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 4 for affiliated services) 2.5 Accreditation and Certification (incl $ 14,130 for affiliated services) 2.6 Other Expenses (incl $ 3.7 Subtotal before Reimbursements and Taxes (Lines 3.1 to 3.6) 3.8 Reimbursements by uninsured plans and fiscal intermediaries 3.9 Taxes, Licenses and Fees (in total, for tying purposes) 3.10 Total (3.7 to 3.9) 3.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX Total (1 to 5) 0 0 0 0 0 394 394 0 XXX 0 0 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 0 0 0 0 0 0 0 XXX (LOCATION) NAIC Company Code 2018 XXX 174 122 15 1 0 390 702 0 XXX 248 28 21 2 0 555 855 0 XXX 394 0 0 0 0 0 0 0 0 0 394 0 702 173 855 0 0 0 0 0 0 2,677 2,677 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,677 2,677 0 877 307 73 7 1 2,023 3,288 0 1,153 132 96 9 1 2,578 3,970 0 XXX Large Group Comprehensive Coverage Expenses: 16,173 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 1,083 for affiliated services) 3.3 EDP Equipment and Software (incl $ 104 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 11 for affiliated services) 3.5 Accreditation and Certification (incl $ 35,033 for affiliated services) 3.6 Other Expenses (incl $ Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions Improve Health Outcomes 1. 185 Asylum Street Hartford, CT 061033408 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX XXX XXX 2,677 0 0 0 0 0 0 0 0 0 2,677 0 3,288 859 3,970 0 0 0 0 0 0 4,945 4,945 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4,945 4,945 0 2,070 560 173 17 2 4,771 7,592 0 2,696 309 225 22 2 6,031 9,286 0 XXX XXX XXX 0 0 0 XXX 4,945 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 4,945 0 XXX 7,592 2,235 9,286 0 79413 9 10 General Administrative Expenses Total Expenses (6 to 9) 709 116 42 4 0 999 1,870 0 7,099 8,969 0 1,132 266 77 7 1 2,338 3,821 0 7,099 10,920 173 4,099 390 256 25 3 5,644 10,417 0 (5,679) 4,738 0 6,129 829 426 41 4 12,923 20,352 0 (5,679) 14,674 859 11,406 966 685 66 7 17,015 30,146 0 11,153 41,298 0 16,173 1,835 1,083 104 11 32,762 51,968 0 11,153 63,121 2,235 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 4. 5. 216-5.MT 6. Individual Mini-Med Plans Expenses: 0 for affiliated services) 4.1 Salaries (including $ 4.2 Outsourced Services 0 for affiliated services) 4.3 EDP Equipment and Software (incl $ 0 for affiliated services) 4.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 4.5 Accreditation and Certification (incl $ 0 for affiliated services) 4.6 Other Expenses (incl $ 4.7 Subtotal before Reimbursements and Taxes (Lines 4.1 to 4.6) 4.8 Reimbursements by uninsured plans and fiscal intermediaries 4.9 Taxes, Licenses and Fees (in total, for tying purposes) 4.10 Total (4.7 to 4.9) 4.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Mini-Med Plans Expenses: 0 for affiliated services) 5.1 Salaries (including $ 5.2 Outsourced Services 0 for affiliated services) 5.3 EDP Equipment and Software (incl $ 0 for affiliated services) 5.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 5.5 Accreditation and Certification (incl $ 0 for affiliated services) 5.6 Other Expenses (incl $ 5.7 Subtotal before Reimbursements and Taxes (Lines 5.1 to 5.6) 5.8 Reimbursements by uninsured plans and fiscal intermediaries 5.9 Taxes, Licenses and Fees (in total, for tying purposes) 5.10 Total (5.7 to 5.9) 5.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Mini-Med Plans Expenses: 0 for affiliated services) 6.1 Salaries (including $ 6.2 Outsourced Services 0 for affiliated services) 6.3 EDP Equipment and Software (incl $ 0 for affiliated services) 6.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 6.5 Accreditation and Certification (incl $ 0 for affiliated services) 6.6 Other Expenses (incl $ 6.7 Subtotal before Reimbursements and Taxes (Lines 6.1 to 6.6) 6.8 Reimbursements by uninsured plans and fiscal intermediaries 6.9 Taxes, Licenses and Fees (in total, for tying purposes) 6.10 Total (6.7 to 6.9) 6.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 7. 8. 216-6.MT 9. Small Group Expatriate Plans Expenses: 0 for affiliated services) 7.1 Salaries (including $ 7.2 Outsourced Services 0 for affiliated services) 7.3 EDP Equipment and Software (incl $ 0 for affiliated services) 7.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 7.5 Accreditation and Certification (incl $ 0 for affiliated services) 7.6 Other Expenses (incl $ 7.7 Subtotal before Reimbursements and Taxes (Lines 7.1 to 7.6) 7.8 Reimbursements by uninsured plans and fiscal intermediaries 7.9 Taxes, Licenses and Fees (in total, for tying purposes) 7.10 Total (7.7 to 7.9) 7.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Expatriate Plans Expenses: 0 for affiliated services) 8.1 Salaries (including $ 8.2 Outsourced Services 0 for affiliated services) 8.3 EDP Equipment and Software (incl $ 0 for affiliated services) 8.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 8.5 Accreditation and Certification (incl $ 0 for affiliated services) 8.6 Other Expenses (incl $ 8.7 Subtotal before Reimbursements and Taxes (Lines 8.1 to 8.6) 8.8 Reimbursements by uninsured plans and fiscal intermediaries 8.9 Taxes, Licenses and Fees (in total, for tying purposes) 8.10 Total (8.7 to 8.9) 8.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Student Health Plans Expenses: 0 for affiliated services) 9.1 Salaries (including $ 9.2 Outsourced Services 0 for affiliated services) 9.3 EDP Equipment and Software (incl $ 0 for affiliated services) 9.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 9.5 Accreditation and Certification (incl $ 0 for affiliated services) 9.6 Other Expenses (incl $ 9.7 Subtotal before Reimbursements and Taxes (Lines 9.1 to 9.6) 9.8 Reimbursements by uninsured plans and fiscal intermediaries 9.9 Taxes, Licenses and Fees (in total, for tying purposes) 9.10 Total (9.7 to 9.9) 9.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 *79413201821628100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes - See Cautionary Statement at http://www.naic.org/documents/committees_e_app_blanks_related_shce_cautionary_statement.pdf) UnitedHealthcare Insurance Company 2. 185 Asylum Street Hartford, CT 061033408 (LOCATION) BUSINESS IN THE STATE OF Nebraska DURING THE YEAR 2018 NAIC Company Code Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 1. 216-1.NE 2. 3. 4. 5. 6. 7. 8. 9. Premium: 1.1 Health premiums earned (From Part 2, Line 1.11) 1.2 Federal high risk pools 1.3 State high risk pools 1.4 Premiums earned including state and federal high risk programs (Lines 1.1 + 1.2 + 1.3) 1.5 Federal taxes and federal assessments 1.6 State insurance, premium and other taxes (Similar local taxes of 3,624,032 ) $ 1.6a Community Benefit Expenditures (informational only) 1.7 Regulatory authority licenses and fees 1.8 Adjusted Premiums Earned (Lines 1.4 - 1.5 - 1.6 - 1.7) 1.9 Net Assumed less Ceded reinsurance premiums earned 1.10 Other Adjustments due to MLR calculations - Premiums 1.11 Risk Revenue 1.12 Net adjusted premiums earned after reinsurance (Lines 1.8 + 1.9 + 1.10 + 1.11) Claims: 2.1 Incurred claims excluding prescription drugs 2.2 Prescription drugs 2.3 Pharmaceutical rebates 2.4 State stop loss, market stabilization and claim/census based assessments (informational only) Incurred medical incentive pools and bonuses Deductible Fraud and Abuse Detection/Recovery Expenses (for MLR use only) 5.0 Total Incurred Claims (Lines 2.1 + 2.2 - 2.3 + 3) (From Part 2, Line 2.15) 5.1 Net Assumed less Ceded reinsurance claims incurred 5.2 Other Adjustments due to MLR calculations - Claims 5.3 Rebates paid 5.4 Estimated rebates unpaid prior year 5.5 Estimated rebates unpaid current year 5.6 Fee for service and co-pay revenue 5.7 Net incurred claims after reinsurance (Lines 5.0 + 5.1 + 5.2 + 5.3 - 5.4 + 5.5 - 5.6) Improving Health Care Quality Expenses Incurred: 6.1 Improve health outcomes 6.2 Activities to prevent hospital readmissions 6.3 Improve patient safety and reduce medical errors 6.4 Wellness and health promotion activities 6.5 Health Information Technology expenses related to health improvement 6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5) Preliminary Medical Loss Ratio: MLR ((Lines 4 + 5.0 + 6.6 - Footnote 2.0)/Line 1.8 Claims Adjustment Expenses: 8.1 Cost containment expenses not included in quality of care expenses in Line 6.6 8.2 All other claims adjustment expenses 8.3 Total claims adjustment expenses (Lines 8.1 + 8.2) Claims Adjustment Expense Ratio (Line 8.3/Line 1.8) 2 Small Group Employer 3 Large Group Employer 4 5 Small Group Employer Individual Expatriate Plans 6 Large Group Employer 7 11 Government Business (excluded by statute) Other Health Business 9 8 Small Group 10 Student Health Plans Large Group 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 79413 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 1,952,759 0 (3,093) 143,789,357 0 (196,581) 214,065,878 0 (67,826) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 40,349,915 0 9,725 83,786,130 0 0 483,944,038 0 (257,775) XXX XXX XXX 1,949,666 35,063 143,592,776 3,414,262 213,998,052 6,813,766 0 0 0 0 0 0 0 0 0 0 0 0 0 343,967 40,359,639 440,558 83,786,130 2,284,785 483,686,263 13,332,402 XXX 46,528 0 46 1,868,028 244 0 0 1,868,272 2,479,564 0 568 137,698,382 13,924 14,031 0 137,726,337 4,302,336 0 1,340 202,880,610 (20,981,907) 313,548 0 182,212,252 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 186,963 0 0 (530,931) 1,726,362 0 0 1,195,431 1,349,957 0 (659) 38,569,783 (101,028) 515 0 38,469,269 452,533 0 0 81,048,811 753,668 537,433 0 82,339,913 8,817,882 0 1,295 461,534,684 (18,588,737) 865,526 0 443,811,474 XXX XXX XXX XXX XXX 8,817,882 0 1,295 461,534,684 (18,588,737) 865,526 0 443,811,474 1,350,042 280,491 85,575 103,093,549 22,396,889 6,925,730 149,420,603 34,351,722 11,224,934 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 32,582,733 256,348 5,917 53,795,506 30,694,223 15,378,183 340,242,433 87,979,673 33,620,339 XXX XXX XXX 340,242,433 87,979,673 33,620,339 0 0 0 1,544,958 0 0 0 (173) (173) 0 1,544,958 2,418 283,670 11,487 118,848,377 0 (737,694) 737,694 0 0 0 118,848,377 113,806 732,925 14,359 173,280,317 (16,623,347) (1,900,688) 30,746 331,512 2,201,508 0 156,657,023 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 544 0 0 32,833,165 (18,427) (191) XXX XXX XXX 0 32,814,547 0 1,105,562 7,082 70,217,108 (191,733) 0 0 0 0 0 70,025,375 116,769 2,122,158 32,928 396,723,925 (16,833,507) (2,638,573) 768,440 331,339 2,201,335 0 379,890,280 XXX XXX 116,769 2,122,158 32,928 396,723,925 (16,833,507) (2,638,573) 768,440 331,339 2,201,335 0 379,890,280 15,622 0 0 0 0 1,150,315 0 0 0 0 1,712,527 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 15,622 0.835 1,150,315 0.872 1,712,527 0.863 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 22,519 39,881 62,400 0.033 1,579,280 2,332,545 3,911,826 0.028 2,347,512 3,236,138 5,583,650 0.028 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 XXX XXX XXX 0 0 0 0 0 0 0 114,290 44,282 36,755 157,604 21,161 560,075 112,420 324,794 95,519 374,361 3,552,829 156,702 361,550 253,123 395,523 0 374,093 XXX 1,467,170 0.885 4,719,726 XXX 112,716 516,754 629,471 0.016 2,130,715 6,604,603 8,735,318 0.108 6,192,742 12,729,921 18,922,663 XXX XXX 0 0 0 0.000 483,944,038 0 (257,775) 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 3,552,829 156,702 361,550 253,123 395,523 0 4,719,726 XXX 0 0 0 6,192,742 12,729,921 18,922,663 XXX XXX XXX 483,686,263 13,332,402 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 (Continued) Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 2 Small Group Employer Individual 10. General and Administrative (G&A) Expenses: 10.1 Direct sales salaries and benefits 10.2 Agents and brokers fees and commissions 10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below) 10.4 Other general and administrative expenses 10.4a Community Benefit Expenditures (informational only) 10.5 Total general and administrative (Lines 10.1 +10.2 + 10.3 + 10.4) 7,861 78,917 860 101,238 0 188,876 3 Large Group Employer 528,931 5,339,806 156,613 6,852,075 0 12,877,425 4 5 Small Group Employer Individual 892,381 6,462,400 207,439 7,017,448 0 14,579,669 0 0 0 0 0 0 Expatriate Plans 6 Large Group Employer 0 0 0 0 0 0 7 8 Small Group 0 0 0 0 0 0 Student Health Plans Large Group 0 0 0 0 0 0 10 11 Government Business (excluded by statute) Other Health Business 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 104,655 1,524,384 68,843 2,977,487 0 4,675,370 141,708 1,842,669 94,878 5,219,524 0 7,298,779 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 1,675,537 15,248,176 528,633 22,167,773 0 39,620,119 0 0 0 0 0 0 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) 12. Income from fees of uninsured plans XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 13. Net investment and other gain/(loss) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 14. Federal income taxes (excluding taxes on Line 1.5 above) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 15. Net gain or (loss) (Lines 11 + 12 + 13 - 14) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 16. ICD-10 Implementation Expenses (informational only; already included in general expenses and line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16. 16a ICD-10 Implementation Expenses (informational only; already included in line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 56,417 938,394 3,679,383 0 0 0 0 0 0 1,195,431 (24,212) (5,186,729) 658,685 XXX 1,675,537 15,248,176 528,633 22,167,773 0 39,620,119 XXX 658,685 0 7,243,270 (127,067) 8,029,022 XXX 0 7,243,270 XXX (127,067) XXX 8,029,022 OTHER INDICATORS: 216-2.NE 1. Number of certificates/policies 178 13,090 19,554 0 0 0 0 0 0 0 59,941 21,002 113,765 0 113,765 2. Number of Covered Lives 375 23,334 36,525 0 0 0 0 0 0 0 107,225 21,002 188,461 0 188,461 3. Number of Groups 2,608 497 0 0 0 0 0 0 1,218 1 4,324 4. Member Months 4,496 296,451 513,042 0 0 0 0 0 0 1,311,060 251,732 2,376,781 XXX Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ XXX 0 ] If yes, show the amount of premiums and claims included. Premiums $ 0 Claims $ 0 AFFORDABLE CARE ACT (ACA) RECEIPTS, PAYMENTS, RECEIVABLES and PAYABLES Current Year Prior Year Comprehensive Health Coverage Comprehensive Health Coverage 1 2 3 4 Small Group Small Group Employer Plans Employer Plans Individual Plans Individual Plans ACA Receivables and Payables 1. Permanent ACA Risk Adjustment Program 1.0 Premium adjustments receivable/(payable) 2. Transitional ACA Reinsurance Program 2.0 Total amounts recoverable for claims (paid & unpaid) 0 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 0 0 (172,582) 3,262,981 XXX (179,319) 0 0 0 804,639 XXX 0 0 0 0 ACA Receipts and Payments 4. Permanent ACA Risk Adjustment Program 4.0 Premium adjustments receipts/(payments) 5. Transitional ACA Reinsurance Program 5.0 Amounts received for claims 0 6. Temporary ACA Risk Corridors Program 6.1 Retrospective premium received 6.2 Rate credits or policy experience refunds paid 0 0 (207,694) 2,239,676 XXX (136,363) 0 0 0 0 0 5,593,719 XXX 0 0 0 (1,745) 4,324 2,375,036 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF 185 Asylum Street Hartford, CT 061033408 Nebraska DURING THE YEAR Comprehensive Health Coverage 1 2 3 Individual Small Group Employer Large Group Employer Small Group Employer Individual Expatriate Plans: 7 8 6 Large Group Employer Small Group 10 11 Government Business (excluded by statute) Other Health Business 9 Student Health Plans Large Group 79413 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.NE Health Premiums Earned: 1,952,759 143,801,427 1.1 Direct premiums written 0 1,960 1.2 Unearned premium prior year 0 0 1.3 Unearned premium current year 0 1,960 1.4 Change in unearned premium (Lines 1.2 - 1.3) 47,094 737,694 1.5 Paid rate credits (173) 0 1.6 Reserve for rate credits current year (173) 0 1.7 Reserve for rate credits prior year 0 0 1.8 Change in reserve for rate credits (Lines 1.6 - 1.7) 0 14,031 1.9 Premium balances written off 0 0 1.10 Group conversion charge 1,952,759 143,789,357 1.11 Total direct premiums earned (Lines 1.1 + 1.4 - 1.9 + 1.10) 0 0 1.12 Assumed premiums earned from non-affiliates 244 13,924 1.13 Net Assumed less Ceded premiums earned from affiliates 0 0 1.14 Ceded premiums earned to non-affiliates 0 14,031 1.15 Other Adjustments due to MLR calculation - Premiums 1,905,909 143,079,617 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 1,523,145 114,914,747 2.1 Paid claims during the year 0 17,212,612 2.2 Direct claim liability current year 805 13,798,374 2.3 Direct claim liability prior year 0 587,779 2.4 Direct claim reserves current year 44 425,456 2.5 Direct claim reserves prior year 27,899 0 2.6 Direct contract reserves current year 52,147 0 2.7 Direct contract reserves prior year 47,094 737,694 2.8 Paid rate credits (173) 0 2.9 Reserve for rate credits current year (173) 0 2.10 Reserve for rate credits prior year 0 283,670 2.11 Incurred medical incentive pools and bonuses (Lines 2.11a + 2.11b - 2.11c) 0 261,996 2.11a Paid medical incentive pools and bonuses current year 0 38,945 2.11b Accrued medical incentive pools and bonuses current year 0 17,271 2.11c Accrued medical incentive pools and bonuses prior year 184 664,295 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 184 3,272,742 2.12a Healthcare receivables current year 0 2,608,447 2.12b Healthcare receivables prior year 0 0 2.13 Group conversion charge 0 0 2.14 Multi-option coverage blended rate adjustment 2.15 Total incurred claims (Lines 2.1 + 2.2 - 2.3 + 2.4 - 2.5 + 2.6 - 2.7 + 2.8 + 2.9 1,544,958 118,848,377 2.10 + 2.11 - 2.12 + 2.13 + 2.14) 0 0 2.16 Assumed incurred claims from non-affiliates 0 0 2.17 Net assumed less ceded incurred claims from affiliates 0 0 2.18 Ceded incurred claims to non-affiliates 0 0 2.19 Other adjustments due to MLR calculation - Claims 1,497,864 118,110,683 2.20 Net Incurred Claims (Lines 2.15 - 2.8 - 2.9 + 2.10 + 2.16 + 2.17 - 2.18 + 2.19) 3. Fraud and Abuse Recoveries that Reduced PAID Claims in Line 2.1 above 0 11,487 (informational only) 6,760,341 for stand-alone dental and $ (a) Column 13, Line 1.1 includes direct written premium of $ 4 Business Subject to MLR Mini-Med Plans 5 (LOCATION) NAIC Company Code 2018 214,379,426 0 0 0 30,315 2,346,251 331,512 2,014,739 313,548 0 214,065,877 0 12,350 20,994,257 313,548 191,352,466 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 170,120,062 16,787,388 16,367,599 237,203 331,885 0 0 30,315 2,346,251 331,512 732,925 287,828 865,438 420,341 (57,168) 3,966,943 4,024,111 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 173,280,317 1,803 0 16,625,150 0 154,611,916 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 14,359 0 0 1,574,028 for stand-alone vision policies. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,726,362 0 0 1,726,362 41,023,503 515,988 1,189,062 (673,074) (1,535,512) 411,221 250,801 160,420 515 0 40,349,915 0 0 101,028 515 41,624,492 84,323,562 0 0 0 5,518,559 922,787 1,267,903 (345,116) 537,433 0 83,786,130 0 753,668 0 537,433 79,903,788 485,480,677 517,948 1,189,062 (671,113) 4,798,150 3,680,086 1,850,043 1,830,043 865,526 0 483,944,037 0 2,506,548 21,095,285 865,526 459,592,634 33,477,773 3,819,034 3,310,578 2,251,195 2,019,168 19,100 28,257 (1,535,512) 411,221 250,801 0 0 0 0 843 2,388 1,545 0 0 81,483,859 4,148,200 11,384,571 11,960 13,377 0 0 5,518,559 922,787 1,267,903 1,105,562 655,525 451,504 1,468 10,307,968 7,140,818 (3,167,150) 0 0 401,322,369 42,497,051 45,194,527 3,088,138 2,789,930 46,998 80,404 4,798,150 3,680,086 1,850,043 2,122,158 1,205,350 1,355,887 439,079 10,916,122 14,383,075 3,466,954 0 0 0 0 0 0 0 0 32,833,165 0 0 18,427 0 34,189,830 70,217,108 0 (191,733) 0 0 64,851,932 396,723,924 1,803 (191,733) 16,643,577 0 373,262,224 0 0 (197,217) 529,817 332,600 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7,082 32,928 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF Nebraska DURING THE YEAR Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities All Expenses 1 Improve Health Outcomes 1. Individual Comprehensive Coverage Expenses: 54,378 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 3,768 for affiliated services) 1.3 EDP Equipment and Software (incl $ 362 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 39 for affiliated services) 1.5 Accreditation and Certification (incl $ 116,843 for affiliated services) 1.6 Other Expenses (incl $ 1.7 Subtotal before Reimbursements and Taxes (Lines 1.1 to 1.6) 1.8 Reimbursements by uninsured plans and fiscal intermediaries 1.9 Taxes, Licenses and Fees (in total, for tying purposes) 1.10 Total (1.7 to 1.9) 1.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 2. 216-4.NE Small Group Comprehensive Coverage Expenses: 5,032,162 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 355,250 for affiliated services) 2.3 EDP Equipment and Software (incl $ 34,100 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 3,703 for affiliated services) 2.5 Accreditation and Certification (incl $ 5,616,420 for affiliated services) 2.6 Other Expenses (incl $ 2.7 Subtotal before Reimbursements and Taxes (Lines 2.1 to 2.6) 2.8 Reimbursements by uninsured plans and fiscal intermediaries 2.9 Taxes, Licenses and Fees (in total, for tying purposes) 2.10 Total (2.7 to 2.9) 2.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 3. Large Group Comprehensive Coverage Expenses: 3,091,772 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 208,719 for affiliated services) 3.3 EDP Equipment and Software (incl $ 20,035 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 2,175 for affiliated services) 3.5 Accreditation and Certification (incl $ 12,591,558 for affiliated services) 3.6 Other Expenses (incl $ 3.7 Subtotal before Reimbursements and Taxes (Lines 3.1 to 3.6) 3.8 Reimbursements by uninsured plans and fiscal intermediaries 3.9 Taxes, Licenses and Fees (in total, for tying purposes) 3.10 Total (3.7 to 3.9) 3.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 185 Asylum Street Hartford, CT 061033408 0 0 0 0 0 15,622 15,622 0 XXX 2 Activities to Prevent Hospital Readmissions 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX Total (1 to 5) 0 0 0 0 0 15,622 15,622 0 XXX 0 0 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 0 0 0 0 0 0 0 XXX (LOCATION) NAIC Company Code 2018 XXX 6,313 770 527 51 5 14,120 21,786 0 XXX 11,709 1,277 929 89 10 25,088 39,101 0 XXX 15,622 0 0 0 0 0 0 0 0 0 15,622 0 21,786 6,324 39,101 0 0 0 0 0 0 1,150,315 1,150,315 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,150,315 1,150,315 0 631,110 135,928 52,701 5,059 549 704,624 1,529,971 0 1,007,795 115,495 84,156 8,078 877 1,063,649 2,280,050 0 XXX 1,150,315 0 0 0 0 0 0 1,712,527 1,712,527 0 XXX 1,712,527 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 1,150,315 0 XXX 1,529,971 425,799 XXX 2,280,050 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,712,527 1,712,527 0 417,217 105,493 34,840 3,344 363 1,710,460 2,271,717 0 574,365 65,823 47,962 4,604 500 2,474,956 3,168,211 0 1,712,527 0 XXX 2,271,717 690,755 XXX 3,168,211 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 79413 9 10 General Administrative Expenses Total Expenses (6 to 9) 36,357 3,195 2,312 219 24 145,353 187,460 0 49,503 236,963 0 54,378 5,242 3,768 359 39 200,182 263,969 0 49,503 313,472 6,324 3,393,257 321,401 218,393 20,963 2,276 8,727,114 12,683,405 0 2,775,957 15,459,361 0 5,032,162 572,824 355,250 34,100 3,703 11,645,702 17,643,740 0 2,775,957 20,419,697 425,799 2,100,189 192,846 125,917 12,087 1,312 11,877,984 14,310,334 0 4,716,732 19,027,066 0 3,091,772 364,162 208,719 20,035 2,175 17,775,927 21,462,789 0 4,716,732 26,179,521 690,755 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 4. 5. 216-5.NE 6. Individual Mini-Med Plans Expenses: 0 for affiliated services) 4.1 Salaries (including $ 4.2 Outsourced Services 0 for affiliated services) 4.3 EDP Equipment and Software (incl $ 0 for affiliated services) 4.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 4.5 Accreditation and Certification (incl $ 0 for affiliated services) 4.6 Other Expenses (incl $ 4.7 Subtotal before Reimbursements and Taxes (Lines 4.1 to 4.6) 4.8 Reimbursements by uninsured plans and fiscal intermediaries 4.9 Taxes, Licenses and Fees (in total, for tying purposes) 4.10 Total (4.7 to 4.9) 4.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Mini-Med Plans Expenses: 0 for affiliated services) 5.1 Salaries (including $ 5.2 Outsourced Services 0 for affiliated services) 5.3 EDP Equipment and Software (incl $ 0 for affiliated services) 5.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 5.5 Accreditation and Certification (incl $ 0 for affiliated services) 5.6 Other Expenses (incl $ 5.7 Subtotal before Reimbursements and Taxes (Lines 5.1 to 5.6) 5.8 Reimbursements by uninsured plans and fiscal intermediaries 5.9 Taxes, Licenses and Fees (in total, for tying purposes) 5.10 Total (5.7 to 5.9) 5.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Mini-Med Plans Expenses: 0 for affiliated services) 6.1 Salaries (including $ 6.2 Outsourced Services 0 for affiliated services) 6.3 EDP Equipment and Software (incl $ 0 for affiliated services) 6.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 6.5 Accreditation and Certification (incl $ 0 for affiliated services) 6.6 Other Expenses (incl $ 6.7 Subtotal before Reimbursements and Taxes (Lines 6.1 to 6.6) 6.8 Reimbursements by uninsured plans and fiscal intermediaries 6.9 Taxes, Licenses and Fees (in total, for tying purposes) 6.10 Total (6.7 to 6.9) 6.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 7. 8. 216-6.NE 9. Small Group Expatriate Plans Expenses: 0 for affiliated services) 7.1 Salaries (including $ 7.2 Outsourced Services 0 for affiliated services) 7.3 EDP Equipment and Software (incl $ 0 for affiliated services) 7.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 7.5 Accreditation and Certification (incl $ 0 for affiliated services) 7.6 Other Expenses (incl $ 7.7 Subtotal before Reimbursements and Taxes (Lines 7.1 to 7.6) 7.8 Reimbursements by uninsured plans and fiscal intermediaries 7.9 Taxes, Licenses and Fees (in total, for tying purposes) 7.10 Total (7.7 to 7.9) 7.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Expatriate Plans Expenses: 0 for affiliated services) 8.1 Salaries (including $ 8.2 Outsourced Services 0 for affiliated services) 8.3 EDP Equipment and Software (incl $ 0 for affiliated services) 8.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 8.5 Accreditation and Certification (incl $ 0 for affiliated services) 8.6 Other Expenses (incl $ 8.7 Subtotal before Reimbursements and Taxes (Lines 8.1 to 8.6) 8.8 Reimbursements by uninsured plans and fiscal intermediaries 8.9 Taxes, Licenses and Fees (in total, for tying purposes) 8.10 Total (8.7 to 8.9) 8.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Student Health Plans Expenses: 0 for affiliated services) 9.1 Salaries (including $ 9.2 Outsourced Services 0 for affiliated services) 9.3 EDP Equipment and Software (incl $ 0 for affiliated services) 9.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 9.5 Accreditation and Certification (incl $ 0 for affiliated services) 9.6 Other Expenses (incl $ 9.7 Subtotal before Reimbursements and Taxes (Lines 9.1 to 9.6) 9.8 Reimbursements by uninsured plans and fiscal intermediaries 9.9 Taxes, Licenses and Fees (in total, for tying purposes) 9.10 Total (9.7 to 9.9) 9.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 *79413201821629100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes - See Cautionary Statement at http://www.naic.org/documents/committees_e_app_blanks_related_shce_cautionary_statement.pdf) UnitedHealthcare Insurance Company 2. 185 Asylum Street Hartford, CT 061033408 (LOCATION) BUSINESS IN THE STATE OF Nevada DURING THE YEAR 2018 NAIC Company Code Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 1. 216-1.NV 2. 3. 4. 5. 6. 7. 8. 9. Premium: 1.1 Health premiums earned (From Part 2, Line 1.11) 1.2 Federal high risk pools 1.3 State high risk pools 1.4 Premiums earned including state and federal high risk programs (Lines 1.1 + 1.2 + 1.3) 1.5 Federal taxes and federal assessments 1.6 State insurance, premium and other taxes (Similar local taxes of 33,753 ) $ 1.6a Community Benefit Expenditures (informational only) 1.7 Regulatory authority licenses and fees 1.8 Adjusted Premiums Earned (Lines 1.4 - 1.5 - 1.6 - 1.7) 1.9 Net Assumed less Ceded reinsurance premiums earned 1.10 Other Adjustments due to MLR calculations - Premiums 1.11 Risk Revenue 1.12 Net adjusted premiums earned after reinsurance (Lines 1.8 + 1.9 + 1.10 + 1.11) Claims: 2.1 Incurred claims excluding prescription drugs 2.2 Prescription drugs 2.3 Pharmaceutical rebates 2.4 State stop loss, market stabilization and claim/census based assessments (informational only) Incurred medical incentive pools and bonuses Deductible Fraud and Abuse Detection/Recovery Expenses (for MLR use only) 5.0 Total Incurred Claims (Lines 2.1 + 2.2 - 2.3 + 3) (From Part 2, Line 2.15) 5.1 Net Assumed less Ceded reinsurance claims incurred 5.2 Other Adjustments due to MLR calculations - Claims 5.3 Rebates paid 5.4 Estimated rebates unpaid prior year 5.5 Estimated rebates unpaid current year 5.6 Fee for service and co-pay revenue 5.7 Net incurred claims after reinsurance (Lines 5.0 + 5.1 + 5.2 + 5.3 - 5.4 + 5.5 - 5.6) Improving Health Care Quality Expenses Incurred: 6.1 Improve health outcomes 6.2 Activities to prevent hospital readmissions 6.3 Improve patient safety and reduce medical errors 6.4 Wellness and health promotion activities 6.5 Health Information Technology expenses related to health improvement 6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5) Preliminary Medical Loss Ratio: MLR ((Lines 4 + 5.0 + 6.6 - Footnote 2.0)/Line 1.8 Claims Adjustment Expenses: 8.1 Cost containment expenses not included in quality of care expenses in Line 6.6 8.2 All other claims adjustment expenses 8.3 Total claims adjustment expenses (Lines 8.1 + 8.2) Claims Adjustment Expense Ratio (Line 8.3/Line 1.8) 2 Small Group Employer 3 Large Group Employer 4 6 Large Group Employer 5 Small Group Employer Individual Expatriate Plans 7 11 Government Business (excluded by statute) Other Health Business 9 8 Small Group 10 Student Health Plans Large Group 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 79413 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 638,251 0 (28) 64,352,701 0 (2,583) 71,636,895 0 (4,602) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 140,368,837 0 65,800 35,160,952 0 0 312,157,636 0 58,586 XXX XXX XXX 312,157,636 0 58,586 638,223 78,285 64,350,118 2,049,365 71,632,293 2,231,891 0 0 0 0 0 0 0 0 0 0 0 0 0 198,721 140,434,637 1,702,480 35,160,952 1,600,342 312,216,223 7,861,084 XXX 126,286 312,216,223 7,987,371 27,549 0 11 532,378 414,618 0 0 946,996 2,051,540 0 1,025 60,248,189 128,228 16,816 0 60,393,233 1,982,727 0 3,222 67,414,453 (9,972,022) 40 0 57,442,471 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (198,721) 997,374 0 0 798,653 2,298,493 0 (27,715) 136,461,378 (156,990) 2,485 0 136,306,873 4,483 0 0 33,556,127 1,198,680 252,160 0 35,006,967 6,364,791 0 (23,456) 298,013,804 (7,390,111) 271,500 0 290,895,193 362 0 0 XXX XXX XXX XXX XXX 6,365,153 0 (23,456) 297,887,155 (7,390,111) 271,500 0 290,768,545 443,756 69,351 19,957 43,239,330 8,881,082 2,537,552 49,954,649 10,354,131 3,056,547 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 108,960,402 998,673 31,661 1,163,011 53,540,981 28,577,265 203,761,147 73,844,219 34,222,982 XXX XXX XXX 203,761,147 73,844,219 34,222,982 9 0 15 493,150 65,100 0 0 0 0 0 558,250 28,330 17,288 4,497 49,600,148 (41,440) (1,568,926) 1,717,987 1,842,852 1,693,791 0 49,558,708 73,059 59,548 759 57,311,781 (8,937,179) (1,032,730) 0 0 1,032,730 0 48,374,603 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 109,927,414 (653,240) 0 XXX XXX XXX 0 109,274,174 0 0 16 26,126,727 0 0 0 0 0 0 26,126,727 101,398 76,836 5,287 243,459,220 (9,566,758) (2,601,656) 1,717,987 1,842,852 2,726,521 0 233,892,462 XXX XXX 101,398 76,836 5,287 243,459,220 (9,566,758) (2,601,656) 1,717,987 1,842,852 2,726,521 0 233,892,462 5,106 0 0 0 0 514,822 0 0 0 0 573,095 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5,106 0.936 514,822 0.832 573,095 0.859 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 8,135 12,715 20,850 0.039 850,587 1,101,735 1,952,322 0.032 849,287 1,047,751 1,897,038 0.028 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 XXX XXX XXX 0 0 0 0 0 0 0 395,578 245,172 196,261 858,703 102,697 0 1,798,411 XXX 0 0 0 0.000 355,527 2,146,849 2,502,376 0.018 XXX 52,139 15,096 111,709 (26,810) 109,429 0 XXX XXX XXX XXX XXX XXX XXX XXX 1,540,740 260,268 307,970 831,893 212,125 9,934 3,215 7,356 3,416 10,376 1,550,674 263,483 315,326 835,309 222,501 261,564 0.786 3,152,998 XXX 34,296 XXX 3,187,294 XXX 445,718 2,359,911 2,805,630 0.084 2,509,255 6,668,961 9,178,216 XXX 84,158 62,717 146,875 XXX 2,593,413 6,731,678 9,325,091 XXX SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 (Continued) Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 2 Small Group Employer Individual 10. General and Administrative (G&A) Expenses: 10.1 Direct sales salaries and benefits 10.2 Agents and brokers fees and commissions 10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below) 10.4 Other general and administrative expenses 10.4a Community Benefit Expenditures (informational only) 10.5 Total general and administrative (Lines 10.1 +10.2 + 10.3 + 10.4) 2,784 29,583 (150) 34,583 0 66,800 3 Large Group Employer 259,048 2,674,153 6,449 3,214,214 0 6,153,863 4 5 Small Group Employer Individual 328,088 2,559,845 80,000 1,707,346 0 4,675,279 0 0 0 0 0 0 Expatriate Plans 6 Large Group Employer 0 0 0 0 0 0 7 8 Small Group 0 0 0 0 0 0 Student Health Plans Large Group 0 0 0 0 0 0 10 11 Government Business (excluded by statute) Other Health Business 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 358,765 5,818,330 241,226 12,222,715 0 18,641,037 80,140 397,405 74,250 2,284,312 0 2,836,106 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 1,028,825 11,479,315 401,775 19,463,170 0 32,373,084 44,005 0 (102) (12,323) 0 31,581 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) 12. Income from fees of uninsured plans XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 13. Net investment and other gain/(loss) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 14. Federal income taxes (excluding taxes on Line 1.5 above) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 15. Net gain or (loss) (Lines 11 + 12 + 13 - 14) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 16. ICD-10 Implementation Expenses (informational only; already included in general expenses and line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16. 16a ICD-10 Implementation Expenses (informational only; already included in line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 295,990 2,213,518 1,922,457 0 0 0 0 0 0 798,653 4,090,875 2,976,940 12,298,434 XXX XXX 1,072,831 11,479,315 401,673 19,450,847 0 32,404,665 11,959,033 846,942 4,077,915 (290,942) 16,667,291 XXX 846,942 4,077,915 XXX (290,942) XXX 17,174,832 OTHER INDICATORS: 216-2.NV 1. Number of certificates/policies 2. Number of Covered Lives 3. Number of Groups 4. Member Months 68 8,173 9,722 0 0 0 0 0 0 0 103,946 35,292 157,201 0 157,201 130 14,416 16,879 0 0 0 0 0 0 0 146,027 35,292 212,744 0 212,744 1,381 146 0 0 0 0 0 0 1,878 1 3,406 0 3,406 144,891 176,780 0 0 0 0 0 0 1,786,295 425,651 2,535,175 0 2,535,175 XXX 1,558 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ XXX 0 ] If yes, show the amount of premiums and claims included. Premiums $ 0 Claims $ 0 AFFORDABLE CARE ACT (ACA) RECEIPTS, PAYMENTS, RECEIVABLES and PAYABLES Current Year Prior Year Comprehensive Health Coverage Comprehensive Health Coverage 1 2 3 4 Small Group Small Group Employer Plans Employer Plans Individual Plans Individual Plans ACA Receivables and Payables 1. Permanent ACA Risk Adjustment Program 1.0 Premium adjustments receivable/(payable) 2. Transitional ACA Reinsurance Program 2.0 Total amounts recoverable for claims (paid & unpaid) 0 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 0 0 (52,524) 278,439 XXX (94,359) 0 (97,964) XXX 0 0 0 0 0 0 674,973 7,721 531,135 ACA Receipts and Payments 4. Permanent ACA Risk Adjustment Program 4.0 Premium adjustments receipts/(payments) 5. Transitional ACA Reinsurance Program 5.0 Amounts received for claims 0 6. Temporary ACA Risk Corridors Program 6.1 Retrospective premium received 6.2 Rate credits or policy experience refunds paid 0 0 (103,879) XXX 0 0 0 0 0 XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF 185 Asylum Street Hartford, CT 061033408 Nevada DURING THE YEAR Comprehensive Health Coverage 1 2 3 Individual Small Group Employer Large Group Employer Small Group Employer Individual Large Group Employer Small Group 11 Student Health Plans Government Business (excluded by statute) Large Group Other Health Business 79413 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 9 Expatriate Plans: 7 8 6 10 13 Total (a) 1. 216-3.NV Health Premiums Earned: 638,251 64,370,048 1.1 Direct premiums written 0 11,157 1.2 Unearned premium prior year 0 11,688 1.3 Unearned premium current year 0 (531) 1.4 Change in unearned premium (Lines 1.2 - 1.3) 434 1,717,987 1.5 Paid rate credits 0 1,693,791 1.6 Reserve for rate credits current year 0 1,842,852 1.7 Reserve for rate credits prior year 0 (149,061) 1.8 Change in reserve for rate credits (Lines 1.6 - 1.7) 0 16,816 1.9 Premium balances written off 0 0 1.10 Group conversion charge 638,251 64,352,701 1.11 Total direct premiums earned (Lines 1.1 + 1.4 - 1.9 + 1.10) 0 0 1.12 Assumed premiums earned from non-affiliates 414,618 128,228 1.13 Net Assumed less Ceded premiums earned from affiliates 0 0 1.14 Ceded premiums earned to non-affiliates 0 16,816 1.15 Other Adjustments due to MLR calculation - Premiums 1,052,436 62,928,819 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 492,569 44,624,842 2.1 Paid claims during the year 207 7,458,737 2.2 Direct claim liability current year 62 4,018,871 2.3 Direct claim liability prior year 2 200,728 2.4 Direct claim reserves current year 0 99,992 2.5 Direct claim reserves prior year 0 0 2.6 Direct contract reserves current year 0 0 2.7 Direct contract reserves prior year 434 1,717,987 2.8 Paid rate credits 0 1,693,791 2.9 Reserve for rate credits current year 0 1,842,852 2.10 Reserve for rate credits prior year 0 17,288 2.11 Incurred medical incentive pools and bonuses (Lines 2.11a + 2.11b - 2.11c) 0 7,271 2.11a Paid medical incentive pools and bonuses current year 0 26,406 2.11b Accrued medical incentive pools and bonuses current year 0 16,388 2.11c Accrued medical incentive pools and bonuses prior year 0 151,509 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 0 1,122,066 2.12a Healthcare receivables current year 0 970,557 2.12b Healthcare receivables prior year 0 0 2.13 Group conversion charge 0 0 2.14 Multi-option coverage blended rate adjustment 2.15 Total incurred claims (Lines 2.1 + 2.2 - 2.3 + 2.4 - 2.5 + 2.6 - 2.7 + 2.8 + 2.9 493,150 49,600,148 2.10 + 2.11 - 2.12 + 2.13 + 2.14) 0 0 2.16 Assumed incurred claims from non-affiliates 65,100 (41,440) 2.17 Net assumed less ceded incurred claims from affiliates 0 0 2.18 Ceded incurred claims to non-affiliates 0 0 2.19 Other adjustments due to MLR calculation - Claims 557,816 47,989,782 2.20 Net Incurred Claims (Lines 2.15 - 2.8 - 2.9 + 2.10 + 2.16 + 2.17 - 2.18 + 2.19) 3. Fraud and Abuse Recoveries that Reduced PAID Claims in Line 2.1 above 15 4,497 (informational only) 22,345,657 for stand-alone dental and $ (a) Column 13, Line 1.1 includes direct written premium of $ 4 Business Subject to MLR Mini-Med Plans 5 (LOCATION) NAIC Company Code 2018 71,636,935 0 0 0 (434) 1,032,730 0 1,032,730 40 0 71,636,895 0 1,439,156 11,411,177 40 60,632,617 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 997,374 0 0 997,374 140,440,713 42,172 111,564 (69,392) 3,491,281 148,692 135,927 12,765 2,485 0 140,368,837 0 5,339 162,329 2,485 136,710,287 35,413,112 0 0 0 2,345,713 986,066 2,171,831 (1,185,765) 252,160 0 35,160,952 0 1,198,680 0 252,160 35,451,844 312,499,059 53,329 123,251 (69,922) 7,554,981 3,861,279 4,150,611 (289,332) 271,500 0 312,157,636 0 4,183,395 11,573,506 271,500 297,773,377 52,112,724 7,617,144 3,630,499 214,530 123,940 0 0 (434) 1,032,730 0 59,548 25,172 69,079 34,703 (29,978) 1,224,043 1,254,020 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 106,541,344 12,462,149 13,222,775 4,249,590 3,556,125 113,562 154,883 3,491,281 148,692 135,927 0 0 0 0 9,493 9,475 (17) 0 0 25,069,569 758,286 2,170,682 0 0 0 0 2,345,713 986,066 2,171,831 0 0 0 0 (1,309,606) 9,022,627 10,332,233 0 0 228,841,048 28,296,523 23,042,890 4,664,850 3,780,057 113,562 154,883 7,554,981 3,861,279 4,150,611 76,836 32,443 95,484 51,091 (1,178,582) 11,378,211 12,556,794 0 0 57,311,781 0 300,239 9,237,418 0 47,342,306 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 109,927,414 0 0 653,240 0 105,770,129 26,126,727 0 0 0 0 24,966,779 243,459,220 0 323,899 9,890,658 0 226,626,813 759 0 0 1,889,504 for stand-alone vision policies. 0 0 0 0 0 0 8,787 14,059 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF Nevada DURING THE YEAR Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities All Expenses 1 Improve Health Outcomes 1. Individual Comprehensive Coverage Expenses: 17,771 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 1,260 for affiliated services) 1.3 EDP Equipment and Software (incl $ 121 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 13 for affiliated services) 1.5 Accreditation and Certification (incl $ 40,797 for affiliated services) 1.6 Other Expenses (incl $ 1.7 Subtotal before Reimbursements and Taxes (Lines 1.1 to 1.6) 1.8 Reimbursements by uninsured plans and fiscal intermediaries 1.9 Taxes, Licenses and Fees (in total, for tying purposes) 1.10 Total (1.7 to 1.9) 1.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 2. 216-4.NV 3. 0 0 0 0 0 5,106 5,106 0 XXX Small Group Comprehensive Coverage Expenses: 1,601,025 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 112,839 for affiliated services) 2.3 EDP Equipment and Software (incl $ 10,831 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 1,176 for affiliated services) 2.5 Accreditation and Certification (incl $ 3,714,868 for affiliated services) 2.6 Other Expenses (incl $ 2.7 Subtotal before Reimbursements and Taxes (Lines 2.1 to 2.6) 2.8 Reimbursements by uninsured plans and fiscal intermediaries 2.9 Taxes, Licenses and Fees (in total, for tying purposes) 2.10 Total (2.7 to 2.9) 2.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 2 Activities to Prevent Hospital Readmissions 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX Total (1 to 5) 0 0 0 0 0 5,106 5,106 0 XXX 0 0 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 0 0 0 0 0 0 0 XXX (LOCATION) NAIC Company Code 2018 XXX 2,287 262 191 18 2 5,115 7,876 0 XXX 3,557 599 297 29 3 7,955 12,438 0 XXX 5,106 0 0 0 0 0 0 0 0 0 5,106 0 7,876 2,249 12,438 0 0 0 0 0 0 514,822 514,822 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 514,822 514,822 0 211,545 108,432 17,665 1,696 184 486,935 826,457 0 312,484 35,811 26,094 2,505 272 698,892 1,076,058 0 XXX Large Group Comprehensive Coverage Expenses: 1,528,823 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 101,252 for affiliated services) 3.3 EDP Equipment and Software (incl $ 9,719 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 1,055 for affiliated services) 3.5 Accreditation and Certification (incl $ 3,493,564 for affiliated services) 3.6 Other Expenses (incl $ 3.7 Subtotal before Reimbursements and Taxes (Lines 3.1 to 3.6) 3.8 Reimbursements by uninsured plans and fiscal intermediaries 3.9 Taxes, Licenses and Fees (in total, for tying purposes) 3.10 Total (3.7 to 3.9) 3.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 185 Asylum Street Hartford, CT 061033408 XXX XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 514,822 0 826,457 209,217 XXX 1,076,058 0 0 0 0 0 0 573,095 573,095 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 573,095 573,095 0 215,174 93,955 17,968 1,725 187 495,916 824,925 0 298,195 34,174 24,901 2,390 260 666,934 1,026,853 0 824,925 226,432 XXX 1,026,853 0 XXX XXX 0 0 0 XXX 573,095 0 XXX 0 0 0 514,822 0 XXX XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX XXX 0 0 XXX 573,095 0 79413 9 10 General Administrative Expenses Total Expenses (6 to 9) 11,927 1,059 772 74 8 52,912 66,753 0 28,143 94,896 0 17,771 1,920 1,260 121 13 71,088 92,173 0 28,143 120,316 2,249 1,076,995 119,350 69,080 6,631 720 4,856,324 6,129,100 0 2,127,135 8,256,235 0 1,601,025 263,593 112,839 10,831 1,176 6,556,972 8,546,437 0 2,127,135 10,673,571 209,217 1,015,454 113,858 58,383 5,604 609 3,379,930 4,573,838 0 2,132,650 6,706,488 0 1,528,823 241,987 101,252 9,719 1,055 5,115,875 6,998,711 0 2,132,650 9,131,361 226,432 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 4. 5. 216-5.NV 6. Individual Mini-Med Plans Expenses: 0 for affiliated services) 4.1 Salaries (including $ 4.2 Outsourced Services 0 for affiliated services) 4.3 EDP Equipment and Software (incl $ 0 for affiliated services) 4.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 4.5 Accreditation and Certification (incl $ 0 for affiliated services) 4.6 Other Expenses (incl $ 4.7 Subtotal before Reimbursements and Taxes (Lines 4.1 to 4.6) 4.8 Reimbursements by uninsured plans and fiscal intermediaries 4.9 Taxes, Licenses and Fees (in total, for tying purposes) 4.10 Total (4.7 to 4.9) 4.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Mini-Med Plans Expenses: 0 for affiliated services) 5.1 Salaries (including $ 5.2 Outsourced Services 0 for affiliated services) 5.3 EDP Equipment and Software (incl $ 0 for affiliated services) 5.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 5.5 Accreditation and Certification (incl $ 0 for affiliated services) 5.6 Other Expenses (incl $ 5.7 Subtotal before Reimbursements and Taxes (Lines 5.1 to 5.6) 5.8 Reimbursements by uninsured plans and fiscal intermediaries 5.9 Taxes, Licenses and Fees (in total, for tying purposes) 5.10 Total (5.7 to 5.9) 5.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Mini-Med Plans Expenses: 0 for affiliated services) 6.1 Salaries (including $ 6.2 Outsourced Services 0 for affiliated services) 6.3 EDP Equipment and Software (incl $ 0 for affiliated services) 6.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 6.5 Accreditation and Certification (incl $ 0 for affiliated services) 6.6 Other Expenses (incl $ 6.7 Subtotal before Reimbursements and Taxes (Lines 6.1 to 6.6) 6.8 Reimbursements by uninsured plans and fiscal intermediaries 6.9 Taxes, Licenses and Fees (in total, for tying purposes) 6.10 Total (6.7 to 6.9) 6.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 7. 8. 216-6.NV 9. Small Group Expatriate Plans Expenses: 0 for affiliated services) 7.1 Salaries (including $ 7.2 Outsourced Services 0 for affiliated services) 7.3 EDP Equipment and Software (incl $ 0 for affiliated services) 7.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 7.5 Accreditation and Certification (incl $ 0 for affiliated services) 7.6 Other Expenses (incl $ 7.7 Subtotal before Reimbursements and Taxes (Lines 7.1 to 7.6) 7.8 Reimbursements by uninsured plans and fiscal intermediaries 7.9 Taxes, Licenses and Fees (in total, for tying purposes) 7.10 Total (7.7 to 7.9) 7.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Expatriate Plans Expenses: 0 for affiliated services) 8.1 Salaries (including $ 8.2 Outsourced Services 0 for affiliated services) 8.3 EDP Equipment and Software (incl $ 0 for affiliated services) 8.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 8.5 Accreditation and Certification (incl $ 0 for affiliated services) 8.6 Other Expenses (incl $ 8.7 Subtotal before Reimbursements and Taxes (Lines 8.1 to 8.6) 8.8 Reimbursements by uninsured plans and fiscal intermediaries 8.9 Taxes, Licenses and Fees (in total, for tying purposes) 8.10 Total (8.7 to 8.9) 8.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Student Health Plans Expenses: 0 for affiliated services) 9.1 Salaries (including $ 9.2 Outsourced Services 0 for affiliated services) 9.3 EDP Equipment and Software (incl $ 0 for affiliated services) 9.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 9.5 Accreditation and Certification (incl $ 0 for affiliated services) 9.6 Other Expenses (incl $ 9.7 Subtotal before Reimbursements and Taxes (Lines 9.1 to 9.6) 9.8 Reimbursements by uninsured plans and fiscal intermediaries 9.9 Taxes, Licenses and Fees (in total, for tying purposes) 9.10 Total (9.7 to 9.9) 9.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 *79413201821630100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes - See Cautionary Statement at http://www.naic.org/documents/committees_e_app_blanks_related_shce_cautionary_statement.pdf) UnitedHealthcare Insurance Company 2. 185 Asylum Street Hartford, CT 061033408 (LOCATION) BUSINESS IN THE STATE OF New Hampshire DURING THE YEAR 2018 NAIC Company Code Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 1. 216-1.NH 2. 3. 4. 5. 6. 7. 8. 9. Premium: 1.1 Health premiums earned (From Part 2, Line 1.11) 1.2 Federal high risk pools 1.3 State high risk pools 1.4 Premiums earned including state and federal high risk programs (Lines 1.1 + 1.2 + 1.3) 1.5 Federal taxes and federal assessments 1.6 State insurance, premium and other taxes (Similar local taxes of 442,903 ) $ 1.6a Community Benefit Expenditures (informational only) 1.7 Regulatory authority licenses and fees 1.8 Adjusted Premiums Earned (Lines 1.4 - 1.5 - 1.6 - 1.7) 1.9 Net Assumed less Ceded reinsurance premiums earned 1.10 Other Adjustments due to MLR calculations - Premiums 1.11 Risk Revenue 1.12 Net adjusted premiums earned after reinsurance (Lines 1.8 + 1.9 + 1.10 + 1.11) Claims: 2.1 Incurred claims excluding prescription drugs 2.2 Prescription drugs 2.3 Pharmaceutical rebates 2.4 State stop loss, market stabilization and claim/census based assessments (informational only) Incurred medical incentive pools and bonuses Deductible Fraud and Abuse Detection/Recovery Expenses (for MLR use only) 5.0 Total Incurred Claims (Lines 2.1 + 2.2 - 2.3 + 3) (From Part 2, Line 2.15) 5.1 Net Assumed less Ceded reinsurance claims incurred 5.2 Other Adjustments due to MLR calculations - Claims 5.3 Rebates paid 5.4 Estimated rebates unpaid prior year 5.5 Estimated rebates unpaid current year 5.6 Fee for service and co-pay revenue 5.7 Net incurred claims after reinsurance (Lines 5.0 + 5.1 + 5.2 + 5.3 - 5.4 + 5.5 - 5.6) Improving Health Care Quality Expenses Incurred: 6.1 Improve health outcomes 6.2 Activities to prevent hospital readmissions 6.3 Improve patient safety and reduce medical errors 6.4 Wellness and health promotion activities 6.5 Health Information Technology expenses related to health improvement 6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5) Preliminary Medical Loss Ratio: MLR ((Lines 4 + 5.0 + 6.6 - Footnote 2.0)/Line 1.8 Claims Adjustment Expenses: 8.1 Cost containment expenses not included in quality of care expenses in Line 6.6 8.2 All other claims adjustment expenses 8.3 Total claims adjustment expenses (Lines 8.1 + 8.2) Claims Adjustment Expense Ratio (Line 8.3/Line 1.8) 2 Small Group Employer 3 Large Group Employer 4 5 Small Group Employer Individual Expatriate Plans 6 Large Group Employer 7 11 Government Business (excluded by statute) Other Health Business 9 8 Small Group 10 Student Health Plans Large Group 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 79413 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 47,527 0 (1) 4,774,091 0 (321) 13,324,056 0 (587) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 74,052,993 0 42,950 37,109,932 0 0 129,308,599 0 42,040 XXX XXX XXX 47,526 7,645 4,773,770 262,685 13,323,469 293,771 0 0 0 0 0 0 0 0 0 0 0 0 0 0 74,095,943 520,306 37,109,932 2,659,479 129,350,640 3,743,886 XXX 4,566 0 19 35,296 0 0 0 35,296 373,791 0 3,902 4,133,393 83 0 0 4,133,475 488,570 0 8,150 12,532,978 (5,363,809) 0 0 7,169,168 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 759,579 0 (17,860) 72,833,917 (15,012) 259 0 72,819,164 279,182 0 0 34,171,271 75,301 262,480 0 34,509,052 1,905,689 0 (5,789) 123,706,854 (5,303,438) 262,739 0 118,666,156 XXX XXX XXX XXX XXX 1,905,689 0 (5,789) 123,706,854 (5,303,438) 262,739 0 118,666,156 5,220 764 269 2,699,018 580,696 255,554 9,070,652 2,260,711 782,462 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 58,397,757 333,837 33,917 8,943,155 41,694,316 24,999,241 79,115,801 44,870,324 26,071,442 XXX XXX XXX 79,115,801 44,870,324 26,071,442 28 0 0 5,716 0 0 0 0 0 0 5,716 37,352 1,529 28 3,025,689 10,858 0 0 0 0 0 3,036,547 117,607 3,411 114 10,552,312 (4,420,305) 0 0 0 0 0 6,132,007 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 213 25,638,229 (4,996) 0 0 0 0 0 25,633,233 154,987 4,939 355 97,919,623 (4,414,327) 0 0 0 0 0 93,505,296 XXX XXX 0 0 0 0 0 58,697,676 116 0 XXX XXX XXX 0 58,697,793 154,987 4,939 355 97,919,623 (4,414,327) 0 0 0 0 0 93,505,296 380 0 0 0 0 38,193 0 0 0 0 106,592 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 265,061 185,129 137,800 575,060 56,031 73,183 27,022 17,513 (31,007) 55,886 380 0.173 38,193 0.741 106,592 0.850 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 1,219,081 XXX 142,597 0.754 1,506,844 XXX 426 625 1,052 0.030 51,415 70,585 121,999 0.030 139,874 142,745 282,618 0.023 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 19,526 1,026,630 1,046,157 0.014 (175,746) 476,682 300,936 0.009 35,494 1,717,267 1,752,762 XXX XXX XXX XXX XXX 0 0 0 0.000 129,308,599 0 42,040 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 483,410 212,151 155,313 544,053 111,917 0 0 0 0 0 483,410 212,151 155,313 544,053 111,917 0 1,506,844 XXX 0 0 0 35,494 1,717,267 1,752,762 XXX XXX XXX 129,350,640 3,743,886 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 (Continued) Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 10. General and Administrative (G&A) Expenses: 10.1 Direct sales salaries and benefits 10.2 Agents and brokers fees and commissions 10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below) 10.4 Other general and administrative expenses 10.4a Community Benefit Expenditures (informational only) 10.5 Total general and administrative (Lines 10.1 +10.2 + 10.3 + 10.4) 3 Large Group Employer 2 Small Group Employer 141 524 (746) 1,006 0 926 16,143 109,048 1,437 184,483 0 311,111 4 5 Small Group Employer Individual 57,174 377,821 13,965 494,006 0 942,965 0 0 0 0 0 0 Expatriate Plans 6 Large Group Employer 0 0 0 0 0 0 7 8 Small Group 0 0 0 0 0 0 Student Health Plans Large Group 0 0 0 0 0 0 10 11 Government Business (excluded by statute) Other Health Business 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 88,187 2,597,121 100,965 7,133,708 0 9,919,980 89,753 180,432 74,100 2,383,570 0 2,727,855 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 251,398 3,264,946 189,720 10,196,773 0 13,902,837 0 0 0 0 0 0 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) 12. Income from fees of uninsured plans XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 13. Net investment and other gain/(loss) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 14. Federal income taxes (excluding taxes on Line 1.5 above) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 15. Net gain or (loss) (Lines 11 + 12 + 13 - 14) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 16. ICD-10 Implementation Expenses (informational only; already included in general expenses and line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16. 16a ICD-10 Implementation Expenses (informational only; already included in line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 39 390 1,352 0 0 0 0 0 0 0 32,880 33,360 68,021 0 68,021 1 803 2,491 0 0 0 0 0 0 0 33,651 33,360 70,306 0 70,306 61 17 0 0 0 0 0 0 67 1 146 0 146 9,034 26,806 0 0 0 0 0 0 413,241 410,882 860,042 0 860,042 27,222 625,626 (295,015) 0 0 0 0 0 0 0 1,936,153 5,704,431 7,998,417 XXX 251,398 3,264,946 189,720 10,196,773 0 13,902,837 XXX 7,998,417 0 0 1,523,248 XXX XXX 88,589 XXX 88,589 XXX 9,433,075 XXX 9,433,075 1,523,248 OTHER INDICATORS: 216-2.NH 1. Number of certificates/policies 2. Number of Covered Lives 3. Number of Groups 4. Member Months XXX 79 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ XXX 0 ] If yes, show the amount of premiums and claims included. Premiums $ 0 Claims $ 0 AFFORDABLE CARE ACT (ACA) RECEIPTS, PAYMENTS, RECEIVABLES and PAYABLES Current Year Prior Year Comprehensive Health Coverage Comprehensive Health Coverage 1 2 3 4 Small Group Small Group Employer Plans Employer Plans Individual Plans Individual Plans ACA Receivables and Payables 1. Permanent ACA Risk Adjustment Program 1.0 Premium adjustments receivable/(payable) 0 2. Transitional ACA Reinsurance Program 2.0 Total amounts recoverable for claims (paid & unpaid) 0 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 0 0 0 0 0 0 347,580 0 (789,462) XXX 0 0 127,797 XXX 0 0 ACA Receipts and Payments 4. Permanent ACA Risk Adjustment Program 4.0 Premium adjustments receipts/(payments) 0 5. Transitional ACA Reinsurance Program 5.0 Amounts received for claims 0 6. Temporary ACA Risk Corridors Program 6.1 Retrospective premium received 6.2 Rate credits or policy experience refunds paid 0 0 XXX 0 0 0 0 0 (178,155) XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF 185 Asylum Street Hartford, CT 061033408 New Hampshire DURING THE YEAR Comprehensive Health Coverage 1 2 3 Individual Small Group Employer Large Group Employer Small Group Employer Individual Expatriate Plans: 7 8 6 Large Group Employer Small Group 10 11 Government Business (excluded by statute) Other Health Business 9 Student Health Plans Large Group 79413 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.NH Health Premiums Earned: 47,527 4,776,670 1.1 Direct premiums written 0 1,394 1.2 Unearned premium prior year 0 3,973 1.3 Unearned premium current year 0 (2,579) 1.4 Change in unearned premium (Lines 1.2 - 1.3) 0 0 1.5 Paid rate credits 0 0 1.6 Reserve for rate credits current year 0 0 1.7 Reserve for rate credits prior year 0 0 1.8 Change in reserve for rate credits (Lines 1.6 - 1.7) 0 0 1.9 Premium balances written off 0 0 1.10 Group conversion charge 47,527 4,774,091 1.11 Total direct premiums earned (Lines 1.1 + 1.4 - 1.9 + 1.10) 0 0 1.12 Assumed premiums earned from non-affiliates 0 83 1.13 Net Assumed less Ceded premiums earned from affiliates 0 0 1.14 Ceded premiums earned to non-affiliates 0 0 1.15 Other Adjustments due to MLR calculation - Premiums 47,527 4,774,174 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 5,713 3,011,850 2.1 Paid claims during the year 16 246,054 2.2 Direct claim liability current year 13 236,719 2.3 Direct claim liability prior year 0 7,648 2.4 Direct claim reserves current year 0 5,948 2.5 Direct claim reserves prior year 0 0 2.6 Direct contract reserves current year 0 0 2.7 Direct contract reserves prior year 0 0 2.8 Paid rate credits 0 0 2.9 Reserve for rate credits current year 0 0 2.10 Reserve for rate credits prior year 0 1,529 2.11 Incurred medical incentive pools and bonuses (Lines 2.11a + 2.11b - 2.11c) 0 215 2.11a Paid medical incentive pools and bonuses current year 0 1,931 2.11b Accrued medical incentive pools and bonuses current year 0 618 2.11c Accrued medical incentive pools and bonuses prior year 0 (1,275) 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 0 93,302 2.12a Healthcare receivables current year 0 94,577 2.12b Healthcare receivables prior year 0 0 2.13 Group conversion charge 0 0 2.14 Multi-option coverage blended rate adjustment 2.15 Total incurred claims (Lines 2.1 + 2.2 - 2.3 + 2.4 - 2.5 + 2.6 - 2.7 + 2.8 + 2.9 5,716 3,025,689 2.10 + 2.11 - 2.12 + 2.13 + 2.14) 0 0 2.16 Assumed incurred claims from non-affiliates 0 10,858 2.17 Net assumed less ceded incurred claims from affiliates 0 0 2.18 Ceded incurred claims to non-affiliates 0 0 2.19 Other adjustments due to MLR calculation - Claims 5,716 3,036,547 2.20 Net Incurred Claims (Lines 2.15 - 2.8 - 2.9 + 2.10 + 2.16 + 2.17 - 2.18 + 2.19) 3. Fraud and Abuse Recoveries that Reduced PAID Claims in Line 2.1 above 0 28 (informational only) 366,743 for stand-alone dental and $ (a) Column 13, Line 1.1 includes direct written premium of $ 4 Business Subject to MLR Mini-Med Plans 5 (LOCATION) NAIC Company Code 2018 13,324,056 0 0 0 0 0 0 0 0 0 13,324,056 5,377,353 848 10,742,010 0 7,960,246 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 74,053,490 0 238 (238) (4,129,213) 6,410 0 6,410 259 0 74,052,993 0 0 15,012 259 78,161,043 37,372,412 0 0 0 0 (2,458) 712,711 (715,169) 262,480 0 37,109,932 0 75,301 0 262,480 38,162,883 129,574,155 1,394 4,211 (2,817) (4,129,213) 3,952 712,711 (708,759) 262,739 0 129,308,599 5,377,353 76,232 10,757,022 262,739 129,105,873 10,582,698 1,232,573 1,241,364 29,924 26,414 0 0 0 0 0 3,411 1,302 4,867 2,759 28,517 340,026 311,509 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 61,060,896 5,884,815 6,631,792 2,042,448 1,984,427 9,788,345 7,329,491 (4,129,213) 6,410 0 0 0 0 0 10,316 10,316 0 0 0 26,554,716 2,934,119 3,620,500 1,776 4,074 0 0 0 (2,458) 712,711 0 0 0 0 (487,360) 7,827,583 8,314,944 0 0 101,215,874 10,297,578 11,730,387 2,081,797 2,020,863 9,788,345 7,329,491 (4,129,213) 3,952 712,711 4,939 1,518 6,798 3,377 (449,802) 8,271,227 8,721,029 0 0 10,552,312 4,351,916 6,725 8,778,946 0 6,132,007 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 58,697,676 0 0 (116) 0 62,820,596 25,638,229 0 (4,996) 0 0 26,348,403 97,919,623 4,351,916 12,587 8,778,830 0 98,343,268 114 0 0 86,306 for stand-alone vision policies. 0 0 0 0 0 0 213 355 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF New Hampshire DURING THE YEAR Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities All Expenses 1 2 Activities to Prevent Hospital Readmissions Improve Health Outcomes 1. Individual Comprehensive Coverage Expenses: 688 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 46 for affiliated services) 1.3 EDP Equipment and Software (incl $ 4 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 1.5 Accreditation and Certification (incl $ 1,567 for affiliated services) 1.6 Other Expenses (incl $ 1.7 Subtotal before Reimbursements and Taxes (Lines 1.1 to 1.6) 1.8 Reimbursements by uninsured plans and fiscal intermediaries 1.9 Taxes, Licenses and Fees (in total, for tying purposes) 1.10 Total (1.7 to 1.9) 1.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 2. 216-4.NH 2.7 Subtotal before Reimbursements and Taxes (Lines 2.1 to 2.6) 2.8 Reimbursements by uninsured plans and fiscal intermediaries 2.9 Taxes, Licenses and Fees (in total, for tying purposes) 2.10 Total (2.7 to 2.9) 2.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 3. 0 0 0 0 0 380 380 0 XXX Small Group Comprehensive Coverage Expenses: 103,652 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 7,356 for affiliated services) 2.3 EDP Equipment and Software (incl $ 706 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 77 for affiliated services) 2.5 Accreditation and Certification (incl $ 239,493 for affiliated services) 2.6 Other Expenses (incl $ 3.7 Subtotal before Reimbursements and Taxes (Lines 3.1 to 3.6) 3.8 Reimbursements by uninsured plans and fiscal intermediaries 3.9 Taxes, Licenses and Fees (in total, for tying purposes) 3.10 Total (3.7 to 3.9) 3.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX Total (1 to 5) 0 0 0 0 0 380 380 0 XXX 0 0 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 0 0 0 0 0 0 0 XXX (LOCATION) NAIC Company Code 2018 XXX 115 29 10 1 0 258 413 0 XXX 178 20 15 1 0 397 611 0 XXX 380 0 0 0 0 0 0 0 0 0 380 0 413 114 611 0 0 0 0 0 0 38,193 38,193 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 38,193 38,193 0 13,266 4,996 1,108 106 12 30,421 49,910 0 20,032 2,296 1,673 161 17 44,804 68,982 0 XXX Large Group Comprehensive Coverage Expenses: 267,142 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 17,705 for affiliated services) 3.3 EDP Equipment and Software (incl $ 1,699 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 185 for affiliated services) 3.5 Accreditation and Certification (incl $ 597,674 for affiliated services) 3.6 Other Expenses (incl $ 185 Asylum Street Hartford, CT 061033408 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX XXX XXX 38,193 0 0 0 0 0 0 0 0 0 38,193 0 49,910 13,044 68,982 0 0 0 0 0 0 106,592 106,592 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 106,592 106,592 0 36,130 13,014 3,017 290 31 83,259 135,742 0 40,457 4,636 3,378 324 35 90,485 139,317 0 XXX XXX XXX 0 0 0 XXX 106,592 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 106,592 0 XXX 135,742 38,505 139,317 0 79413 9 10 General Administrative Expenses Total Expenses (6 to 9) 395 29 22 2 0 1,214 1,662 0 3,876 5,538 0 688 78 46 4 0 2,250 3,067 0 3,876 6,943 114 70,353 8,878 4,575 439 48 224,239 308,532 0 383,379 691,911 0 103,652 16,170 7,356 706 77 337,657 465,617 0 383,379 848,996 13,044 190,555 20,024 11,310 1,086 118 702,205 925,296 0 521,949 1,447,246 0 267,142 37,675 17,705 1,699 185 982,541 1,306,947 0 521,949 1,828,897 38,505 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 4. 5. 216-5.NH 6. Individual Mini-Med Plans Expenses: 0 for affiliated services) 4.1 Salaries (including $ 4.2 Outsourced Services 0 for affiliated services) 4.3 EDP Equipment and Software (incl $ 0 for affiliated services) 4.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 4.5 Accreditation and Certification (incl $ 0 for affiliated services) 4.6 Other Expenses (incl $ 4.7 Subtotal before Reimbursements and Taxes (Lines 4.1 to 4.6) 4.8 Reimbursements by uninsured plans and fiscal intermediaries 4.9 Taxes, Licenses and Fees (in total, for tying purposes) 4.10 Total (4.7 to 4.9) 4.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Mini-Med Plans Expenses: 0 for affiliated services) 5.1 Salaries (including $ 5.2 Outsourced Services 0 for affiliated services) 5.3 EDP Equipment and Software (incl $ 0 for affiliated services) 5.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 5.5 Accreditation and Certification (incl $ 0 for affiliated services) 5.6 Other Expenses (incl $ 5.7 Subtotal before Reimbursements and Taxes (Lines 5.1 to 5.6) 5.8 Reimbursements by uninsured plans and fiscal intermediaries 5.9 Taxes, Licenses and Fees (in total, for tying purposes) 5.10 Total (5.7 to 5.9) 5.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Mini-Med Plans Expenses: 0 for affiliated services) 6.1 Salaries (including $ 6.2 Outsourced Services 0 for affiliated services) 6.3 EDP Equipment and Software (incl $ 0 for affiliated services) 6.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 6.5 Accreditation and Certification (incl $ 0 for affiliated services) 6.6 Other Expenses (incl $ 6.7 Subtotal before Reimbursements and Taxes (Lines 6.1 to 6.6) 6.8 Reimbursements by uninsured plans and fiscal intermediaries 6.9 Taxes, Licenses and Fees (in total, for tying purposes) 6.10 Total (6.7 to 6.9) 6.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 7. 8. 216-6.NH 9. Small Group Expatriate Plans Expenses: 0 for affiliated services) 7.1 Salaries (including $ 7.2 Outsourced Services 0 for affiliated services) 7.3 EDP Equipment and Software (incl $ 0 for affiliated services) 7.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 7.5 Accreditation and Certification (incl $ 0 for affiliated services) 7.6 Other Expenses (incl $ 7.7 Subtotal before Reimbursements and Taxes (Lines 7.1 to 7.6) 7.8 Reimbursements by uninsured plans and fiscal intermediaries 7.9 Taxes, Licenses and Fees (in total, for tying purposes) 7.10 Total (7.7 to 7.9) 7.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Expatriate Plans Expenses: 0 for affiliated services) 8.1 Salaries (including $ 8.2 Outsourced Services 0 for affiliated services) 8.3 EDP Equipment and Software (incl $ 0 for affiliated services) 8.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 8.5 Accreditation and Certification (incl $ 0 for affiliated services) 8.6 Other Expenses (incl $ 8.7 Subtotal before Reimbursements and Taxes (Lines 8.1 to 8.6) 8.8 Reimbursements by uninsured plans and fiscal intermediaries 8.9 Taxes, Licenses and Fees (in total, for tying purposes) 8.10 Total (8.7 to 8.9) 8.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Student Health Plans Expenses: 0 for affiliated services) 9.1 Salaries (including $ 9.2 Outsourced Services 0 for affiliated services) 9.3 EDP Equipment and Software (incl $ 0 for affiliated services) 9.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 9.5 Accreditation and Certification (incl $ 0 for affiliated services) 9.6 Other Expenses (incl $ 9.7 Subtotal before Reimbursements and Taxes (Lines 9.1 to 9.6) 9.8 Reimbursements by uninsured plans and fiscal intermediaries 9.9 Taxes, Licenses and Fees (in total, for tying purposes) 9.10 Total (9.7 to 9.9) 9.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 *79413201821631100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes - See Cautionary Statement at http://www.naic.org/documents/committees_e_app_blanks_related_shce_cautionary_statement.pdf) UnitedHealthcare Insurance Company 2. 185 Asylum Street Hartford, CT 061033408 (LOCATION) BUSINESS IN THE STATE OF New Jersey DURING THE YEAR 2018 NAIC Company Code Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 2 Small Group Employer Individual 1. 216-1.NJ 2. 3. 4. 5. 6. 7. 8. 9. Premium: 1.1 Health premiums earned (From Part 2, Line 1.11) 1.2 Federal high risk pools 1.3 State high risk pools 1.4 Premiums earned including state and federal high risk programs (Lines 1.1 + 1.2 + 1.3) 1.5 Federal taxes and federal assessments 1.6 State insurance, premium and other taxes (Similar local taxes of 102,065 ) $ 1.6a Community Benefit Expenditures (informational only) 1.7 Regulatory authority licenses and fees 1.8 Adjusted Premiums Earned (Lines 1.4 - 1.5 - 1.6 - 1.7) 1.9 Net Assumed less Ceded reinsurance premiums earned 1.10 Other Adjustments due to MLR calculations - Premiums 1.11 Risk Revenue 1.12 Net adjusted premiums earned after reinsurance (Lines 1.8 + 1.9 + 1.10 + 1.11) Claims: 2.1 Incurred claims excluding prescription drugs 2.2 Prescription drugs 2.3 Pharmaceutical rebates 2.4 State stop loss, market stabilization and claim/census based assessments (informational only) Incurred medical incentive pools and bonuses Deductible Fraud and Abuse Detection/Recovery Expenses (for MLR use only) 5.0 Total Incurred Claims (Lines 2.1 + 2.2 - 2.3 + 3) (From Part 2, Line 2.15) 5.1 Net Assumed less Ceded reinsurance claims incurred 5.2 Other Adjustments due to MLR calculations - Claims 5.3 Rebates paid 5.4 Estimated rebates unpaid prior year 5.5 Estimated rebates unpaid current year 5.6 Fee for service and co-pay revenue 5.7 Net incurred claims after reinsurance (Lines 5.0 + 5.1 + 5.2 + 5.3 - 5.4 + 5.5 - 5.6) Improving Health Care Quality Expenses Incurred: 6.1 Improve health outcomes 6.2 Activities to prevent hospital readmissions 6.3 Improve patient safety and reduce medical errors 6.4 Wellness and health promotion activities 6.5 Health Information Technology expenses related to health improvement 6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5) Preliminary Medical Loss Ratio: MLR ((Lines 4 + 5.0 + 6.6 - Footnote 2.0)/Line 1.8 Claims Adjustment Expenses: 8.1 Cost containment expenses not included in quality of care expenses in Line 6.6 8.2 All other claims adjustment expenses 8.3 Total claims adjustment expenses (Lines 8.1 + 8.2) Claims Adjustment Expense Ratio (Line 8.3/Line 1.8) 0 0 0 3 Large Group Employer 1 0 0 4 5 Small Group Employer Individual Expatriate Plans 6 Large Group Employer 7 11 Government Business (excluded by statute) Other Health Business 9 8 Small Group 10 Student Health Plans Large Group 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 79413 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 175,591,065 0 (10,260) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 732,592,943 0 387,218 262,945,588 0 0 1,171,129,597 0 376,958 XXX XXX XXX 1,171,129,597 0 376,958 XXX 71,463 1,171,506,554 24,708,229 1,383 0 0 0 398 1 (7,697) 175,580,804 6,646,414 0 0 0 0 0 0 0 0 0 0 0 0 0 0 732,980,161 6,281,996 262,945,588 11,715,654 1,171,506,554 24,636,766 6 0 0 (404) 0 0 0 (404) 5,685 0 0 2,013 0 (1) 0 2,012 656,206 0 126,068 168,152,116 (32,820,440) 0 0 135,331,676 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10,424,076 0 (108,214) 716,382,302 (528,649) 4,964 0 715,858,617 28,866 0 0 251,201,069 1,025,028 1,280,588 0 253,506,685 11,114,838 0 17,854 1,135,737,096 (32,324,061) 1,285,551 0 1,104,698,586 XXX XXX XXX XXX XXX 11,116,221 0 17,854 1,135,664,250 (32,324,061) 1,285,551 0 1,104,625,740 179 0 0 21,294 1,359 456 119,912,761 27,891,827 7,618,311 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 573,958,199 14,609,508 251,357 35,880,464 317,721,780 173,261,964 729,772,897 360,224,474 181,132,087 XXX XXX XXX 729,772,897 360,224,474 181,132,087 0 0 0 179 0 0 0 0 0 0 179 0 33 0 22,231 10,036 0 0 0 0 0 32,267 1,239,746 623,778 77,964 140,810,055 (27,020,460) 181,630 0 181,630 0 0 113,789,595 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 760,358 57,691 181,100,638 0 0 0 0 0 0 181,100,638 1,240,504 1,384,170 135,655 910,249,454 (27,464,031) 181,630 0 181,630 0 0 882,785,423 XXX XXX 0 0 759 0 0 588,316,350 (453,607) 0 XXX XXX XXX 0 587,862,743 1,240,504 1,384,170 135,655 910,249,454 (27,464,031) 181,630 0 181,630 0 0 882,785,423 0 0 0 0 0 0 0 0 0 0 1,404,729 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,043,920 13,662 24,231 4,630,856 221,426 13,571,767 152,503 685,900 43,798 814,212 16,020,415 166,164 710,132 4,674,654 1,035,637 4,847 1,551 3,490 1,648 5,041 16,025,262 167,716 713,622 4,676,302 1,040,679 0 (0.444) 0 11.045 1,404,729 0.846 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 5,934,095 XXX 15,268,179 0.782 22,607,002 XXX 16,578 XXX 22,623,580 XXX 0 0 0 0.000 1 (53) (53) (0.026) 1,918,405 1,984,648 3,903,053 0.023 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 570,170 9,121,795 9,691,965 0.014 3,253,085 14,016,519 17,269,603 0.069 5,741,660 25,122,908 30,864,569 XXX 41,105 32,477 73,581 XXX 5,782,765 25,155,385 30,938,150 XXX XXX XXX XXX XXX 0 XXX XXX XXX XXX XXX XXX XXX XXX SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 (Continued) Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 10. General and Administrative (G&A) Expenses: 10.1 Direct sales salaries and benefits 10.2 Agents and brokers fees and commissions 10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below) 10.4 Other general and administrative expenses 10.4a Community Benefit Expenditures (informational only) 10.5 Total general and administrative (Lines 10.1 +10.2 + 10.3 + 10.4) 3 Large Group Employer 2 Small Group Employer 0 0 (2,183) 0 0 (2,183) 0 (2,527) (3) 134 0 (2,397) 4 5 Small Group Employer Individual 671,558 5,280,401 67,168 2,611,216 0 8,630,343 0 0 0 0 0 0 Expatriate Plans 6 Large Group Employer 0 0 0 0 0 0 7 8 Small Group 0 0 0 0 0 0 Student Health Plans Large Group 0 0 0 0 0 0 10 11 Government Business (excluded by statute) Other Health Business 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 984,209 24,571,329 1,132,223 65,298,335 0 91,986,096 480,801 1,491,364 577,057 16,336,357 0 18,885,579 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 2,136,568 31,340,567 1,774,262 84,246,042 0 119,497,439 21,231 0 25,195 675,413 0 721,839 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) 20,383,718 20,982,686 48,944,153 12. Income from fees of uninsured plans XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 13. Net investment and other gain/(loss) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 13,797,146 XXX 14. Federal income taxes (excluding taxes on Line 1.5 above) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 839,898 XXX 839,898 15. Net gain or (loss) (Lines 11 + 12 + 13 - 14) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 61,901,402 XXX 62,188,611 16. ICD-10 Implementation Expenses (informational only; already included in general expenses and line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16. 16a ICD-10 Implementation Expenses (informational only; already included in line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,600 (27,806) 7,603,956 0 0 0 0 0 0 0 XXX 2,157,799 31,340,567 1,799,457 84,921,455 0 120,219,278 48,059,310 1,172,052 1,172,052 13,797,146 OTHER INDICATORS: 216-2.NJ 1. Number of certificates/policies 0 0 12,485 0 0 0 0 0 0 0 391,336 192,354 596,175 0 596,175 2. Number of Covered Lives 0 0 27,689 0 0 0 0 0 0 0 506,453 192,354 726,496 0 726,496 3. Number of Groups 0 112 0 0 0 0 0 0 3,660 7 3,779 0 3,779 4. Member Months 0 326,337 0 0 0 0 0 0 6,135,298 2,316,680 8,778,315 0 8,778,315 XXX 0 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ XXX 0 ] If yes, show the amount of premiums and claims included. Premiums $ 0 Claims $ 0 AFFORDABLE CARE ACT (ACA) RECEIPTS, PAYMENTS, RECEIVABLES and PAYABLES Current Year Prior Year Comprehensive Health Coverage Comprehensive Health Coverage 1 2 3 4 Small Group Small Group Employer Plans Employer Plans Individual Plans Individual Plans ACA Receivables and Payables 1. Permanent ACA Risk Adjustment Program 1.0 Premium adjustments receivable/(payable) 0 2. Transitional ACA Reinsurance Program 2.0 Total amounts recoverable for claims (paid & unpaid) 0 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 0 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 XXX ACA Receipts and Payments 4. Permanent ACA Risk Adjustment Program 4.0 Premium adjustments receipts/(payments) 0 5. Transitional ACA Reinsurance Program 5.0 Amounts received for claims 0 6. Temporary ACA Risk Corridors Program 6.1 Retrospective premium received 6.2 Rate credits or policy experience refunds paid 0 0 XXX 0 0 0 0 0 XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF 185 Asylum Street Hartford, CT 061033408 New Jersey DURING THE YEAR Comprehensive Health Coverage 1 2 3 Individual Small Group Employer Large Group Employer Small Group Employer Individual Expatriate Plans: 7 8 6 Large Group Employer Small Group 10 11 Government Business (excluded by statute) Other Health Business 9 Student Health Plans Large Group 79413 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.NJ Health Premiums Earned: 0 1.1 Direct premiums written 0 1.2 Unearned premium prior year 0 1.3 Unearned premium current year 0 1.4 Change in unearned premium (Lines 1.2 - 1.3) 179 1.5 Paid rate credits 0 1.6 Reserve for rate credits current year 0 1.7 Reserve for rate credits prior year 0 1.8 Change in reserve for rate credits (Lines 1.6 - 1.7) 0 1.9 Premium balances written off 0 1.10 Group conversion charge 0 1.11 Total direct premiums earned (Lines 1.1 + 1.4 - 1.9 + 1.10) 0 1.12 Assumed premiums earned from non-affiliates 0 1.13 Net Assumed less Ceded premiums earned from affiliates 0 1.14 Ceded premiums earned to non-affiliates 0 1.15 Other Adjustments due to MLR calculation - Premiums (179) 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 0 2.1 Paid claims during the year 0 2.2 Direct claim liability current year 0 2.3 Direct claim liability prior year 0 2.4 Direct claim reserves current year 0 2.5 Direct claim reserves prior year 0 2.6 Direct contract reserves current year 0 2.7 Direct contract reserves prior year 179 2.8 Paid rate credits 0 2.9 Reserve for rate credits current year 0 2.10 Reserve for rate credits prior year 0 2.11 Incurred medical incentive pools and bonuses (Lines 2.11a + 2.11b - 2.11c) 0 2.11a Paid medical incentive pools and bonuses current year 0 2.11b Accrued medical incentive pools and bonuses current year 0 2.11c Accrued medical incentive pools and bonuses prior year 0 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 0 2.12a Healthcare receivables current year 0 2.12b Healthcare receivables prior year 0 2.13 Group conversion charge 0 2.14 Multi-option coverage blended rate adjustment 2.15 Total incurred claims (Lines 2.1 + 2.2 - 2.3 + 2.4 - 2.5 + 2.6 - 2.7 + 2.8 + 2.9 179 2.10 + 2.11 - 2.12 + 2.13 + 2.14) 0 2.16 Assumed incurred claims from non-affiliates 0 2.17 Net assumed less ceded incurred claims from affiliates 0 2.18 Ceded incurred claims to non-affiliates 0 2.19 Other adjustments due to MLR calculation - Claims 0 2.20 Net Incurred Claims (Lines 2.15 - 2.8 - 2.9 + 2.10 + 2.16 + 2.17 - 2.18 + 2.19) 3. Fraud and Abuse Recoveries that Reduced PAID Claims in Line 2.1 above 0 (informational only) 21,990,116 for stand-alone dental and $ (a) Column 13, Line 1.1 includes direct written premium of $ 4 Business Subject to MLR Mini-Med Plans 5 (LOCATION) NAIC Company Code 2018 0 0 0 0 0 0 0 0 (1) 0 1 0 0 0 (1) 0 175,591,065 0 0 0 (34,339) 0 181,630 (181,630) 0 0 175,591,065 392,350 521 33,213,311 0 142,986,594 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 14,578 25,194 18,288 757 30 0 0 0 0 0 33 33 1 0 14 14 0 0 0 141,439,541 17,837,721 19,457,119 446,103 490,466 0 0 (34,339) 0 181,630 623,778 142,257 800,802 319,281 (626,467) 3,042,995 3,669,461 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 22,231 0 10,036 0 0 32,267 140,810,056 215,824 (489,578) 26,746,707 0 114,005,565 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 77,964 0 0 9,180,615 for stand-alone vision policies. 0 0 0 0 20 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 732,556,389 102,009 60,491 41,518 22,362,307 (93,433) 133,674 (227,108) 4,964 0 732,592,943 0 0 528,649 4,964 709,934,059 264,226,176 0 0 0 14,661,069 1,953,070 15,282,527 (13,329,458) 1,280,588 0 262,945,588 0 1,025,028 0 1,280,588 263,919,593 1,172,373,630 102,009 60,491 41,518 36,989,215 1,859,636 15,597,832 (13,738,195) 1,285,551 0 1,171,129,597 392,350 1,025,548 33,741,960 1,285,551 1,116,840,067 566,330,006 59,904,552 60,005,634 26,101,750 26,182,898 188,850 84,114 22,362,307 (93,433) 133,674 0 0 0 0 71,362 71,550 188 0 0 188,409,648 8,518,314 16,640,250 8,905 6,365 0 0 14,661,069 1,953,070 15,282,527 760,358 775,871 237,633 253,146 1,281,584 61,217,116 59,935,532 0 0 896,129,137 86,189,192 95,960,064 26,557,515 26,679,759 188,850 84,114 36,989,215 1,859,636 15,597,832 1,384,170 918,161 1,038,436 572,427 726,493 64,331,675 63,605,181 0 0 0 0 0 0 0 0 588,316,350 0 0 453,607 0 565,727,544 181,100,638 0 0 0 0 179,769,027 910,249,454 215,824 (479,542) 27,200,314 0 859,534,403 0 0 95,443 (64,636) (96,590) (161,226) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 173,428 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF New Jersey DURING THE YEAR All Expenses 1 2. Individual Comprehensive Coverage Expenses: 0 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 0 for affiliated services) 1.3 EDP Equipment and Software (incl $ 0 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 1.5 Accreditation and Certification (incl $ 0 for affiliated services) 1.6 Other Expenses (incl $ 1.7 Subtotal before Reimbursements and Taxes (Lines 1.1 to 1.6) 1.8 Reimbursements by uninsured plans and fiscal intermediaries 1.9 Taxes, Licenses and Fees (in total, for tying purposes) 1.10 Total (1.7 to 1.9) 1.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 216-4.NJ 2.7 Subtotal before Reimbursements and Taxes (Lines 2.1 to 2.6) 2.8 Reimbursements by uninsured plans and fiscal intermediaries 2.9 Taxes, Licenses and Fees (in total, for tying purposes) 2.10 Total (2.7 to 2.9) 2.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 3. 0 0 0 0 0 0 0 0 XXX Small Group Comprehensive Coverage Expenses: 19 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 2 for affiliated services) 2.3 EDP Equipment and Software (incl $ 0 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 2.5 Accreditation and Certification (incl $ 40 for affiliated services) 2.6 Other Expenses (incl $ Large Group Comprehensive Coverage Expenses: 3,096,368 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 204,500 for affiliated services) 3.3 EDP Equipment and Software (incl $ 19,630 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 2,131 for affiliated services) 3.5 Accreditation and Certification (incl $ 6,953,749 for affiliated services) 3.6 Other Expenses (incl $ 3.7 Subtotal before Reimbursements and Taxes (Lines 3.1 to 3.6) 3.8 Reimbursements by uninsured plans and fiscal intermediaries 3.9 Taxes, Licenses and Fees (in total, for tying purposes) 3.10 Total (3.7 to 3.9) 3.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions Improve Health Outcomes 1. 185 Asylum Street Hartford, CT 061033408 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX Total (1 to 5) 0 0 0 0 0 0 0 0 XXX 0 0 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 0 0 0 0 0 0 0 XXX (LOCATION) NAIC Company Code 2018 XXX 0 0 0 0 0 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 (16) (2) (1) 0 0 (35) (53) 0 XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 1 0 (53) 0 0 0 0 0 0 1,404,729 1,404,729 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,404,729 1,404,729 0 417,773 452,591 34,886 3,349 364 961,899 1,870,862 0 565,180 64,771 47,195 4,530 492 1,264,063 1,946,231 0 1,404,729 0 XXX 1,870,862 448,398 XXX 1,946,231 0 XXX 1,404,729 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 79413 9 10 General Administrative Expenses Total Expenses (6 to 9) 0 0 0 0 0 0 0 0 (2,177) (2,177) 0 0 0 0 0 0 0 0 0 (2,177) (2,177) 0 34 4 3 0 0 (2,434) (2,393) 0 5,681 3,288 0 19 2 2 0 0 (2,468) (2,446) 0 5,681 3,235 0 2,113,415 356,493 122,418 11,751 1,276 5,914,593 8,519,945 0 978,632 9,498,578 0 3,096,368 873,855 204,500 19,630 2,131 9,545,283 13,741,767 0 978,632 14,720,399 448,398 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 4. 5. 216-5.NJ 6. Individual Mini-Med Plans Expenses: 0 for affiliated services) 4.1 Salaries (including $ 4.2 Outsourced Services 0 for affiliated services) 4.3 EDP Equipment and Software (incl $ 0 for affiliated services) 4.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 4.5 Accreditation and Certification (incl $ 0 for affiliated services) 4.6 Other Expenses (incl $ 4.7 Subtotal before Reimbursements and Taxes (Lines 4.1 to 4.6) 4.8 Reimbursements by uninsured plans and fiscal intermediaries 4.9 Taxes, Licenses and Fees (in total, for tying purposes) 4.10 Total (4.7 to 4.9) 4.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Mini-Med Plans Expenses: 0 for affiliated services) 5.1 Salaries (including $ 5.2 Outsourced Services 0 for affiliated services) 5.3 EDP Equipment and Software (incl $ 0 for affiliated services) 5.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 5.5 Accreditation and Certification (incl $ 0 for affiliated services) 5.6 Other Expenses (incl $ 5.7 Subtotal before Reimbursements and Taxes (Lines 5.1 to 5.6) 5.8 Reimbursements by uninsured plans and fiscal intermediaries 5.9 Taxes, Licenses and Fees (in total, for tying purposes) 5.10 Total (5.7 to 5.9) 5.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Mini-Med Plans Expenses: 0 for affiliated services) 6.1 Salaries (including $ 6.2 Outsourced Services 0 for affiliated services) 6.3 EDP Equipment and Software (incl $ 0 for affiliated services) 6.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 6.5 Accreditation and Certification (incl $ 0 for affiliated services) 6.6 Other Expenses (incl $ 6.7 Subtotal before Reimbursements and Taxes (Lines 6.1 to 6.6) 6.8 Reimbursements by uninsured plans and fiscal intermediaries 6.9 Taxes, Licenses and Fees (in total, for tying purposes) 6.10 Total (6.7 to 6.9) 6.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 7. 8. 216-6.NJ 9. Small Group Expatriate Plans Expenses: 0 for affiliated services) 7.1 Salaries (including $ 7.2 Outsourced Services 0 for affiliated services) 7.3 EDP Equipment and Software (incl $ 0 for affiliated services) 7.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 7.5 Accreditation and Certification (incl $ 0 for affiliated services) 7.6 Other Expenses (incl $ 7.7 Subtotal before Reimbursements and Taxes (Lines 7.1 to 7.6) 7.8 Reimbursements by uninsured plans and fiscal intermediaries 7.9 Taxes, Licenses and Fees (in total, for tying purposes) 7.10 Total (7.7 to 7.9) 7.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Expatriate Plans Expenses: 0 for affiliated services) 8.1 Salaries (including $ 8.2 Outsourced Services 0 for affiliated services) 8.3 EDP Equipment and Software (incl $ 0 for affiliated services) 8.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 8.5 Accreditation and Certification (incl $ 0 for affiliated services) 8.6 Other Expenses (incl $ 8.7 Subtotal before Reimbursements and Taxes (Lines 8.1 to 8.6) 8.8 Reimbursements by uninsured plans and fiscal intermediaries 8.9 Taxes, Licenses and Fees (in total, for tying purposes) 8.10 Total (8.7 to 8.9) 8.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Student Health Plans Expenses: 0 for affiliated services) 9.1 Salaries (including $ 9.2 Outsourced Services 0 for affiliated services) 9.3 EDP Equipment and Software (incl $ 0 for affiliated services) 9.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 9.5 Accreditation and Certification (incl $ 0 for affiliated services) 9.6 Other Expenses (incl $ 9.7 Subtotal before Reimbursements and Taxes (Lines 9.1 to 9.6) 9.8 Reimbursements by uninsured plans and fiscal intermediaries 9.9 Taxes, Licenses and Fees (in total, for tying purposes) 9.10 Total (9.7 to 9.9) 9.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 *79413201821632100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes - See Cautionary Statement at http://www.naic.org/documents/committees_e_app_blanks_related_shce_cautionary_statement.pdf) UnitedHealthcare Insurance Company 2. 185 Asylum Street Hartford, CT 061033408 (LOCATION) BUSINESS IN THE STATE OF New Mexico DURING THE YEAR 2018 NAIC Company Code Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 1. 216-1.NM 2. 3. 4. 5. 6. 7. 8. 9. Premium: 1.1 Health premiums earned (From Part 2, Line 1.11) 1.2 Federal high risk pools 1.3 State high risk pools 1.4 Premiums earned including state and federal high risk programs (Lines 1.1 + 1.2 + 1.3) 1.5 Federal taxes and federal assessments 1.6 State insurance, premium and other taxes (Similar local taxes of 61,132 ) $ 1.6a Community Benefit Expenditures (informational only) 1.7 Regulatory authority licenses and fees 1.8 Adjusted Premiums Earned (Lines 1.4 - 1.5 - 1.6 - 1.7) 1.9 Net Assumed less Ceded reinsurance premiums earned 1.10 Other Adjustments due to MLR calculations - Premiums 1.11 Risk Revenue 1.12 Net adjusted premiums earned after reinsurance (Lines 1.8 + 1.9 + 1.10 + 1.11) Claims: 2.1 Incurred claims excluding prescription drugs 2.2 Prescription drugs 2.3 Pharmaceutical rebates 2.4 State stop loss, market stabilization and claim/census based assessments (informational only) Incurred medical incentive pools and bonuses Deductible Fraud and Abuse Detection/Recovery Expenses (for MLR use only) 5.0 Total Incurred Claims (Lines 2.1 + 2.2 - 2.3 + 3) (From Part 2, Line 2.15) 5.1 Net Assumed less Ceded reinsurance claims incurred 5.2 Other Adjustments due to MLR calculations - Claims 5.3 Rebates paid 5.4 Estimated rebates unpaid prior year 5.5 Estimated rebates unpaid current year 5.6 Fee for service and co-pay revenue 5.7 Net incurred claims after reinsurance (Lines 5.0 + 5.1 + 5.2 + 5.3 - 5.4 + 5.5 - 5.6) Improving Health Care Quality Expenses Incurred: 6.1 Improve health outcomes 6.2 Activities to prevent hospital readmissions 6.3 Improve patient safety and reduce medical errors 6.4 Wellness and health promotion activities 6.5 Health Information Technology expenses related to health improvement 6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5) Preliminary Medical Loss Ratio: MLR ((Lines 4 + 5.0 + 6.6 - Footnote 2.0)/Line 1.8 Claims Adjustment Expenses: 8.1 Cost containment expenses not included in quality of care expenses in Line 6.6 8.2 All other claims adjustment expenses 8.3 Total claims adjustment expenses (Lines 8.1 + 8.2) Claims Adjustment Expense Ratio (Line 8.3/Line 1.8) 2 Small Group Employer 3 Large Group Employer 4 6 Large Group Employer 5 Small Group Employer Individual Expatriate Plans 7 11 Government Business (excluded by statute) Other Health Business 9 8 Small Group 10 Student Health Plans Large Group 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 79413 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 73,318,548 0 (56,310) 412,125,122 0 0 594,467,541 0 (1,101,176) XXX XXX XXX 0 (340,864) 73,262,238 713,123 412,125,122 16,749,099 593,366,365 19,964,319 XXX 0 0 0 0 0 0 0 0 (5,801) 0 (13,399) 360,064 1,365,619 0 0 1,725,682 2,102,830 0 20,910 70,425,375 (113,239) 146 0 70,312,282 41,789 0 70 395,334,164 0 323,737 0 395,657,901 4,052,385 0 154,053 569,195,607 (6,410,155) 327,953 0 563,113,405 XXX XXX XXX XXX XXX 4,052,385 0 154,053 569,195,607 (6,410,155) 327,953 0 563,113,405 0 0 0 0 0 0 (1,607) 0 0 53,030,355 2,199,665 32,733 297,300,075 73,553,738 46,483,872 427,397,045 92,006,514 51,484,784 XXX XXX XXX 427,397,045 92,006,514 51,484,784 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (1,607) 2,976,875 0 XXX XXX XXX 0 2,975,269 0 0 0 55,197,288 211,816 0 XXX XXX XXX 0 55,409,104 0 425,948 0 324,795,889 0 (1,697,853) 0 (320,749) 1,377,105 0 324,795,889 342,910 461,260 6,266 468,380,035 (2,968,805) (1,891,002) 604,971 852,956 2,138,987 0 465,411,231 XXX XXX 342,910 461,260 6,266 468,380,035 (2,968,805) (1,891,002) 604,971 852,956 2,138,987 0 465,411,231 131,403 0 (2,182) 41,004,438 0 (464,269) 67,888,030 0 (578,415) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 129,222 (16,784) 40,540,169 1,454,670 67,309,615 1,405,076 0 0 0 0 0 0 0 0 0 0 0 0 14,122 0 314 131,570 0 0 0 131,570 830,761 0 66,701 38,188,037 0 4,070 0 38,192,107 1,068,685 0 79,457 64,756,397 (7,662,534) 0 0 57,093,863 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 125,534 68,663 20,946 25,484,755 6,975,060 2,113,129 51,457,932 9,209,388 2,834,104 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 173,251 0 0 0 0 0 0 173,251 106,788 5,742 1,356 30,352,428 0 (193,149) 604,971 1,173,705 761,883 0 30,352,428 236,122 29,570 4,910 57,862,786 (6,157,497) 0 0 0 0 0 51,705,289 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,051 0 0 0 0 328,036 0 0 0 0 543,104 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 66,893 0 0 202,819 101,315 76,580 571,012 43,529 1,674,168 562,384 638,850 1,297,887 1,179,399 2,749,178 663,699 782,323 1,868,899 1,222,928 1,051 1.325 328,036 0.803 543,104 0.902 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 66,893 XXX 995,255 XXX 5,352,688 0.835 7,287,027 XXX 2,308 3,494 5,802 0.044 479,315 651,547 1,130,863 0.030 796,113 991,159 1,787,272 0.028 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 49,631 1,109,507 1,159,139 0.016 3,915,915 7,315,406 11,231,321 0.028 5,243,282 10,071,115 15,314,397 XXX 594,467,541 0 (1,101,176) 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 2,749,178 663,699 782,323 1,868,899 1,222,928 0 7,287,027 XXX 0 0 0 5,243,282 10,071,115 15,314,397 XXX XXX XXX 593,366,365 19,964,319 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 (Continued) Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 10. General and Administrative (G&A) Expenses: 10.1 Direct sales salaries and benefits 10.2 Agents and brokers fees and commissions 10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below) 10.4 Other general and administrative expenses 10.4a Community Benefit Expenditures (informational only) 10.5 Total general and administrative (Lines 10.1 +10.2 + 10.3 + 10.4) 3 Large Group Employer 2 Small Group Employer 786 9,446 (150) 10,267 0 20,349 153,761 2,008,811 24,951 1,954,874 0 4,142,397 4 5 Small Group Employer Individual 294,174 1,297,992 1,806 2,045,786 0 3,639,757 0 0 0 0 0 0 Expatriate Plans 6 Large Group Employer 0 0 0 0 0 0 7 8 Small Group 0 0 0 0 0 0 Student Health Plans Large Group 0 0 0 0 0 0 10 11 Government Business (excluded by statute) Other Health Business 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 53,445 0 53,445 115,009 2,980,081 139,620 7,143,382 0 10,378,092 1,477,499 5,862,202 497,460 14,657,070 0 22,494,231 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 2,041,228 12,158,532 663,687 25,864,823 0 40,728,271 0 0 0 0 0 0 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) 31,783,771 34,372,481 12. Income from fees of uninsured plans XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 13. Net investment and other gain/(loss) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 14. Federal income taxes (excluding taxes on Line 1.5 above) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 15. Net gain or (loss) (Lines 11 + 12 + 13 - 14) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 16. ICD-10 Implementation Expenses (informational only; already included in general expenses and line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16. 16a ICD-10 Implementation Expenses (informational only; already included in line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (68,882) 2,238,384 (581,560) 0 0 0 0 0 0 (1,369,924) 2,370,692 XXX 2,041,228 12,158,532 663,687 25,864,823 0 40,728,271 34,372,481 0 0 8,976,973 XXX XXX 130,705 XXX 130,705 XXX 43,218,748 XXX 43,218,748 8,976,973 OTHER INDICATORS: 216-2.NM 1. Number of certificates/policies 20 4,372 6,922 0 0 0 0 0 0 0 45,062 56,923 113,299 0 113,299 2. Number of Covered Lives 37 7,265 12,313 0 0 0 0 0 0 0 53,071 56,923 129,609 0 129,609 3. Number of Groups 772 160 0 0 0 0 0 0 581 0 1,513 0 1,513 4. Member Months 440 87,712 150,301 0 0 0 0 0 0 641,169 665,481 1,545,103 0 1,545,103 XXX Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ XXX 0 ] If yes, show the amount of premiums and claims included. Premiums $ 0 Claims $ 0 AFFORDABLE CARE ACT (ACA) RECEIPTS, PAYMENTS, RECEIVABLES and PAYABLES Current Year Prior Year Comprehensive Health Coverage Comprehensive Health Coverage 1 2 3 4 Small Group Small Group Employer Plans Employer Plans Individual Plans Individual Plans ACA Receivables and Payables 1. Permanent ACA Risk Adjustment Program 1.0 Premium adjustments receivable/(payable) 2. Transitional ACA Reinsurance Program 2.0 Total amounts recoverable for claims (paid & unpaid) 0 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 0 0 (67,769) (1,728,522) XXX (86,006) 0 0 0 1,097,315 XXX 0 0 0 0 ACA Receipts and Payments 4. Permanent ACA Risk Adjustment Program 4.0 Premium adjustments receipts/(payments) 5. Transitional ACA Reinsurance Program 5.0 Amounts received for claims 0 6. Temporary ACA Risk Corridors Program 6.1 Retrospective premium received 6.2 Rate credits or policy experience refunds paid 0 0 (90,278) 894,094 XXX (86,771) 0 0 0 0 0 420,293 XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF 185 Asylum Street Hartford, CT 061033408 New Mexico DURING THE YEAR Comprehensive Health Coverage 1 2 3 Individual Small Group Employer Large Group Employer Small Group Employer Individual Expatriate Plans: 7 8 6 Large Group Employer Small Group 10 11 Government Business (excluded by statute) Other Health Business 9 Student Health Plans Large Group 79413 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.NM Health Premiums Earned: 131,403 41,005,728 1.1 Direct premiums written 0 7,408 1.2 Unearned premium prior year 0 4,628 1.3 Unearned premium current year 0 2,779 1.4 Change in unearned premium (Lines 1.2 - 1.3) 420 604,971 1.5 Paid rate credits 0 761,883 1.6 Reserve for rate credits current year 0 1,173,705 1.7 Reserve for rate credits prior year 0 (411,822) 1.8 Change in reserve for rate credits (Lines 1.6 - 1.7) 0 4,070 1.9 Premium balances written off 0 0 1.10 Group conversion charge 131,403 41,004,438 1.11 Total direct premiums earned (Lines 1.1 + 1.4 - 1.9 + 1.10) 0 0 1.12 Assumed premiums earned from non-affiliates 0 0 1.13 Net Assumed less Ceded premiums earned from affiliates 0 0 1.14 Ceded premiums earned to non-affiliates 0 4,070 1.15 Other Adjustments due to MLR calculation - Premiums 130,984 40,815,359 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 172,832 29,762,542 2.1 Paid claims during the year 0 3,899,441 2.2 Direct claim liability current year 1 3,332,759 2.3 Direct claim liability prior year 0 81,297 2.4 Direct claim reserves current year 0 78,972 2.5 Direct claim reserves prior year 0 0 2.6 Direct contract reserves current year 0 0 2.7 Direct contract reserves prior year 420 604,971 2.8 Paid rate credits 0 761,883 2.9 Reserve for rate credits current year 0 1,173,705 2.10 Reserve for rate credits prior year 0 5,742 2.11 Incurred medical incentive pools and bonuses (Lines 2.11a + 2.11b - 2.11c) 0 5,413 2.11a Paid medical incentive pools and bonuses current year 0 14,029 2.11b Accrued medical incentive pools and bonuses current year 0 13,700 2.11c Accrued medical incentive pools and bonuses prior year 0 178,012 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 0 896,484 2.12a Healthcare receivables current year 0 718,471 2.12b Healthcare receivables prior year 0 0 2.13 Group conversion charge 0 0 2.14 Multi-option coverage blended rate adjustment 2.15 Total incurred claims (Lines 2.1 + 2.2 - 2.3 + 2.4 - 2.5 + 2.6 - 2.7 + 2.8 + 2.9 173,251 30,352,428 2.10 + 2.11 - 2.12 + 2.13 + 2.14) 0 0 2.16 Assumed incurred claims from non-affiliates 0 0 2.17 Net assumed less ceded incurred claims from affiliates 0 0 2.18 Ceded incurred claims to non-affiliates 0 0 2.19 Other adjustments due to MLR calculation - Claims 172,831 30,159,279 2.20 Net Incurred Claims (Lines 2.15 - 2.8 - 2.9 + 2.10 + 2.16 + 2.17 - 2.18 + 2.19) 3. Fraud and Abuse Recoveries that Reduced PAID Claims in Line 2.1 above 0 1,356 (informational only) 2,064,715 for stand-alone dental and $ (a) Column 13, Line 1.1 includes direct written premium of $ 4 Business Subject to MLR Mini-Med Plans 5 (LOCATION) NAIC Company Code 2018 67,873,590 0 (14,441) 14,441 355,232 (274,256) 75,227 (349,483) 0 0 67,888,030 0 0 7,662,534 0 60,219,747 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,365,619 0 0 1,365,619 73,317,529 861 (304) 1,165 (553,593) 80,677 52,788 27,889 146 0 73,318,548 0 0 113,239 146 73,731,158 412,448,859 0 0 0 1,405,758 2,474,774 1,690,745 784,029 323,737 0 412,125,122 0 0 0 323,737 410,259,072 594,777,110 8,269 (10,116) 18,385 1,812,787 3,043,078 2,992,464 50,613 327,953 0 594,467,541 0 1,365,619 7,775,774 327,953 586,521,939 56,095,443 6,673,734 4,777,202 199,275 94,948 0 0 355,232 (274,256) 75,227 29,570 10,655 57,785 38,870 268,834 1,207,567 938,734 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (2,040,082) (812,493) (2,850,968) 0 0 0 0 0 0 0 0 0 0 0 1 43 43 0 0 56,034,664 6,584,570 6,243,526 3,924,704 4,571,156 20,184 30,990 (553,593) 80,677 52,788 0 0 0 0 (4,541) (4,541) 0 0 0 321,861,263 41,606,998 37,012,787 534,131 502,217 0 0 1,405,758 2,474,774 1,690,745 425,948 287,898 311,720 173,670 4,307,232 22,139,415 17,832,182 0 0 461,886,661 57,952,252 48,515,307 4,739,406 5,247,293 20,184 30,990 1,812,787 3,043,078 2,992,464 461,260 303,966 383,534 226,240 4,749,538 24,238,968 19,489,430 0 0 57,862,786 0 0 6,157,497 0 51,699,540 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (1,607) 0 2,976,875 0 0 2,975,269 55,197,288 0 0 (211,816) 0 55,934,808 324,795,889 0 0 0 0 322,606,103 468,380,035 0 2,976,875 5,945,680 0 463,547,830 4,910 0 0 665,992 for stand-alone vision policies. 0 0 0 0 0 6,266 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF New Mexico DURING THE YEAR All Expenses 1 Improve Health Outcomes 1. Individual Comprehensive Coverage Expenses: 4,940 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 349 for affiliated services) 1.3 EDP Equipment and Software (incl $ 34 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 4 for affiliated services) 1.5 Accreditation and Certification (incl $ 11,071 for affiliated services) 1.6 Other Expenses (incl $ 1.7 Subtotal before Reimbursements and Taxes (Lines 1.1 to 1.6) 1.8 Reimbursements by uninsured plans and fiscal intermediaries 1.9 Taxes, Licenses and Fees (in total, for tying purposes) 1.10 Total (1.7 to 1.9) 1.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 2. 216-4.NM 3. 0 0 0 0 0 1,051 1,051 0 XXX Small Group Comprehensive Coverage Expenses: 982,417 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 69,658 for affiliated services) 2.3 EDP Equipment and Software (incl $ 6,686 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 726 for affiliated services) 2.5 Accreditation and Certification (incl $ 2,235,321 for affiliated services) 2.6 Other Expenses (incl $ 2.7 Subtotal before Reimbursements and Taxes (Lines 2.1 to 2.6) 2.8 Reimbursements by uninsured plans and fiscal intermediaries 2.9 Taxes, Licenses and Fees (in total, for tying purposes) 2.10 Total (2.7 to 2.9) 2.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX Total (1 to 5) 0 0 0 0 0 1,051 1,051 0 XXX 0 0 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 0 0 0 0 0 0 0 XXX (LOCATION) NAIC Company Code 2018 XXX 619 175 52 5 1 1,384 2,234 0 XXX 992 114 83 8 1 2,219 3,416 0 XXX 1,051 0 0 0 0 0 0 0 0 0 1,051 0 2,234 633 3,416 0 0 0 0 0 0 328,036 328,036 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 328,036 328,036 0 120,587 55,429 10,070 967 105 277,829 464,986 0 184,777 21,176 15,430 1,481 161 413,266 636,290 0 XXX Large Group Comprehensive Coverage Expenses: 1,477,648 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 99,709 for affiliated services) 3.3 EDP Equipment and Software (incl $ 9,571 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 1,039 for affiliated services) 3.5 Accreditation and Certification (incl $ 3,306,850 for affiliated services) 3.6 Other Expenses (incl $ 3.7 Subtotal before Reimbursements and Taxes (Lines 3.1 to 3.6) 3.8 Reimbursements by uninsured plans and fiscal intermediaries 3.9 Taxes, Licenses and Fees (in total, for tying purposes) 3.10 Total (3.7 to 3.9) 3.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 185 Asylum Street Hartford, CT 061033408 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX XXX XXX 328,036 0 0 0 0 0 0 0 0 0 328,036 0 464,986 123,751 636,290 0 0 0 0 0 0 543,104 543,104 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 543,104 543,104 0 193,482 116,060 16,157 1,551 168 445,414 772,831 0 281,604 32,272 23,515 2,257 245 629,826 969,720 0 XXX XXX XXX 0 0 0 XXX 543,104 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 543,104 0 XXX 772,831 210,890 969,720 0 79413 9 10 General Administrative Expenses Total Expenses (6 to 9) 3,330 321 215 21 2 16,555 20,443 0 14,492 34,935 0 4,940 609 349 34 4 21,209 27,145 0 14,492 41,637 633 677,052 88,113 44,159 4,239 460 3,292,534 4,106,558 0 962,888 5,069,446 0 982,417 164,717 69,658 6,686 726 4,311,664 5,535,869 0 962,888 6,498,757 123,751 1,002,562 131,021 60,037 5,763 626 2,418,276 3,618,286 0 1,214,335 4,832,620 0 1,477,648 279,353 99,709 9,571 1,039 4,036,620 5,903,941 0 1,214,335 7,118,276 210,890 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 4. 5. 216-5.NM 6. Individual Mini-Med Plans Expenses: 0 for affiliated services) 4.1 Salaries (including $ 4.2 Outsourced Services 0 for affiliated services) 4.3 EDP Equipment and Software (incl $ 0 for affiliated services) 4.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 4.5 Accreditation and Certification (incl $ 0 for affiliated services) 4.6 Other Expenses (incl $ 4.7 Subtotal before Reimbursements and Taxes (Lines 4.1 to 4.6) 4.8 Reimbursements by uninsured plans and fiscal intermediaries 4.9 Taxes, Licenses and Fees (in total, for tying purposes) 4.10 Total (4.7 to 4.9) 4.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Mini-Med Plans Expenses: 0 for affiliated services) 5.1 Salaries (including $ 5.2 Outsourced Services 0 for affiliated services) 5.3 EDP Equipment and Software (incl $ 0 for affiliated services) 5.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 5.5 Accreditation and Certification (incl $ 0 for affiliated services) 5.6 Other Expenses (incl $ 5.7 Subtotal before Reimbursements and Taxes (Lines 5.1 to 5.6) 5.8 Reimbursements by uninsured plans and fiscal intermediaries 5.9 Taxes, Licenses and Fees (in total, for tying purposes) 5.10 Total (5.7 to 5.9) 5.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Mini-Med Plans Expenses: 0 for affiliated services) 6.1 Salaries (including $ 6.2 Outsourced Services 0 for affiliated services) 6.3 EDP Equipment and Software (incl $ 0 for affiliated services) 6.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 6.5 Accreditation and Certification (incl $ 0 for affiliated services) 6.6 Other Expenses (incl $ 6.7 Subtotal before Reimbursements and Taxes (Lines 6.1 to 6.6) 6.8 Reimbursements by uninsured plans and fiscal intermediaries 6.9 Taxes, Licenses and Fees (in total, for tying purposes) 6.10 Total (6.7 to 6.9) 6.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 7. 8. 216-6.NM 9. Small Group Expatriate Plans Expenses: 0 for affiliated services) 7.1 Salaries (including $ 7.2 Outsourced Services 0 for affiliated services) 7.3 EDP Equipment and Software (incl $ 0 for affiliated services) 7.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 7.5 Accreditation and Certification (incl $ 0 for affiliated services) 7.6 Other Expenses (incl $ 7.7 Subtotal before Reimbursements and Taxes (Lines 7.1 to 7.6) 7.8 Reimbursements by uninsured plans and fiscal intermediaries 7.9 Taxes, Licenses and Fees (in total, for tying purposes) 7.10 Total (7.7 to 7.9) 7.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Expatriate Plans Expenses: 0 for affiliated services) 8.1 Salaries (including $ 8.2 Outsourced Services 0 for affiliated services) 8.3 EDP Equipment and Software (incl $ 0 for affiliated services) 8.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 8.5 Accreditation and Certification (incl $ 0 for affiliated services) 8.6 Other Expenses (incl $ 8.7 Subtotal before Reimbursements and Taxes (Lines 8.1 to 8.6) 8.8 Reimbursements by uninsured plans and fiscal intermediaries 8.9 Taxes, Licenses and Fees (in total, for tying purposes) 8.10 Total (8.7 to 8.9) 8.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Student Health Plans Expenses: 0 for affiliated services) 9.1 Salaries (including $ 9.2 Outsourced Services 0 for affiliated services) 9.3 EDP Equipment and Software (incl $ 0 for affiliated services) 9.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 9.5 Accreditation and Certification (incl $ 0 for affiliated services) 9.6 Other Expenses (incl $ 9.7 Subtotal before Reimbursements and Taxes (Lines 9.1 to 9.6) 9.8 Reimbursements by uninsured plans and fiscal intermediaries 9.9 Taxes, Licenses and Fees (in total, for tying purposes) 9.10 Total (9.7 to 9.9) 9.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 *79413201821633100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes - See Cautionary Statement at http://www.naic.org/documents/committees_e_app_blanks_related_shce_cautionary_statement.pdf) UnitedHealthcare Insurance Company 2. 185 Asylum Street Hartford, CT 061033408 (LOCATION) BUSINESS IN THE STATE OF New York DURING THE YEAR 2018 NAIC Company Code Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 2 Small Group Employer Individual 1. 216-1.NY 2. 3. 4. 5. 6. 7. 8. 9. Premium: 1.1 Health premiums earned (From Part 2, Line 1.11) 1.2 Federal high risk pools 1.3 State high risk pools 1.4 Premiums earned including state and federal high risk programs (Lines 1.1 + 1.2 + 1.3) 1.5 Federal taxes and federal assessments 1.6 State insurance, premium and other taxes (Similar local taxes of 0 ) $ 1.6a Community Benefit Expenditures (informational only) 1.7 Regulatory authority licenses and fees 1.8 Adjusted Premiums Earned (Lines 1.4 - 1.5 - 1.6 - 1.7) 1.9 Net Assumed less Ceded reinsurance premiums earned 1.10 Other Adjustments due to MLR calculations - Premiums 1.11 Risk Revenue 1.12 Net adjusted premiums earned after reinsurance (Lines 1.8 + 1.9 + 1.10 + 1.11) Claims: 2.1 Incurred claims excluding prescription drugs 2.2 Prescription drugs 2.3 Pharmaceutical rebates 2.4 State stop loss, market stabilization and claim/census based assessments (informational only) Incurred medical incentive pools and bonuses Deductible Fraud and Abuse Detection/Recovery Expenses (for MLR use only) 5.0 Total Incurred Claims (Lines 2.1 + 2.2 - 2.3 + 3) (From Part 2, Line 2.15) 5.1 Net Assumed less Ceded reinsurance claims incurred 5.2 Other Adjustments due to MLR calculations - Claims 5.3 Rebates paid 5.4 Estimated rebates unpaid prior year 5.5 Estimated rebates unpaid current year 5.6 Fee for service and co-pay revenue 5.7 Net incurred claims after reinsurance (Lines 5.0 + 5.1 + 5.2 + 5.3 - 5.4 + 5.5 - 5.6) Improving Health Care Quality Expenses Incurred: 6.1 Improve health outcomes 6.2 Activities to prevent hospital readmissions 6.3 Improve patient safety and reduce medical errors 6.4 Wellness and health promotion activities 6.5 Health Information Technology expenses related to health improvement 6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5) Preliminary Medical Loss Ratio: MLR ((Lines 4 + 5.0 + 6.6 - Footnote 2.0)/Line 1.8 Claims Adjustment Expenses: 8.1 Cost containment expenses not included in quality of care expenses in Line 6.6 8.2 All other claims adjustment expenses 8.3 Total claims adjustment expenses (Lines 8.1 + 8.2) Claims Adjustment Expense Ratio (Line 8.3/Line 1.8) 0 0 0 0 (22,639) 3 Large Group Employer 0 0 0 0 (193,778) 4 5 Small Group Employer Individual Expatriate Plans 6 Large Group Employer 7 11 Government Business (excluded by statute) Other Health Business 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 9 8 Small Group 10 Student Health Plans Large Group 79413 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4,377,293 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5,113,985 0 3,574,521 0 12,849,383 0 0 0 (4,377,293) 285,329,172 0 0 280,951,879 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (5,113,985) 631,283,738 0 0 626,169,753 0 0 0 (3,574,521) 139,348,495 0 0 135,773,973 0 0 0 XXX 203,188 0 13,052,571 0 0 0 0 0 0 (13,052,571) 1,060,302,148 0 0 1,047,249,577 0 0 0 22,639 411,111 0 0 433,749 0 0 0 193,778 3,929,633 0 0 4,123,410 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 0 0 0 0 488,840 0 0 0 0 0 488,840 0 0 0 0 4,199,916 0 0 0 0 0 4,199,916 0 0 0 0 224,843,469 0 0 0 0 0 224,843,469 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 97,851,999 0 0 0 0 0 97,852,000 0 0 0 0 823,937,214 0 0 0 0 0 823,937,215 XXX XXX 0 0 0 0 0 0 496,552,990 0 XXX XXX XXX 0 496,552,990 0 0 0 0 823,937,214 0 0 0 0 0 823,937,215 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 XXX XXX XXX 0 XXX XXX 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 (12,849,383) 1,060,302,148 0 0 1,047,452,765 XXX XXX XXX XXX XXX XXX XXX XXX 0 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 0 XXX 0 XXX 0 0 0 XXX 0 0 0 0 0 0 XXX 0 0 0 XXX 0 0 0 XXX SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 (Continued) Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 10. General and Administrative (G&A) Expenses: 10.1 Direct sales salaries and benefits 10.2 Agents and brokers fees and commissions 10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below) 10.4 Other general and administrative expenses 10.4a Community Benefit Expenditures (informational only) 10.5 Total general and administrative (Lines 10.1 +10.2 + 10.3 + 10.4) 3 Large Group Employer 2 Small Group Employer 0 0 0 35,894 0 35,894 0 0 0 702,281 0 702,281 4 5 Small Group Employer Individual 0 0 0 38,516,193 0 38,516,193 0 0 0 0 0 0 Expatriate Plans 6 Large Group Employer 0 0 0 0 0 0 7 8 Small Group 0 0 0 0 0 0 Student Health Plans Large Group 0 0 0 0 0 0 10 11 Government Business (excluded by statute) Other Health Business 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 109,063,801 0 109,063,801 0 0 0 23,556,075 0 23,556,075 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 0 0 0 171,874,243 0 171,874,243 0 0 0 (1,150,484) 0 (1,150,484) 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) 20,552,962 14,365,899 51,641,307 12. Income from fees of uninsured plans XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 13. Net investment and other gain/(loss) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 237 XXX 14. Federal income taxes (excluding taxes on Line 1.5 above) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 14 XXX 14 15. Net gain or (loss) (Lines 11 + 12 + 13 - 14) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 51,641,530 XXX 52,458,137 16. ICD-10 Implementation Expenses (informational only; already included in general expenses and line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16. 16a ICD-10 Implementation Expenses (informational only; already included in line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (90,984) (778,786) 17,592,217 0 0 0 0 0 (1) 0 XXX 0 0 0 170,723,759 0 170,723,759 52,588,604 (130,689) (130,689) 237 OTHER INDICATORS: 216-2.NY 1. Number of certificates/policies 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2. Number of Covered Lives 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3. Number of Groups 0 0 0 0 0 0 0 0 0 0 0 0 0 4. Member Months 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX 0 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ XXX 0 ] If yes, show the amount of premiums and claims included. Premiums $ 0 Claims $ 0 AFFORDABLE CARE ACT (ACA) RECEIPTS, PAYMENTS, RECEIVABLES and PAYABLES Current Year Prior Year Comprehensive Health Coverage Comprehensive Health Coverage 1 2 3 4 Small Group Small Group Employer Plans Employer Plans Individual Plans Individual Plans ACA Receivables and Payables 1. Permanent ACA Risk Adjustment Program 1.0 Premium adjustments receivable/(payable) 0 2. Transitional ACA Reinsurance Program 2.0 Total amounts recoverable for claims (paid & unpaid) 0 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 0 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 XXX ACA Receipts and Payments 4. Permanent ACA Risk Adjustment Program 4.0 Premium adjustments receipts/(payments) 0 5. Transitional ACA Reinsurance Program 5.0 Amounts received for claims 0 6. Temporary ACA Risk Corridors Program 6.1 Retrospective premium received 6.2 Rate credits or policy experience refunds paid 0 0 XXX 0 0 0 0 0 XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF 185 Asylum Street Hartford, CT 061033408 New York DURING THE YEAR Comprehensive Health Coverage 1 2 3 Individual Small Group Employer Large Group Employer Small Group Employer Individual Expatriate Plans: 7 8 6 Large Group Employer Small Group 10 11 Government Business (excluded by statute) Other Health Business 9 Student Health Plans Large Group 79413 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.NY Health Premiums Earned: 0 0 1.1 Direct premiums written 0 0 1.2 Unearned premium prior year 0 0 1.3 Unearned premium current year 0 0 1.4 Change in unearned premium (Lines 1.2 - 1.3) 0 0 1.5 Paid rate credits 0 0 1.6 Reserve for rate credits current year 0 0 1.7 Reserve for rate credits prior year 0 0 1.8 Change in reserve for rate credits (Lines 1.6 - 1.7) 0 0 1.9 Premium balances written off 0 0 1.10 Group conversion charge 0 0 1.11 Total direct premiums earned (Lines 1.1 + 1.4 - 1.9 + 1.10) 0 0 1.12 Assumed premiums earned from non-affiliates 411,111 3,929,633 1.13 Net Assumed less Ceded premiums earned from affiliates 0 0 1.14 Ceded premiums earned to non-affiliates 0 0 1.15 Other Adjustments due to MLR calculation - Premiums 411,111 3,929,633 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 0 0 2.1 Paid claims during the year 0 0 2.2 Direct claim liability current year 0 0 2.3 Direct claim liability prior year 0 0 2.4 Direct claim reserves current year 0 0 2.5 Direct claim reserves prior year 0 0 2.6 Direct contract reserves current year 0 0 2.7 Direct contract reserves prior year 0 0 2.8 Paid rate credits 0 0 2.9 Reserve for rate credits current year 0 0 2.10 Reserve for rate credits prior year 0 0 2.11 Incurred medical incentive pools and bonuses (Lines 2.11a + 2.11b - 2.11c) 0 0 2.11a Paid medical incentive pools and bonuses current year 0 0 2.11b Accrued medical incentive pools and bonuses current year 0 0 2.11c Accrued medical incentive pools and bonuses prior year 0 0 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 0 0 2.12a Healthcare receivables current year 0 0 2.12b Healthcare receivables prior year 0 0 2.13 Group conversion charge 0 0 2.14 Multi-option coverage blended rate adjustment 2.15 Total incurred claims (Lines 2.1 + 2.2 - 2.3 + 2.4 - 2.5 + 2.6 - 2.7 + 2.8 + 2.9 0 0 2.10 + 2.11 - 2.12 + 2.13 + 2.14) 0 0 2.16 Assumed incurred claims from non-affiliates 488,840 4,199,916 2.17 Net assumed less ceded incurred claims from affiliates 0 0 2.18 Ceded incurred claims to non-affiliates 0 0 2.19 Other adjustments due to MLR calculation - Claims 488,840 4,199,916 2.20 Net Incurred Claims (Lines 2.15 - 2.8 - 2.9 + 2.10 + 2.16 + 2.17 - 2.18 + 2.19) 3. Fraud and Abuse Recoveries that Reduced PAID Claims in Line 2.1 above 0 0 (informational only) 0 for stand-alone dental and $ (a) Column 13, Line 1.1 includes direct written premium of $ 4 Business Subject to MLR Mini-Med Plans 5 (LOCATION) NAIC Company Code 2018 0 0 0 0 0 0 0 0 0 0 0 0 338,008,118 52,678,946 0 285,329,172 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 631,283,738 0 0 631,283,738 0 0 0 0 0 0 0 0 0 0 0 0 139,348,495 0 0 139,348,494 0 0 0 0 0 0 0 0 0 0 0 0 1,112,981,094 52,678,946 0 1,060,302,148 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 265,678,027 40,834,558 0 224,843,469 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 496,552,990 0 0 496,552,990 0 0 97,851,999 0 0 97,852,000 0 0 864,771,772 40,834,558 0 823,937,215 0 0 0 for stand-alone vision policies. 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF New York DURING THE YEAR All Expenses 1 2. 216-4.NY 3. Individual Comprehensive Coverage Expenses: 0 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 0 for affiliated services) 1.3 EDP Equipment and Software (incl $ 0 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 1.5 Accreditation and Certification (incl $ 0 for affiliated services) 1.6 Other Expenses (incl $ 1.7 Subtotal before Reimbursements and Taxes (Lines 1.1 to 1.6) 1.8 Reimbursements by uninsured plans and fiscal intermediaries 1.9 Taxes, Licenses and Fees (in total, for tying purposes) 1.10 Total (1.7 to 1.9) 1.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Comprehensive Coverage Expenses: 0 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 0 for affiliated services) 2.3 EDP Equipment and Software (incl $ 0 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 2.5 Accreditation and Certification (incl $ 0 for affiliated services) 2.6 Other Expenses (incl $ 2.7 Subtotal before Reimbursements and Taxes (Lines 2.1 to 2.6) 2.8 Reimbursements by uninsured plans and fiscal intermediaries 2.9 Taxes, Licenses and Fees (in total, for tying purposes) 2.10 Total (2.7 to 2.9) 2.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Comprehensive Coverage Expenses: 0 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 0 for affiliated services) 3.3 EDP Equipment and Software (incl $ 0 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 3.5 Accreditation and Certification (incl $ 0 for affiliated services) 3.6 Other Expenses (incl $ 3.7 Subtotal before Reimbursements and Taxes (Lines 3.1 to 3.6) 3.8 Reimbursements by uninsured plans and fiscal intermediaries 3.9 Taxes, Licenses and Fees (in total, for tying purposes) 3.10 Total (3.7 to 3.9) 3.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions Improve Health Outcomes 1. 185 Asylum Street Hartford, CT 061033408 0 0 0 0 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX Total (1 to 5) 0 0 0 0 0 0 0 0 XXX 0 0 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 0 0 0 0 0 0 0 XXX (LOCATION) NAIC Company Code 2018 XXX 0 0 0 0 0 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 79413 9 10 General Administrative Expenses Total Expenses (6 to 9) 0 0 0 0 0 35,894 35,894 0 0 35,894 0 0 0 0 0 0 35,894 35,894 0 0 35,894 0 0 0 0 0 0 702,281 702,281 0 0 702,281 0 0 0 0 0 0 702,281 702,281 0 0 702,281 0 0 0 0 0 0 38,516,193 38,516,193 0 0 38,516,193 0 0 0 0 0 0 38,516,193 38,516,193 0 0 38,516,193 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 4. 5. 216-5.NY 6. Individual Mini-Med Plans Expenses: 0 for affiliated services) 4.1 Salaries (including $ 4.2 Outsourced Services 0 for affiliated services) 4.3 EDP Equipment and Software (incl $ 0 for affiliated services) 4.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 4.5 Accreditation and Certification (incl $ 0 for affiliated services) 4.6 Other Expenses (incl $ 4.7 Subtotal before Reimbursements and Taxes (Lines 4.1 to 4.6) 4.8 Reimbursements by uninsured plans and fiscal intermediaries 4.9 Taxes, Licenses and Fees (in total, for tying purposes) 4.10 Total (4.7 to 4.9) 4.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Mini-Med Plans Expenses: 0 for affiliated services) 5.1 Salaries (including $ 5.2 Outsourced Services 0 for affiliated services) 5.3 EDP Equipment and Software (incl $ 0 for affiliated services) 5.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 5.5 Accreditation and Certification (incl $ 0 for affiliated services) 5.6 Other Expenses (incl $ 5.7 Subtotal before Reimbursements and Taxes (Lines 5.1 to 5.6) 5.8 Reimbursements by uninsured plans and fiscal intermediaries 5.9 Taxes, Licenses and Fees (in total, for tying purposes) 5.10 Total (5.7 to 5.9) 5.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Mini-Med Plans Expenses: 0 for affiliated services) 6.1 Salaries (including $ 6.2 Outsourced Services 0 for affiliated services) 6.3 EDP Equipment and Software (incl $ 0 for affiliated services) 6.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 6.5 Accreditation and Certification (incl $ 0 for affiliated services) 6.6 Other Expenses (incl $ 6.7 Subtotal before Reimbursements and Taxes (Lines 6.1 to 6.6) 6.8 Reimbursements by uninsured plans and fiscal intermediaries 6.9 Taxes, Licenses and Fees (in total, for tying purposes) 6.10 Total (6.7 to 6.9) 6.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 7. 8. 216-6.NY 9. Small Group Expatriate Plans Expenses: 0 for affiliated services) 7.1 Salaries (including $ 7.2 Outsourced Services 0 for affiliated services) 7.3 EDP Equipment and Software (incl $ 0 for affiliated services) 7.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 7.5 Accreditation and Certification (incl $ 0 for affiliated services) 7.6 Other Expenses (incl $ 7.7 Subtotal before Reimbursements and Taxes (Lines 7.1 to 7.6) 7.8 Reimbursements by uninsured plans and fiscal intermediaries 7.9 Taxes, Licenses and Fees (in total, for tying purposes) 7.10 Total (7.7 to 7.9) 7.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Expatriate Plans Expenses: 0 for affiliated services) 8.1 Salaries (including $ 8.2 Outsourced Services 0 for affiliated services) 8.3 EDP Equipment and Software (incl $ 0 for affiliated services) 8.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 8.5 Accreditation and Certification (incl $ 0 for affiliated services) 8.6 Other Expenses (incl $ 8.7 Subtotal before Reimbursements and Taxes (Lines 8.1 to 8.6) 8.8 Reimbursements by uninsured plans and fiscal intermediaries 8.9 Taxes, Licenses and Fees (in total, for tying purposes) 8.10 Total (8.7 to 8.9) 8.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Student Health Plans Expenses: 0 for affiliated services) 9.1 Salaries (including $ 9.2 Outsourced Services 0 for affiliated services) 9.3 EDP Equipment and Software (incl $ 0 for affiliated services) 9.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 9.5 Accreditation and Certification (incl $ 0 for affiliated services) 9.6 Other Expenses (incl $ 9.7 Subtotal before Reimbursements and Taxes (Lines 9.1 to 9.6) 9.8 Reimbursements by uninsured plans and fiscal intermediaries 9.9 Taxes, Licenses and Fees (in total, for tying purposes) 9.10 Total (9.7 to 9.9) 9.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 *79413201821634100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes - See Cautionary Statement at http://www.naic.org/documents/committees_e_app_blanks_related_shce_cautionary_statement.pdf) UnitedHealthcare Insurance Company 2. 185 Asylum Street Hartford, CT 061033408 (LOCATION) BUSINESS IN THE STATE OF North Carolina DURING THE YEAR 2018 NAIC Company Code Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 1. 216-1.NC 2. 3. 4. 5. 6. 7. 8. 9. Premium: 1.1 Health premiums earned (From Part 2, Line 1.11) 1.2 Federal high risk pools 1.3 State high risk pools 1.4 Premiums earned including state and federal high risk programs (Lines 1.1 + 1.2 + 1.3) 1.5 Federal taxes and federal assessments 1.6 State insurance, premium and other taxes (Similar local taxes of 141,735 ) $ 1.6a Community Benefit Expenditures (informational only) 1.7 Regulatory authority licenses and fees 1.8 Adjusted Premiums Earned (Lines 1.4 - 1.5 - 1.6 - 1.7) 1.9 Net Assumed less Ceded reinsurance premiums earned 1.10 Other Adjustments due to MLR calculations - Premiums 1.11 Risk Revenue 1.12 Net adjusted premiums earned after reinsurance (Lines 1.8 + 1.9 + 1.10 + 1.11) Claims: 2.1 Incurred claims excluding prescription drugs 2.2 Prescription drugs 2.3 Pharmaceutical rebates 2.4 State stop loss, market stabilization and claim/census based assessments (informational only) Incurred medical incentive pools and bonuses Deductible Fraud and Abuse Detection/Recovery Expenses (for MLR use only) 5.0 Total Incurred Claims (Lines 2.1 + 2.2 - 2.3 + 3) (From Part 2, Line 2.15) 5.1 Net Assumed less Ceded reinsurance claims incurred 5.2 Other Adjustments due to MLR calculations - Claims 5.3 Rebates paid 5.4 Estimated rebates unpaid prior year 5.5 Estimated rebates unpaid current year 5.6 Fee for service and co-pay revenue 5.7 Net incurred claims after reinsurance (Lines 5.0 + 5.1 + 5.2 + 5.3 - 5.4 + 5.5 - 5.6) Improving Health Care Quality Expenses Incurred: 6.1 Improve health outcomes 6.2 Activities to prevent hospital readmissions 6.3 Improve patient safety and reduce medical errors 6.4 Wellness and health promotion activities 6.5 Health Information Technology expenses related to health improvement 6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5) Preliminary Medical Loss Ratio: MLR ((Lines 4 + 5.0 + 6.6 - Footnote 2.0)/Line 1.8 Claims Adjustment Expenses: 8.1 Cost containment expenses not included in quality of care expenses in Line 6.6 8.2 All other claims adjustment expenses 8.3 Total claims adjustment expenses (Lines 8.1 + 8.2) Claims Adjustment Expense Ratio (Line 8.3/Line 1.8) 2 Small Group Employer 3 Large Group Employer 4 5 Small Group Employer Individual Expatriate Plans 6 Large Group Employer 7 11 Government Business (excluded by statute) Other Health Business 9 8 Small Group 10 Student Health Plans Large Group 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 79413 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 2,191,476 0 (959) 207,192,540 0 (5,566) 318,178,593 0 (24,933) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 534,691,817 0 167,922 306,969,973 0 0 1,369,224,399 0 136,464 XXX XXX XXX 2,190,517 110,554 207,186,974 6,882,163 318,153,660 9,356,902 0 0 0 0 0 0 0 0 0 0 0 0 0 0 534,859,738 875,541 306,969,973 13,030,572 1,369,360,863 30,255,731 XXX 58,515 0 2,377 2,019,072 6,796 0 0 2,025,867 3,255,282 0 260,654 196,788,875 372,115 134,803 0 197,295,793 4,278,673 0 323,879 304,194,206 (42,710,124) 7,551 0 261,491,633 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10,125,333 0 3,150 523,855,714 (956,667) 17,600 0 522,916,647 32,705 0 0 293,906,697 2,204,722 2,287,895 0 298,399,313 17,750,509 0 590,060 1,320,764,563 (41,083,158) 2,447,848 0 1,282,129,253 XXX XXX XXX XXX XXX 17,750,509 0 590,060 1,320,764,563 (41,083,158) 2,447,848 0 1,282,129,253 1,285,022 324,817 94,030 135,378,500 36,837,336 11,315,052 233,034,183 57,158,373 17,215,758 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 308,141,023 161,734,614 132,231 122,991,740 224,429,712 121,164,373 800,830,468 480,484,852 149,921,444 XXX XXX XXX 800,830,468 480,484,852 149,921,444 1 30 1 1,515,839 0 0 0 0 0 0 1,515,839 310,616 120,545 18,156 161,021,329 0 1,946,360 2,982,683 5,365,916 436,873 0 161,021,329 283,696 28,637 19,582 273,005,435 (35,704,286) (257,133) 257,133 0 0 0 237,301,149 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5,063,722 9,203 231,320,801 0 0 0 0 0 0 231,320,801 594,350 5,212,934 46,942 1,136,606,810 (35,460,070) 1,689,195 3,239,816 5,365,916 436,873 0 1,101,146,708 XXX XXX 0 0 37 0 0 469,743,406 244,216 (32) XXX XXX XXX 0 469,987,590 594,350 5,212,934 46,942 1,136,606,810 (35,460,070) 1,689,195 3,239,816 5,365,916 436,873 0 1,101,146,708 17,532 0 0 0 0 1,657,540 0 0 0 0 2,545,429 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 929,029 441,162 376,720 2,276,346 257,711 1,711,375 352,264 888,125 309,774 1,153,568 6,860,905 793,426 1,264,845 2,586,120 1,411,279 17,532 0.759 1,657,540 0.827 2,545,429 0.906 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 4,280,968 XXX 4,415,106 0.802 12,916,575 XXX 17,294 41,792 59,086 0.029 2,340,872 3,635,266 5,976,138 0.030 3,505,937 4,911,299 8,417,237 0.028 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 1,482,003 6,987,167 8,469,170 0.016 3,138,660 19,004,287 22,142,947 0.075 10,484,766 34,579,811 45,064,576 XXX XXX XXX XXX XXX 0 0 0 0.000 1,369,224,399 0 136,464 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 6,860,905 793,426 1,264,845 2,586,120 1,411,279 0 12,916,575 XXX 0 0 0 10,484,766 34,579,811 45,064,576 XXX XXX XXX 1,369,360,863 30,255,731 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 (Continued) Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 10. General and Administrative (G&A) Expenses: 10.1 Direct sales salaries and benefits 10.2 Agents and brokers fees and commissions 10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below) 10.4 Other general and administrative expenses 10.4a Community Benefit Expenditures (informational only) 10.5 Total general and administrative (Lines 10.1 +10.2 + 10.3 + 10.4) 3 Large Group Employer 2 Small Group Employer 5,588 37,931 (3,472) 103,255 0 143,303 794,110 5,872,963 103,117 10,229,438 0 16,999,627 4 5 Small Group Employer Individual 1,452,877 997,553 388,335 8,366,813 0 11,205,578 0 0 0 0 0 0 Expatriate Plans 6 Large Group Employer 0 0 0 0 0 0 7 8 Small Group 0 0 0 0 0 0 Student Health Plans Large Group 0 0 0 0 0 0 10 11 Government Business (excluded by statute) Other Health Business 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,318,548 18,852,373 793,262 36,928,909 0 57,893,093 0 552,013 3,827,549 482,204 15,939,416 0 20,801,183 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 4,123,137 29,588,370 1,763,445 71,567,831 0 107,042,783 0 0 0 0 0 0 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) (17,714,174) 19,719,277 15,958,611 12. Income from fees of uninsured plans XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 13. Net investment and other gain/(loss) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 19,067,361 XXX 14. Federal income taxes (excluding taxes on Line 1.5 above) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 1,468,421 XXX 1,468,421 15. Net gain or (loss) (Lines 11 + 12 + 13 - 14) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 33,557,552 XXX 33,557,552 16. ICD-10 Implementation Expenses (informational only; already included in general expenses and line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16. 16a ICD-10 Implementation Expenses (informational only; already included in line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 290,109 11,641,158 2,022,241 0 0 0 0 0 0 XXX 4,123,137 29,588,370 1,763,445 71,567,831 0 107,042,783 15,958,611 0 0 19,067,361 OTHER INDICATORS: 216-2.NC 1. Number of certificates/policies 203 61,017 55,082 0 0 0 0 0 0 0 474,008 132,930 723,240 0 723,240 2. Number of Covered Lives 313 94,954 86,487 0 0 0 0 0 0 0 634,821 132,930 949,505 0 949,505 3. Number of Groups 9,164 1,048 0 0 0 0 0 0 7,317 3 17,532 0 17,532 4. Member Months 1,094,647 1,069,483 0 0 0 0 0 0 7,707,581 1,616,661 11,492,131 0 11,492,131 XXX 3,759 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ XXX 0 ] If yes, show the amount of premiums and claims included. Premiums $ 0 Claims $ 0 AFFORDABLE CARE ACT (ACA) RECEIPTS, PAYMENTS, RECEIVABLES and PAYABLES Current Year Prior Year Comprehensive Health Coverage Comprehensive Health Coverage 1 2 3 4 Small Group Small Group Employer Plans Employer Plans Individual Plans Individual Plans ACA Receivables and Payables 1. Permanent ACA Risk Adjustment Program 1.0 Premium adjustments receivable/(payable) 2. Transitional ACA Reinsurance Program 2.0 Total amounts recoverable for claims (paid & unpaid) 0 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 0 0 38,105 (9,327,629) XXX 15,649 0 0 0 (7,547,812) XXX 0 0 0 0 ACA Receipts and Payments 4. Permanent ACA Risk Adjustment Program 4.0 Premium adjustments receipts/(payments) 5. Transitional ACA Reinsurance Program 5.0 Amounts received for claims 0 6. Temporary ACA Risk Corridors Program 6.1 Retrospective premium received 6.2 Rate credits or policy experience refunds paid 0 0 62,862 (8,568,806) XXX (79,126) 0 0 0 0 0 (2,700,563) XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF 185 Asylum Street Hartford, CT 061033408 North Carolina DURING THE YEAR Comprehensive Health Coverage 1 2 3 Individual Small Group Employer Small Group Employer Individual Expatriate Plans: 7 8 6 Large Group Employer Small Group 10 11 Government Business (excluded by statute) Other Health Business 9 Student Health Plans Large Group 79413 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.NC Health Premiums Earned: 2,191,476 207,323,925 1.1 Direct premiums written 0 59,128 1.2 Unearned premium prior year 0 55,710 1.3 Unearned premium current year 0 3,418 1.4 Change in unearned premium (Lines 1.2 - 1.3) 213,374 2,982,683 1.5 Paid rate credits 0 436,873 1.6 Reserve for rate credits current year 0 5,365,916 1.7 Reserve for rate credits prior year 0 (4,929,043) 1.8 Change in reserve for rate credits (Lines 1.6 - 1.7) 0 134,803 1.9 Premium balances written off 0 0 1.10 Group conversion charge 2,191,476 207,192,540 1.11 Total direct premiums earned (Lines 1.1 + 1.4 - 1.9 + 1.10) 0 0 1.12 Assumed premiums earned from non-affiliates 6,796 372,115 1.13 Net Assumed less Ceded premiums earned from affiliates 0 0 1.14 Ceded premiums earned to non-affiliates 0 134,803 1.15 Other Adjustments due to MLR calculation - Premiums 1,984,898 209,645,818 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 1,380,663 157,014,529 2.1 Paid claims during the year 56,797 20,199,592 2.2 Direct claim liability current year 51,630 14,456,313 2.3 Direct claim liability prior year 4,185 438,727 2.4 Direct claim reserves current year 7,843 297,985 2.5 Direct claim reserves prior year 231,924 0 2.6 Direct contract reserves current year 310,695 0 2.7 Direct contract reserves prior year 213,374 2,982,683 2.8 Paid rate credits 0 436,873 2.9 Reserve for rate credits current year 0 5,365,916 2.10 Reserve for rate credits prior year 30 120,545 2.11 Incurred medical incentive pools and bonuses (Lines 2.11a + 2.11b - 2.11c) 30 103,034 2.11a Paid medical incentive pools and bonuses current year 0 96,371 2.11b Accrued medical incentive pools and bonuses current year 0 78,859 2.11c Accrued medical incentive pools and bonuses prior year 966 51,404 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 1,750 4,504,543 2.12a Healthcare receivables current year 784 4,453,139 2.12b Healthcare receivables prior year 0 0 2.13 Group conversion charge 0 0 2.14 Multi-option coverage blended rate adjustment 2.15 Total incurred claims (Lines 2.1 + 2.2 - 2.3 + 2.4 - 2.5 + 2.6 - 2.7 + 2.8 + 2.9 1,515,839 161,021,329 2.10 + 2.11 - 2.12 + 2.13 + 2.14) 0 0 2.16 Assumed incurred claims from non-affiliates 0 0 2.17 Net assumed less ceded incurred claims from affiliates 0 0 2.18 Ceded incurred claims to non-affiliates 0 0 2.19 Other adjustments due to MLR calculation - Claims 1,302,465 162,967,690 2.20 Net Incurred Claims (Lines 2.15 - 2.8 - 2.9 + 2.10 + 2.16 + 2.17 - 2.18 + 2.19) 3. Fraud and Abuse Recoveries that Reduced PAID Claims in Line 2.1 above 1 18,156 (informational only) 78,280,993 for stand-alone dental and $ (a) Column 13, Line 1.1 includes direct written premium of $ Large Group Employer 4 Business Subject to MLR Mini-Med Plans 5 (LOCATION) NAIC Company Code 2018 318,186,065 78 0 78 (78,456) 0 (353,813) 353,813 7,551 0 318,178,593 0 183,520 42,893,644 7,551 275,200,663 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 269,209,972 31,494,472 29,001,214 648,034 617,906 0 0 (78,456) 0 (353,813) 28,637 184,846 404,018 560,227 (968,084) 6,719,847 7,687,931 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 273,005,435 0 0 35,704,286 0 237,025,792 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 19,582 0 0 23,079,340 for stand-alone vision policies. 0 0 0 0 0 138,944 (138,944) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 534,741,121 43,966 75,670 (31,704) 4,718,095 294,837 361,752 (66,915) 17,600 0 534,691,817 0 0 956,667 17,600 529,101,570 309,257,868 0 0 0 5,830,149 549,353 5,893,547 (5,344,194) 2,287,895 0 306,969,973 0 2,204,722 0 2,287,895 310,976,635 1,371,700,455 103,172 131,380 (28,208) 13,665,844 1,281,063 11,267,402 (9,986,339) 2,447,848 0 1,369,224,399 0 2,767,153 43,850,311 2,447,848 1,326,909,584 467,221,040 42,161,254 41,032,221 12,822,036 13,315,155 556,425 3,281,262 4,718,095 294,837 361,752 0 0 0 0 39,890 39,890 0 0 0 230,969,654 21,825,825 30,404,330 26,002 27,084 0 0 5,830,149 549,353 5,893,547 5,063,722 7,694,054 4,868,540 7,498,872 (3,381,056) 42,670,819 46,051,876 0 0 1,125,934,801 115,598,996 114,945,708 13,938,982 14,265,973 788,349 3,591,957 13,665,844 1,281,063 11,267,402 5,212,934 7,981,963 5,368,929 8,137,958 (4,256,880) 53,936,850 58,193,730 0 0 469,743,406 0 0 (244,216) 0 465,336,442 231,320,801 0 0 0 0 230,834,846 1,136,606,810 0 0 35,460,070 0 1,097,467,235 9,203 46,942 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF North Carolina DURING THE YEAR All Expenses 1 Improve Health Outcomes 1. Individual Comprehensive Coverage Expenses: 56,184 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 3,330 for affiliated services) 1.3 EDP Equipment and Software (incl $ 320 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 35 for affiliated services) 1.5 Accreditation and Certification (incl $ 98,707 for affiliated services) 1.6 Other Expenses (incl $ 1.7 Subtotal before Reimbursements and Taxes (Lines 1.1 to 1.6) 1.8 Reimbursements by uninsured plans and fiscal intermediaries 1.9 Taxes, Licenses and Fees (in total, for tying purposes) 1.10 Total (1.7 to 1.9) 1.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 2. 216-4.NC Small Group Comprehensive Coverage Expenses: 5,216,439 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 371,670 for affiliated services) 2.3 EDP Equipment and Software (incl $ 35,676 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 3,874 for affiliated services) 2.5 Accreditation and Certification (incl $ 11,639,952 for affiliated services) 2.6 Other Expenses (incl $ 2.7 Subtotal before Reimbursements and Taxes (Lines 2.1 to 2.6) 2.8 Reimbursements by uninsured plans and fiscal intermediaries 2.9 Taxes, Licenses and Fees (in total, for tying purposes) 2.10 Total (2.7 to 2.9) 2.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 3. Large Group Comprehensive Coverage Expenses: 6,971,093 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 465,160 for affiliated services) 3.3 EDP Equipment and Software (incl $ 44,650 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 4,848 for affiliated services) 3.5 Accreditation and Certification (incl $ 15,321,448 for affiliated services) 3.6 Other Expenses (incl $ 3.7 Subtotal before Reimbursements and Taxes (Lines 3.1 to 3.6) 3.8 Reimbursements by uninsured plans and fiscal intermediaries 3.9 Taxes, Licenses and Fees (in total, for tying purposes) 3.10 Total (3.7 to 3.9) 3.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 185 Asylum Street Hartford, CT 061033408 0 0 0 0 0 17,532 17,532 0 XXX Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX Total (1 to 5) 0 0 0 0 0 17,532 17,532 0 XXX 0 0 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 0 0 0 0 0 0 0 XXX (LOCATION) NAIC Company Code 2018 XXX 4,865 577 406 39 4 10,881 16,773 0 XXX 14,280 1,214 875 84 9 24,775 41,237 0 XXX 17,532 0 0 0 0 0 0 0 0 0 17,532 0 16,773 4,495 41,237 0 0 0 0 0 0 1,657,540 1,657,540 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,657,540 1,657,540 0 623,800 148,291 52,090 5,000 543 1,437,156 2,266,880 0 1,032,806 118,347 86,244 8,278 899 2,309,939 3,556,513 0 XXX 1,657,540 0 0 0 0 0 0 2,545,429 2,545,429 0 XXX 2,545,429 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 1,657,540 0 XXX 2,266,880 638,818 XXX 3,556,513 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,545,429 2,545,429 0 931,734 232,971 77,804 7,468 811 2,143,895 3,394,683 0 1,397,505 160,157 116,698 11,202 1,216 3,125,612 4,812,390 0 2,545,429 0 XXX 3,394,683 1,018,173 XXX 4,812,390 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 79413 9 10 General Administrative Expenses Total Expenses (6 to 9) 37,039 3,236 2,049 179 21 103,855 146,379 0 58,890 205,270 0 56,184 5,027 3,330 302 35 157,043 221,921 0 58,890 280,812 4,495 3,559,833 372,364 233,335 22,397 2,432 12,649,992 16,840,354 0 3,827,955 20,668,309 0 5,216,439 639,002 371,670 35,676 3,874 18,054,627 24,321,286 0 3,827,955 28,149,242 638,818 4,641,854 438,974 270,657 25,980 2,821 5,340,885 10,721,171 0 5,297,122 16,018,293 0 6,971,093 832,102 465,160 44,650 4,848 13,155,821 21,473,673 0 5,297,122 26,770,795 1,018,173 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 4. 5. 216-5.NC 6. Individual Mini-Med Plans Expenses: 0 for affiliated services) 4.1 Salaries (including $ 4.2 Outsourced Services 0 for affiliated services) 4.3 EDP Equipment and Software (incl $ 0 for affiliated services) 4.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 4.5 Accreditation and Certification (incl $ 0 for affiliated services) 4.6 Other Expenses (incl $ 4.7 Subtotal before Reimbursements and Taxes (Lines 4.1 to 4.6) 4.8 Reimbursements by uninsured plans and fiscal intermediaries 4.9 Taxes, Licenses and Fees (in total, for tying purposes) 4.10 Total (4.7 to 4.9) 4.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Mini-Med Plans Expenses: 0 for affiliated services) 5.1 Salaries (including $ 5.2 Outsourced Services 0 for affiliated services) 5.3 EDP Equipment and Software (incl $ 0 for affiliated services) 5.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 5.5 Accreditation and Certification (incl $ 0 for affiliated services) 5.6 Other Expenses (incl $ 5.7 Subtotal before Reimbursements and Taxes (Lines 5.1 to 5.6) 5.8 Reimbursements by uninsured plans and fiscal intermediaries 5.9 Taxes, Licenses and Fees (in total, for tying purposes) 5.10 Total (5.7 to 5.9) 5.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Mini-Med Plans Expenses: 0 for affiliated services) 6.1 Salaries (including $ 6.2 Outsourced Services 0 for affiliated services) 6.3 EDP Equipment and Software (incl $ 0 for affiliated services) 6.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 6.5 Accreditation and Certification (incl $ 0 for affiliated services) 6.6 Other Expenses (incl $ 6.7 Subtotal before Reimbursements and Taxes (Lines 6.1 to 6.6) 6.8 Reimbursements by uninsured plans and fiscal intermediaries 6.9 Taxes, Licenses and Fees (in total, for tying purposes) 6.10 Total (6.7 to 6.9) 6.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 7. 8. 216-6.NC 9. Small Group Expatriate Plans Expenses: 0 for affiliated services) 7.1 Salaries (including $ 7.2 Outsourced Services 0 for affiliated services) 7.3 EDP Equipment and Software (incl $ 0 for affiliated services) 7.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 7.5 Accreditation and Certification (incl $ 0 for affiliated services) 7.6 Other Expenses (incl $ 7.7 Subtotal before Reimbursements and Taxes (Lines 7.1 to 7.6) 7.8 Reimbursements by uninsured plans and fiscal intermediaries 7.9 Taxes, Licenses and Fees (in total, for tying purposes) 7.10 Total (7.7 to 7.9) 7.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Expatriate Plans Expenses: 0 for affiliated services) 8.1 Salaries (including $ 8.2 Outsourced Services 0 for affiliated services) 8.3 EDP Equipment and Software (incl $ 0 for affiliated services) 8.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 8.5 Accreditation and Certification (incl $ 0 for affiliated services) 8.6 Other Expenses (incl $ 8.7 Subtotal before Reimbursements and Taxes (Lines 8.1 to 8.6) 8.8 Reimbursements by uninsured plans and fiscal intermediaries 8.9 Taxes, Licenses and Fees (in total, for tying purposes) 8.10 Total (8.7 to 8.9) 8.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Student Health Plans Expenses: 0 for affiliated services) 9.1 Salaries (including $ 9.2 Outsourced Services 0 for affiliated services) 9.3 EDP Equipment and Software (incl $ 0 for affiliated services) 9.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 9.5 Accreditation and Certification (incl $ 0 for affiliated services) 9.6 Other Expenses (incl $ 9.7 Subtotal before Reimbursements and Taxes (Lines 9.1 to 9.6) 9.8 Reimbursements by uninsured plans and fiscal intermediaries 9.9 Taxes, Licenses and Fees (in total, for tying purposes) 9.10 Total (9.7 to 9.9) 9.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 *79413201821635100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes - See Cautionary Statement at http://www.naic.org/documents/committees_e_app_blanks_related_shce_cautionary_statement.pdf) UnitedHealthcare Insurance Company 2. 185 Asylum Street Hartford, CT 061033408 (LOCATION) BUSINESS IN THE STATE OF North Dakota DURING THE YEAR 2018 NAIC Company Code Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 2 Small Group Employer Individual 1. 216-1.ND 2. 3. 4. 5. 6. 7. 8. 9. Premium: 1.1 Health premiums earned (From Part 2, Line 1.11) 1.2 Federal high risk pools 1.3 State high risk pools 1.4 Premiums earned including state and federal high risk programs (Lines 1.1 + 1.2 + 1.3) 1.5 Federal taxes and federal assessments 1.6 State insurance, premium and other taxes (Similar local taxes of 949 ) $ 1.6a Community Benefit Expenditures (informational only) 1.7 Regulatory authority licenses and fees 1.8 Adjusted Premiums Earned (Lines 1.4 - 1.5 - 1.6 - 1.7) 1.9 Net Assumed less Ceded reinsurance premiums earned 1.10 Other Adjustments due to MLR calculations - Premiums 1.11 Risk Revenue 1.12 Net adjusted premiums earned after reinsurance (Lines 1.8 + 1.9 + 1.10 + 1.11) Claims: 2.1 Incurred claims excluding prescription drugs 2.2 Prescription drugs 2.3 Pharmaceutical rebates 2.4 State stop loss, market stabilization and claim/census based assessments (informational only) Incurred medical incentive pools and bonuses Deductible Fraud and Abuse Detection/Recovery Expenses (for MLR use only) 5.0 Total Incurred Claims (Lines 2.1 + 2.2 - 2.3 + 3) (From Part 2, Line 2.15) 5.1 Net Assumed less Ceded reinsurance claims incurred 5.2 Other Adjustments due to MLR calculations - Claims 5.3 Rebates paid 5.4 Estimated rebates unpaid prior year 5.5 Estimated rebates unpaid current year 5.6 Fee for service and co-pay revenue 5.7 Net incurred claims after reinsurance (Lines 5.0 + 5.1 + 5.2 + 5.3 - 5.4 + 5.5 - 5.6) Improving Health Care Quality Expenses Incurred: 6.1 Improve health outcomes 6.2 Activities to prevent hospital readmissions 6.3 Improve patient safety and reduce medical errors 6.4 Wellness and health promotion activities 6.5 Health Information Technology expenses related to health improvement 6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5) Preliminary Medical Loss Ratio: MLR ((Lines 4 + 5.0 + 6.6 - Footnote 2.0)/Line 1.8 Claims Adjustment Expenses: 8.1 Cost containment expenses not included in quality of care expenses in Line 6.6 8.2 All other claims adjustment expenses 8.3 Total claims adjustment expenses (Lines 8.1 + 8.2) Claims Adjustment Expense Ratio (Line 8.3/Line 1.8) 3 Large Group Employer 4 5 Small Group Employer Individual Expatriate Plans 6 Large Group Employer 7 11 Government Business (excluded by statute) Other Health Business 9 8 Small Group 10 Student Health Plans Large Group 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 79413 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 33,889 0 (4,742) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5,190,855 0 2,918 3,002,921 0 0 8,227,665 0 (1,824) XXX XXX XXX 0 215 29,147 3,598 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5,193,773 27,292 3,002,921 39,245 8,225,841 70,503 XXX 0 0 0 (215) 0 0 0 (215) 359 0 0 25,191 (6,778) 0 0 18,413 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 86,685 0 (757) 5,080,554 (1,773) 22 0 5,078,803 433 0 0 2,963,243 0 24,698 0 2,987,941 87,477 0 (757) 8,068,619 (8,551) 24,720 0 8,084,788 XXX XXX XXX XXX XXX 87,477 0 (757) 8,068,619 (8,551) 24,720 0 8,084,788 0 0 0 0 0 0 0 154 0 0 0 (154) 0 0 0 (154) 8,227,665 0 (1,824) 0 0 0 0 8,225,841 70,503 50 0 0 0 0 0 1,117 0 55 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4,076,269 30,681 3,656 (47,533) 6,460,868 3,794,021 4,029,903 6,491,549 3,797,732 XXX XXX XXX 4,029,903 6,491,549 3,797,732 0 0 0 50 0 0 0 0 0 0 50 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,062 (363) 0 0 0 0 0 700 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,619,314 0 0 0 0 0 0 2,619,314 0 0 0 6,723,720 (293) 0 0 0 0 0 6,723,428 XXX XXX 0 0 0 0 0 4,103,294 70 0 XXX XXX XXX 0 4,103,364 0 0 0 6,723,720 (293) 0 0 0 0 0 6,723,428 0 0 0 0 0 0 0 0 0 0 271 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8,646 101 199 38,352 1,866 0 (0.325) 0 0.000 271 0.053 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 49,164 XXX 0 0 0 0.003 0 0 0 0.000 241 225 466 0.018 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 XXX XXX XXX XXX 0 0 0 0.000 3,929 82,687 86,616 0.017 1,696 1,255 668 (2,834) 2,562 0 XXX XXX XXX XXX XXX XXX XXX XXX 10,613 1,356 867 35,518 4,428 3,347 0.885 52,782 XXX (16,241) 33,178 16,937 0.006 (12,071) 116,090 104,019 XXX 0 0 0 0 0 10,613 1,356 867 35,518 4,428 0 52,782 XXX 0 0 0 (12,071) 116,090 104,019 XXX XXX XXX SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 (Continued) Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 10. General and Administrative (G&A) Expenses: 10.1 Direct sales salaries and benefits 10.2 Agents and brokers fees and commissions 10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below) 10.4 Other general and administrative expenses 10.4a Community Benefit Expenditures (informational only) 10.5 Total general and administrative (Lines 10.1 +10.2 + 10.3 + 10.4) 3 Large Group Employer 2 Small Group Employer 0 0 (822) 0 0 (822) 0 0 (1,077) 0 0 (1,077) 4 5 Small Group Employer Individual 112 1,687 10 751 0 2,559 0 0 0 0 0 0 Expatriate Plans 6 Large Group Employer 0 0 0 0 0 0 7 8 Small Group 0 0 0 0 0 0 Student Health Plans Large Group 0 0 0 0 0 0 10 11 Government Business (excluded by statute) Other Health Business 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8,768 194,500 9,063 536,553 0 748,885 7,104 2,799 7,246 201,133 0 218,283 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 15,984 198,987 14,420 738,437 0 967,828 0 0 0 0 0 0 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) 12. Income from fees of uninsured plans XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 13. Net investment and other gain/(loss) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 14. Federal income taxes (excluding taxes on Line 1.5 above) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 15. Net gain or (loss) (Lines 11 + 12 + 13 - 14) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 16. ICD-10 Implementation Expenses (informational only; already included in general expenses and line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16. 16a ICD-10 Implementation Expenses (informational only; already included in line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 618 862 14,417 0 0 0 0 0 0 0 90,774 130,060 236,732 XXX 15,984 198,987 14,420 738,437 0 967,828 XXX 236,732 0 0 95,011 XXX XXX 5,526 XXX 5,526 XXX 326,216 XXX 326,216 95,011 OTHER INDICATORS: 216-2.ND 1. Number of certificates/policies 0 0 25 0 0 0 0 0 0 0 3,224 3,077 6,326 0 6,326 2. Number of Covered Lives 0 0 51 0 0 0 0 0 0 0 3,766 3,077 6,894 0 6,894 3. Number of Groups 0 1 0 0 0 0 0 0 54 0 55 0 55 4. Member Months 0 51 0 0 0 0 0 0 41,605 37,743 79,399 0 79,399 XXX 0 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ XXX 0 ] If yes, show the amount of premiums and claims included. Premiums $ 0 Claims $ 0 AFFORDABLE CARE ACT (ACA) RECEIPTS, PAYMENTS, RECEIVABLES and PAYABLES Current Year Prior Year Comprehensive Health Coverage Comprehensive Health Coverage 1 2 3 4 Small Group Small Group Employer Plans Employer Plans Individual Plans Individual Plans ACA Receivables and Payables 1. Permanent ACA Risk Adjustment Program 1.0 Premium adjustments receivable/(payable) 0 2. Transitional ACA Reinsurance Program 2.0 Total amounts recoverable for claims (paid & unpaid) 0 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 0 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 XXX ACA Receipts and Payments 4. Permanent ACA Risk Adjustment Program 4.0 Premium adjustments receipts/(payments) 0 5. Transitional ACA Reinsurance Program 5.0 Amounts received for claims 0 6. Temporary ACA Risk Corridors Program 6.1 Retrospective premium received 6.2 Rate credits or policy experience refunds paid 0 0 XXX 0 0 0 0 0 XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF 185 Asylum Street Hartford, CT 061033408 North Dakota DURING THE YEAR Comprehensive Health Coverage 1 2 3 Individual Small Group Employer Large Group Employer Small Group Employer Individual Expatriate Plans: 7 8 6 Large Group Employer Small Group 10 11 Government Business (excluded by statute) Other Health Business 9 Student Health Plans Large Group 79413 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.ND Health Premiums Earned: 0 1.1 Direct premiums written 0 1.2 Unearned premium prior year 0 1.3 Unearned premium current year 0 1.4 Change in unearned premium (Lines 1.2 - 1.3) 50 1.5 Paid rate credits 0 1.6 Reserve for rate credits current year 0 1.7 Reserve for rate credits prior year 0 1.8 Change in reserve for rate credits (Lines 1.6 - 1.7) 0 1.9 Premium balances written off 0 1.10 Group conversion charge 0 1.11 Total direct premiums earned (Lines 1.1 + 1.4 - 1.9 + 1.10) 0 1.12 Assumed premiums earned from non-affiliates 0 1.13 Net Assumed less Ceded premiums earned from affiliates 0 1.14 Ceded premiums earned to non-affiliates 0 1.15 Other Adjustments due to MLR calculation - Premiums (50) 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: (2) 2.1 Paid claims during the year 2 2.2 Direct claim liability current year 0 2.3 Direct claim liability prior year 0 2.4 Direct claim reserves current year 0 2.5 Direct claim reserves prior year 0 2.6 Direct contract reserves current year 0 2.7 Direct contract reserves prior year 50 2.8 Paid rate credits 0 2.9 Reserve for rate credits current year 0 2.10 Reserve for rate credits prior year 0 2.11 Incurred medical incentive pools and bonuses (Lines 2.11a + 2.11b - 2.11c) 0 2.11a Paid medical incentive pools and bonuses current year 0 2.11b Accrued medical incentive pools and bonuses current year 0 2.11c Accrued medical incentive pools and bonuses prior year 0 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 0 2.12a Healthcare receivables current year 0 2.12b Healthcare receivables prior year 0 2.13 Group conversion charge 0 2.14 Multi-option coverage blended rate adjustment 2.15 Total incurred claims (Lines 2.1 + 2.2 - 2.3 + 2.4 - 2.5 + 2.6 - 2.7 + 2.8 + 2.9 50 2.10 + 2.11 - 2.12 + 2.13 + 2.14) 0 2.16 Assumed incurred claims from non-affiliates 0 2.17 Net assumed less ceded incurred claims from affiliates 0 2.18 Ceded incurred claims to non-affiliates 0 2.19 Other adjustments due to MLR calculation - Claims 0 2.20 Net Incurred Claims (Lines 2.15 - 2.8 - 2.9 + 2.10 + 2.16 + 2.17 - 2.18 + 2.19) 3. Fraud and Abuse Recoveries that Reduced PAID Claims in Line 2.1 above 0 (informational only) 196,492 for stand-alone dental and $ (a) Column 13, Line 1.1 includes direct written premium of $ 4 Business Subject to MLR Mini-Med Plans 5 (LOCATION) NAIC Company Code 2018 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 33,889 0 0 0 (50) 0 0 0 0 0 33,889 0 0 6,778 0 27,161 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5,190,877 0 0 0 (39,692) 0 0 0 22 0 5,190,855 0 0 1,773 22 5,228,795 3,027,619 0 0 0 0 234,962 281,587 (46,625) 24,698 0 3,002,921 0 0 0 24,698 3,074,244 8,252,385 0 0 0 (39,692) 234,962 281,587 (46,625) 24,720 0 8,227,665 0 0 8,551 24,720 8,330,151 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,020 (853) 0 1 0 0 0 (50) 0 0 0 0 0 0 55 55 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4,045,388 692,321 596,738 135,765 132,446 85 259 (39,692) 0 0 0 0 0 0 1,130 1,130 0 0 0 1,642,469 247,912 190,267 0 0 0 0 0 234,962 281,587 0 0 0 0 (965,825) 674,344 1,640,168 0 0 5,689,875 939,382 787,006 135,766 132,446 85 259 (39,692) 234,962 281,587 0 0 0 0 (964,640) 675,529 1,640,168 0 0 0 0 0 0 0 0 1,062 0 0 363 0 750 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4,103,294 0 0 (70) 0 4,143,056 2,619,314 0 0 0 0 2,665,939 6,723,720 0 0 293 0 6,809,744 0 0 0 25,201 for stand-alone vision policies. 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF North Dakota DURING THE YEAR Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities All Expenses 1 2 Activities to Prevent Hospital Readmissions Improve Health Outcomes 1. 2. 216-4.ND 3. Individual Comprehensive Coverage Expenses: 0 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 0 for affiliated services) 1.3 EDP Equipment and Software (incl $ 0 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 1.5 Accreditation and Certification (incl $ 0 for affiliated services) 1.6 Other Expenses (incl $ 1.7 Subtotal before Reimbursements and Taxes (Lines 1.1 to 1.6) 1.8 Reimbursements by uninsured plans and fiscal intermediaries 1.9 Taxes, Licenses and Fees (in total, for tying purposes) 1.10 Total (1.7 to 1.9) 1.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Comprehensive Coverage Expenses: 0 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 0 for affiliated services) 2.3 EDP Equipment and Software (incl $ 0 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 2.5 Accreditation and Certification (incl $ 0 for affiliated services) 2.6 Other Expenses (incl $ 2.7 Subtotal before Reimbursements and Taxes (Lines 2.1 to 2.6) 2.8 Reimbursements by uninsured plans and fiscal intermediaries 2.9 Taxes, Licenses and Fees (in total, for tying purposes) 2.10 Total (2.7 to 2.9) 2.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 0 0 0 0 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX Total (1 to 5) 0 0 0 0 0 0 0 0 XXX 0 0 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 0 0 0 0 0 0 0 XXX (LOCATION) NAIC Company Code 2018 XXX 0 0 0 0 0 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX Large Group Comprehensive Coverage Expenses: 662 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 46 for affiliated services) 3.3 EDP Equipment and Software (incl $ 4 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 3.5 Accreditation and Certification (incl $ 1,451 for affiliated services) 3.6 Other Expenses (incl $ 3.7 Subtotal before Reimbursements and Taxes (Lines 3.1 to 3.6) 3.8 Reimbursements by uninsured plans and fiscal intermediaries 3.9 Taxes, Licenses and Fees (in total, for tying purposes) 3.10 Total (3.7 to 3.9) 3.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 185 Asylum Street Hartford, CT 061033408 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 271 271 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 271 271 0 67 8 6 1 0 153 233 0 63 7 5 1 0 142 219 0 XXX XXX XXX 0 0 0 XXX 271 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 271 0 XXX 233 73 219 0 79413 9 10 General Administrative Expenses Total Expenses (6 to 9) 0 0 0 0 0 0 0 0 (822) (822) 0 0 0 0 0 0 0 0 0 (822) (822) 0 0 0 0 0 0 0 0 0 (1,077) (1,077) 0 0 0 0 0 0 0 0 0 (1,077) (1,077) 0 532 49 35 3 0 1,922 2,542 0 390 2,932 0 662 64 46 4 0 2,488 3,265 0 390 3,655 73 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 4. 5. 216-5.ND 6. Individual Mini-Med Plans Expenses: 0 for affiliated services) 4.1 Salaries (including $ 4.2 Outsourced Services 0 for affiliated services) 4.3 EDP Equipment and Software (incl $ 0 for affiliated services) 4.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 4.5 Accreditation and Certification (incl $ 0 for affiliated services) 4.6 Other Expenses (incl $ 4.7 Subtotal before Reimbursements and Taxes (Lines 4.1 to 4.6) 4.8 Reimbursements by uninsured plans and fiscal intermediaries 4.9 Taxes, Licenses and Fees (in total, for tying purposes) 4.10 Total (4.7 to 4.9) 4.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Mini-Med Plans Expenses: 0 for affiliated services) 5.1 Salaries (including $ 5.2 Outsourced Services 0 for affiliated services) 5.3 EDP Equipment and Software (incl $ 0 for affiliated services) 5.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 5.5 Accreditation and Certification (incl $ 0 for affiliated services) 5.6 Other Expenses (incl $ 5.7 Subtotal before Reimbursements and Taxes (Lines 5.1 to 5.6) 5.8 Reimbursements by uninsured plans and fiscal intermediaries 5.9 Taxes, Licenses and Fees (in total, for tying purposes) 5.10 Total (5.7 to 5.9) 5.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Mini-Med Plans Expenses: 0 for affiliated services) 6.1 Salaries (including $ 6.2 Outsourced Services 0 for affiliated services) 6.3 EDP Equipment and Software (incl $ 0 for affiliated services) 6.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 6.5 Accreditation and Certification (incl $ 0 for affiliated services) 6.6 Other Expenses (incl $ 6.7 Subtotal before Reimbursements and Taxes (Lines 6.1 to 6.6) 6.8 Reimbursements by uninsured plans and fiscal intermediaries 6.9 Taxes, Licenses and Fees (in total, for tying purposes) 6.10 Total (6.7 to 6.9) 6.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 7. 8. 216-6.ND 9. Small Group Expatriate Plans Expenses: 0 for affiliated services) 7.1 Salaries (including $ 7.2 Outsourced Services 0 for affiliated services) 7.3 EDP Equipment and Software (incl $ 0 for affiliated services) 7.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 7.5 Accreditation and Certification (incl $ 0 for affiliated services) 7.6 Other Expenses (incl $ 7.7 Subtotal before Reimbursements and Taxes (Lines 7.1 to 7.6) 7.8 Reimbursements by uninsured plans and fiscal intermediaries 7.9 Taxes, Licenses and Fees (in total, for tying purposes) 7.10 Total (7.7 to 7.9) 7.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Expatriate Plans Expenses: 0 for affiliated services) 8.1 Salaries (including $ 8.2 Outsourced Services 0 for affiliated services) 8.3 EDP Equipment and Software (incl $ 0 for affiliated services) 8.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 8.5 Accreditation and Certification (incl $ 0 for affiliated services) 8.6 Other Expenses (incl $ 8.7 Subtotal before Reimbursements and Taxes (Lines 8.1 to 8.6) 8.8 Reimbursements by uninsured plans and fiscal intermediaries 8.9 Taxes, Licenses and Fees (in total, for tying purposes) 8.10 Total (8.7 to 8.9) 8.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Student Health Plans Expenses: 0 for affiliated services) 9.1 Salaries (including $ 9.2 Outsourced Services 0 for affiliated services) 9.3 EDP Equipment and Software (incl $ 0 for affiliated services) 9.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 9.5 Accreditation and Certification (incl $ 0 for affiliated services) 9.6 Other Expenses (incl $ 9.7 Subtotal before Reimbursements and Taxes (Lines 9.1 to 9.6) 9.8 Reimbursements by uninsured plans and fiscal intermediaries 9.9 Taxes, Licenses and Fees (in total, for tying purposes) 9.10 Total (9.7 to 9.9) 9.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 *79413201821636100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes - See Cautionary Statement at http://www.naic.org/documents/committees_e_app_blanks_related_shce_cautionary_statement.pdf) UnitedHealthcare Insurance Company 2. 185 Asylum Street Hartford, CT 061033408 (LOCATION) BUSINESS IN THE STATE OF Ohio DURING THE YEAR 2018 NAIC Company Code Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 1. 216-1.OH 2. 3. 4. 5. 6. 7. 8. 9. Premium: 1.1 Health premiums earned (From Part 2, Line 1.11) 1.2 Federal high risk pools 1.3 State high risk pools 1.4 Premiums earned including state and federal high risk programs (Lines 1.1 + 1.2 + 1.3) 1.5 Federal taxes and federal assessments 1.6 State insurance, premium and other taxes (Similar local taxes of 142,055 ) $ 1.6a Community Benefit Expenditures (informational only) 1.7 Regulatory authority licenses and fees 1.8 Adjusted Premiums Earned (Lines 1.4 - 1.5 - 1.6 - 1.7) 1.9 Net Assumed less Ceded reinsurance premiums earned 1.10 Other Adjustments due to MLR calculations - Premiums 1.11 Risk Revenue 1.12 Net adjusted premiums earned after reinsurance (Lines 1.8 + 1.9 + 1.10 + 1.11) Claims: 2.1 Incurred claims excluding prescription drugs 2.2 Prescription drugs 2.3 Pharmaceutical rebates 2.4 State stop loss, market stabilization and claim/census based assessments (informational only) Incurred medical incentive pools and bonuses Deductible Fraud and Abuse Detection/Recovery Expenses (for MLR use only) 5.0 Total Incurred Claims (Lines 2.1 + 2.2 - 2.3 + 3) (From Part 2, Line 2.15) 5.1 Net Assumed less Ceded reinsurance claims incurred 5.2 Other Adjustments due to MLR calculations - Claims 5.3 Rebates paid 5.4 Estimated rebates unpaid prior year 5.5 Estimated rebates unpaid current year 5.6 Fee for service and co-pay revenue 5.7 Net incurred claims after reinsurance (Lines 5.0 + 5.1 + 5.2 + 5.3 - 5.4 + 5.5 - 5.6) Improving Health Care Quality Expenses Incurred: 6.1 Improve health outcomes 6.2 Activities to prevent hospital readmissions 6.3 Improve patient safety and reduce medical errors 6.4 Wellness and health promotion activities 6.5 Health Information Technology expenses related to health improvement 6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5) Preliminary Medical Loss Ratio: MLR ((Lines 4 + 5.0 + 6.6 - Footnote 2.0)/Line 1.8 Claims Adjustment Expenses: 8.1 Cost containment expenses not included in quality of care expenses in Line 6.6 8.2 All other claims adjustment expenses 8.3 Total claims adjustment expenses (Lines 8.1 + 8.2) Claims Adjustment Expense Ratio (Line 8.3/Line 1.8) 2 Small Group Employer 3 Large Group Employer 4 5 Small Group Employer Individual Expatriate Plans 6 Large Group Employer 7 11 Government Business (excluded by statute) Other Health Business 9 8 Small Group 10 Student Health Plans Large Group 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 79413 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 718,133,648 0 338,632 173,584,672 0 0 1,533,274,269 0 31,543 XXX XXX XXX 5,907 (1,119,252) 718,472,280 6,335,740 173,584,672 7,618,947 1,533,305,811 40,188,616 XXX 0 0 0 0 0 0 0 0 0 0 0 1,125,159 20,878,418 0 0 22,003,577 11,128,823 0 (146,625) 701,154,342 (1,183,543) 14,317 0 699,985,115 22,184 0 0 165,943,541 7,743,179 1,579,093 0 175,265,813 19,393,174 0 (84,133) 1,473,808,154 (60,838,470) 1,641,550 0 1,414,611,234 XXX XXX XXX XXX XXX 19,393,174 0 (84,133) 1,473,808,105 (60,838,470) 1,641,550 0 1,414,611,185 0 0 0 0 0 0 0 0 0 564,365,118 4,897,883 169,802 7,387,624 255,210,038 139,786,818 1,026,231,229 362,350,502 172,288,845 XXX XXX XXX 1,026,231,229 362,350,502 172,288,845 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 26,501,793 0 XXX XXX XXX 0 26,501,793 273 0 0 569,093,199 (884,851) 0 XXX XXX XXX 0 568,208,349 0 (9,885) 179 122,800,959 10,475,013 0 0 0 0 0 133,275,972 686,199 827,330 363,127 1,217,120,216 (38,265,629) (4,200,686) 3,350,308 2,683,087 3,533,466 0 1,178,854,587 XXX XXX 686,199 827,330 363,127 1,217,120,216 (38,265,629) (4,200,686) 3,350,308 2,683,087 3,533,466 0 1,178,854,587 0 0 0 0 0 1,259,599 202,388 165,021 4,986,104 264,986 0 6,878,099 XXX 1,323,036 0.748 13,333,536 XXX 554,497 9,675,518 10,230,015 0.015 2,047,459 11,625,698 13,673,157 0.082 8,905,863 29,549,631 38,455,494 XXX 1,701,751 0 (1,787) 61,029,336 0 (32,463) 578,818,953 0 (272,839) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,699,964 161,081 60,996,873 4,620,901 578,546,114 22,571,198 0 0 0 0 0 0 0 0 0 0 0 0 9,355 0 648 1,528,880 265 0 0 1,529,145 766,174 0 4,652 55,605,146 6,374 22,653 0 55,634,173 7,466,639 0 57,192 548,451,086 (88,283,161) 25,487 0 460,193,412 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 724,109 264,159 91,484 38,391,687 7,730,528 2,783,238 415,362,690 94,247,893 29,457,503 0 0 0 0 0 0 0 0 0 0 0 0 9 0 2 896,784 0 0 0 0 0 0 896,784 49,853 (62,727) 44,043 43,276,252 0 (4,200,686) 3,350,308 2,683,087 3,533,466 0 43,276,252 636,064 899,941 318,902 481,053,022 (74,357,585) 0 0 0 0 0 406,695,437 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 13,614 0 0 0 0 488,235 0 0 0 0 4,630,552 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 13,614 0.595 488,235 0.788 4,630,552 0.886 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 7,853 20,309 28,162 0.018 486,140 759,610 1,245,750 0.022 5,809,914 7,468,496 13,278,410 0.024 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 5,907 0 0 XXX 0 0 0 0.000 267,050 73,696 557,466 (125,585) 550,410 1,533,274,269 0 31,543 50 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 6,659,049 276,085 722,488 4,860,519 815,396 0 0 0 0 0 6,659,049 276,085 722,488 4,860,519 815,396 0 13,333,536 XXX 0 0 0 8,905,863 29,549,631 38,455,494 XXX XXX XXX 1,533,305,811 40,188,666 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 (Continued) Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 10. General and Administrative (G&A) Expenses: 10.1 Direct sales salaries and benefits 10.2 Agents and brokers fees and commissions 10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below) 10.4 Other general and administrative expenses 10.4a Community Benefit Expenditures (informational only) 10.5 Total general and administrative (Lines 10.1 +10.2 + 10.3 + 10.4) 3 Large Group Employer 2 Small Group Employer 1,903 15,397 (12,588) 70,454 0 75,165 173,989 1,458,397 (283,309) 2,760,706 0 4,109,783 4 5 Small Group Employer Individual 2,255,254 2,509,004 481,327 10,991,718 0 16,237,304 0 0 0 0 0 0 Expatriate Plans 6 Large Group Employer 0 0 0 0 0 0 7 8 Small Group 0 0 0 0 0 0 Student Health Plans Large Group 0 0 0 0 0 0 10 11 Government Business (excluded by statute) Other Health Business 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 24 0 24 1,104,043 25,740,648 1,266,015 65,229,303 0 93,340,008 354,874 1,990,858 376,310 11,616,595 0 14,338,638 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 3,890,064 31,714,304 1,827,755 90,668,800 0 128,100,922 0 0 (9) (240) 0 (249) 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) (4,498,240) 21,328,644 12,655,010 55,866,696 12. Income from fees of uninsured plans XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 13. Net investment and other gain/(loss) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 19,647,868 XXX 14. Federal income taxes (excluding taxes on Line 1.5 above) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 280,152 XXX 280,152 15. Net gain or (loss) (Lines 11 + 12 + 13 - 14) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 75,234,412 XXX 75,234,611 16. ICD-10 Implementation Expenses (informational only; already included in general expenses and line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16. 16a ICD-10 Implementation Expenses (informational only; already included in line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 515,420 6,514,153 19,351,709 0 0 0 0 0 0 XXX 3,890,064 31,714,304 1,827,746 90,668,560 0 128,100,673 55,866,895 0 0 19,647,868 OTHER INDICATORS: 216-2.OH 1. Number of certificates/policies 122 4,473 57,120 0 0 0 0 0 0 0 463,380 152,419 677,514 0 677,514 2. Number of Covered Lives 164 8,196 108,647 0 0 0 0 0 0 5 634,023 152,419 903,454 0 903,454 3. Number of Groups 636 491 0 0 0 0 0 0 3,664 13 4,804 0 4,804 4. Member Months 110,714 1,511,605 0 0 0 0 0 70 7,513,742 1,869,424 11,007,720 0 11,007,720 XXX 2,165 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ XXX 0 ] If yes, show the amount of premiums and claims included. Premiums $ 0 Claims $ 0 AFFORDABLE CARE ACT (ACA) RECEIPTS, PAYMENTS, RECEIVABLES and PAYABLES Current Year Prior Year Comprehensive Health Coverage Comprehensive Health Coverage 1 2 3 4 Small Group Small Group Employer Plans Employer Plans Individual Plans Individual Plans ACA Receivables and Payables 1. Permanent ACA Risk Adjustment Program 1.0 Premium adjustments receivable/(payable) 2. Transitional ACA Reinsurance Program 2.0 Total amounts recoverable for claims (paid & unpaid) 0 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 0 0 0 0 0 0 0 0 15,218 273,294 16,782 711,415 294,671 (231,108) XXX (65,496) 0 (811,387) XXX ACA Receipts and Payments 4. Permanent ACA Risk Adjustment Program 4.0 Premium adjustments receipts/(payments) 5. Transitional ACA Reinsurance Program 5.0 Amounts received for claims 0 6. Temporary ACA Risk Corridors Program 6.1 Retrospective premium received 6.2 Rate credits or policy experience refunds paid 0 0 XXX 0 0 0 0 0 XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF 185 Asylum Street Hartford, CT 061033408 Ohio DURING THE YEAR Comprehensive Health Coverage 1 2 3 Individual Small Group Employer Large Group Employer Small Group Employer Individual Expatriate Plans: 7 8 6 Large Group Employer Small Group 10 11 Government Business (excluded by statute) Other Health Business 9 Student Health Plans Large Group 79413 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.OH Health Premiums Earned: 1,701,751 61,052,032 1.1 Direct premiums written 0 5,985 1.2 Unearned premium prior year 0 6,028 1.3 Unearned premium current year 0 (43) 1.4 Change in unearned premium (Lines 1.2 - 1.3) 136,878 3,350,308 1.5 Paid rate credits 0 3,533,466 1.6 Reserve for rate credits current year 0 2,683,087 1.7 Reserve for rate credits prior year 0 850,378 1.8 Change in reserve for rate credits (Lines 1.6 - 1.7) 0 22,653 1.9 Premium balances written off 0 0 1.10 Group conversion charge 1,701,751 61,029,336 1.11 Total direct premiums earned (Lines 1.1 + 1.4 - 1.9 + 1.10) 0 0 1.12 Assumed premiums earned from non-affiliates 265 5,995 1.13 Net Assumed less Ceded premiums earned from affiliates 0 (378) 1.14 Ceded premiums earned to non-affiliates 0 22,653 1.15 Other Adjustments due to MLR calculation - Premiums 1,565,137 56,857,677 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 873,489 39,540,522 2.1 Paid claims during the year 172,549 5,203,746 2.2 Direct claim liability current year 46,743 6,298,816 2.3 Direct claim liability prior year 15,230 513,099 2.4 Direct claim reserves current year 6,372 360,586 2.5 Direct claim reserves prior year 548,831 0 2.6 Direct contract reserves current year 795,079 0 2.7 Direct contract reserves prior year 136,878 3,350,308 2.8 Paid rate credits 0 3,533,466 2.9 Reserve for rate credits current year 0 2,683,087 2.10 Reserve for rate credits prior year 0 (62,727) 2.11 Incurred medical incentive pools and bonuses (Lines 2.11a + 2.11b - 2.11c) 0 10,059 2.11a Paid medical incentive pools and bonuses current year 0 256,459 2.11b Accrued medical incentive pools and bonuses current year 0 329,245 2.11c Accrued medical incentive pools and bonuses prior year 1,999 (540,327) 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 1,999 1,261,063 2.12a Healthcare receivables current year 0 1,801,390 2.12b Healthcare receivables prior year 0 0 2.13 Group conversion charge 0 0 2.14 Multi-option coverage blended rate adjustment 2.15 Total incurred claims (Lines 2.1 + 2.2 - 2.3 + 2.4 - 2.5 + 2.6 - 2.7 + 2.8 + 2.9 896,784 43,276,252 2.10 + 2.11 - 2.12 + 2.13 + 2.14) 0 0 2.16 Assumed incurred claims from non-affiliates 0 0 2.17 Net assumed less ceded incurred claims from affiliates 0 0 2.18 Ceded incurred claims to non-affiliates 0 0 2.19 Other adjustments due to MLR calculation - Claims 759,906 39,075,566 2.20 Net Incurred Claims (Lines 2.15 - 2.8 - 2.9 + 2.10 + 2.16 + 2.17 - 2.18 + 2.19) 3. Fraud and Abuse Recoveries that Reduced PAID Claims in Line 2.1 above 2 44,043 (informational only) 23,278,147 for stand-alone dental and $ (a) Column 13, Line 1.1 includes direct written premium of $ 4 Business Subject to MLR Mini-Med Plans 5 (LOCATION) NAIC Company Code 2018 578,844,440 0 0 0 164,056 (65,630) (428,882) 363,252 25,487 0 578,818,953 1,485,230 28,592 89,796,983 25,487 490,033,971 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 478,234,358 60,245,499 61,957,681 1,029,170 1,255,760 0 0 164,056 (65,630) (428,882) 899,941 141,802 2,337,222 1,579,082 (3,330,187) 11,547,642 14,877,829 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 481,053,022 1,351,081 0 75,708,666 0 406,168,129 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 318,902 0 0 8,421,772 for stand-alone vision policies. 0 0 0 0 5,907 0 0 0 0 0 0 0 0 0 5,907 0 20,878,418 0 0 20,884,325 718,222,995 38,768 113,798 (75,030) 5,383,452 2,090,888 2,611,196 (520,308) 14,317 0 718,133,648 0 0 1,183,543 14,317 712,101,278 175,163,766 0 0 0 9,330,211 3,610,909 9,347,507 (5,736,598) 1,579,093 0 173,584,672 0 7,743,179 0 1,579,093 179,313,332 1,534,990,890 44,753 119,826 (75,072) 18,364,905 9,169,633 14,212,909 (5,043,276) 1,641,550 0 1,533,274,268 1,485,230 28,656,448 90,980,148 1,641,550 1,460,755,719 561,527,179 65,772,514 63,133,184 30,820,400 30,620,386 250,697 336,429 5,383,452 2,090,888 2,611,196 0 0 0 0 50,736 60,240 9,505 0 0 123,538,053 4,137,179 10,588,106 0 0 0 0 9,330,211 3,610,909 9,347,507 (9,885) (3) 0 9,883 (2,130,106) 47,595,220 49,725,326 0 0 1,202,802,960 136,762,523 142,344,926 32,377,900 32,243,105 799,528 1,131,508 18,364,905 9,169,633 14,212,909 827,330 151,858 2,602,171 1,926,700 (5,947,885) 60,466,165 66,414,050 0 0 0 0 26,501,793 0 0 26,501,793 569,093,199 0 0 884,851 0 563,345,205 122,800,959 0 10,475,013 0 0 129,682,359 1,217,120,216 1,351,081 36,976,805 76,593,516 0 1,165,532,957 0 0 16,724 379,672 (910,640) 1,231,037 320,396 0 0 0 0 0 0 0 0 0 8,490 8,490 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF Ohio DURING THE YEAR All Expenses 1 Improve Health Outcomes 1. Individual Comprehensive Coverage Expenses: 38,499 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 1,474 for affiliated services) 1.3 EDP Equipment and Software (incl $ 142 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 15 for affiliated services) 1.5 Accreditation and Certification (incl $ 40,875 for affiliated services) 1.6 Other Expenses (incl $ 1.7 Subtotal before Reimbursements and Taxes (Lines 1.1 to 1.6) 1.8 Reimbursements by uninsured plans and fiscal intermediaries 1.9 Taxes, Licenses and Fees (in total, for tying purposes) 1.10 Total (1.7 to 1.9) 1.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 2. 216-4.OH 3. 0 0 0 0 0 13,614 13,614 0 XXX Small Group Comprehensive Coverage Expenses: 2,018,306 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 143,736 for affiliated services) 2.3 EDP Equipment and Software (incl $ 13,797 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 1,498 for affiliated services) 2.5 Accreditation and Certification (incl $ 1,796,159 for affiliated services) 2.6 Other Expenses (incl $ 2.7 Subtotal before Reimbursements and Taxes (Lines 2.1 to 2.6) 2.8 Reimbursements by uninsured plans and fiscal intermediaries 2.9 Taxes, Licenses and Fees (in total, for tying purposes) 2.10 Total (2.7 to 2.9) 2.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Comprehensive Coverage Expenses: 9,372,380 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 611,881 for affiliated services) 3.3 EDP Equipment and Software (incl $ 58,733 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 6,377 for affiliated services) 3.5 Accreditation and Certification (incl $ 24,083,525 for affiliated services) 3.6 Other Expenses (incl $ 3.7 Subtotal before Reimbursements and Taxes (Lines 3.1 to 3.6) 3.8 Reimbursements by uninsured plans and fiscal intermediaries 3.9 Taxes, Licenses and Fees (in total, for tying purposes) 3.10 Total (3.7 to 3.9) 3.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 185 Asylum Street Hartford, CT 061033408 Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX Total (1 to 5) 0 0 0 0 0 13,614 13,614 0 XXX 0 0 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 0 0 0 0 0 0 0 XXX (LOCATION) NAIC Company Code 2018 XXX 2,229 255 186 18 2 4,985 7,675 0 XXX 9,855 393 270 26 3 9,573 20,121 0 XXX 13,614 0 0 0 0 0 0 0 0 0 13,614 0 7,675 1,531 20,121 0 0 0 0 0 0 488,235 488,235 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 488,235 488,235 0 237,199 21,335 19,807 1,901 206 189,470 469,919 0 375,575 43,042 31,362 3,010 327 288,994 742,310 0 XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX XXX XXX 488,235 0 0 0 0 0 0 0 0 0 488,235 0 469,919 140,025 742,310 0 0 0 0 0 0 4,630,552 4,630,552 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4,630,552 4,630,552 0 1,439,520 377,209 120,207 11,538 1,253 3,675,349 5,625,076 0 1,965,355 225,234 164,116 15,753 1,710 4,946,652 7,318,821 0 4,630,552 0 XXX 5,625,076 1,731,471 XXX 7,318,821 0 XXX 4,630,552 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 79413 9 10 General Administrative Expenses Total Expenses (6 to 9) 26,415 1,352 1,018 67 11 58,756 87,619 0 (2,085) 85,534 0 38,499 2,001 1,474 111 15 86,928 129,029 0 (2,085) 126,944 1,531 1,405,532 134,496 92,567 8,885 965 2,738,210 4,380,655 0 533,475 4,914,130 0 2,018,306 198,873 143,736 13,797 1,498 3,704,909 6,081,119 0 533,475 6,614,594 140,025 5,967,504 508,123 327,558 31,442 3,414 8,759,795 15,597,836 0 8,497,811 24,095,647 0 9,372,380 1,110,566 611,881 58,733 6,377 22,012,348 33,172,285 0 8,497,811 41,670,096 1,731,471 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 4. 5. 216-5.OH 6. Individual Mini-Med Plans Expenses: 0 for affiliated services) 4.1 Salaries (including $ 4.2 Outsourced Services 0 for affiliated services) 4.3 EDP Equipment and Software (incl $ 0 for affiliated services) 4.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 4.5 Accreditation and Certification (incl $ 0 for affiliated services) 4.6 Other Expenses (incl $ 4.7 Subtotal before Reimbursements and Taxes (Lines 4.1 to 4.6) 4.8 Reimbursements by uninsured plans and fiscal intermediaries 4.9 Taxes, Licenses and Fees (in total, for tying purposes) 4.10 Total (4.7 to 4.9) 4.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Mini-Med Plans Expenses: 0 for affiliated services) 5.1 Salaries (including $ 5.2 Outsourced Services 0 for affiliated services) 5.3 EDP Equipment and Software (incl $ 0 for affiliated services) 5.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 5.5 Accreditation and Certification (incl $ 0 for affiliated services) 5.6 Other Expenses (incl $ 5.7 Subtotal before Reimbursements and Taxes (Lines 5.1 to 5.6) 5.8 Reimbursements by uninsured plans and fiscal intermediaries 5.9 Taxes, Licenses and Fees (in total, for tying purposes) 5.10 Total (5.7 to 5.9) 5.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Mini-Med Plans Expenses: 0 for affiliated services) 6.1 Salaries (including $ 6.2 Outsourced Services 0 for affiliated services) 6.3 EDP Equipment and Software (incl $ 0 for affiliated services) 6.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 6.5 Accreditation and Certification (incl $ 0 for affiliated services) 6.6 Other Expenses (incl $ 6.7 Subtotal before Reimbursements and Taxes (Lines 6.1 to 6.6) 6.8 Reimbursements by uninsured plans and fiscal intermediaries 6.9 Taxes, Licenses and Fees (in total, for tying purposes) 6.10 Total (6.7 to 6.9) 6.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 7. 8. 216-6.OH 9. Small Group Expatriate Plans Expenses: 0 for affiliated services) 7.1 Salaries (including $ 7.2 Outsourced Services 0 for affiliated services) 7.3 EDP Equipment and Software (incl $ 0 for affiliated services) 7.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 7.5 Accreditation and Certification (incl $ 0 for affiliated services) 7.6 Other Expenses (incl $ 7.7 Subtotal before Reimbursements and Taxes (Lines 7.1 to 7.6) 7.8 Reimbursements by uninsured plans and fiscal intermediaries 7.9 Taxes, Licenses and Fees (in total, for tying purposes) 7.10 Total (7.7 to 7.9) 7.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Expatriate Plans Expenses: 0 for affiliated services) 8.1 Salaries (including $ 8.2 Outsourced Services 0 for affiliated services) 8.3 EDP Equipment and Software (incl $ 0 for affiliated services) 8.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 8.5 Accreditation and Certification (incl $ 0 for affiliated services) 8.6 Other Expenses (incl $ 8.7 Subtotal before Reimbursements and Taxes (Lines 8.1 to 8.6) 8.8 Reimbursements by uninsured plans and fiscal intermediaries 8.9 Taxes, Licenses and Fees (in total, for tying purposes) 8.10 Total (8.7 to 8.9) 8.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Student Health Plans Expenses: 0 for affiliated services) 9.1 Salaries (including $ 9.2 Outsourced Services 0 for affiliated services) 9.3 EDP Equipment and Software (incl $ 0 for affiliated services) 9.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 9.5 Accreditation and Certification (incl $ 0 for affiliated services) 9.6 Other Expenses (incl $ 9.7 Subtotal before Reimbursements and Taxes (Lines 9.1 to 9.6) 9.8 Reimbursements by uninsured plans and fiscal intermediaries 9.9 Taxes, Licenses and Fees (in total, for tying purposes) 9.10 Total (9.7 to 9.9) 9.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 *79413201821637100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes - See Cautionary Statement at http://www.naic.org/documents/committees_e_app_blanks_related_shce_cautionary_statement.pdf) UnitedHealthcare Insurance Company 2. 185 Asylum Street Hartford, CT 061033408 (LOCATION) BUSINESS IN THE STATE OF Oklahoma DURING THE YEAR 2018 NAIC Company Code Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 1. 216-1.OK 2. 3. 4. 5. 6. 7. 8. 9. Premium: 1.1 Health premiums earned (From Part 2, Line 1.11) 1.2 Federal high risk pools 1.3 State high risk pools 1.4 Premiums earned including state and federal high risk programs (Lines 1.1 + 1.2 + 1.3) 1.5 Federal taxes and federal assessments 1.6 State insurance, premium and other taxes (Similar local taxes of 53,092 ) $ 1.6a Community Benefit Expenditures (informational only) 1.7 Regulatory authority licenses and fees 1.8 Adjusted Premiums Earned (Lines 1.4 - 1.5 - 1.6 - 1.7) 1.9 Net Assumed less Ceded reinsurance premiums earned 1.10 Other Adjustments due to MLR calculations - Premiums 1.11 Risk Revenue 1.12 Net adjusted premiums earned after reinsurance (Lines 1.8 + 1.9 + 1.10 + 1.11) Claims: 2.1 Incurred claims excluding prescription drugs 2.2 Prescription drugs 2.3 Pharmaceutical rebates 2.4 State stop loss, market stabilization and claim/census based assessments (informational only) Incurred medical incentive pools and bonuses Deductible Fraud and Abuse Detection/Recovery Expenses (for MLR use only) 5.0 Total Incurred Claims (Lines 2.1 + 2.2 - 2.3 + 3) (From Part 2, Line 2.15) 5.1 Net Assumed less Ceded reinsurance claims incurred 5.2 Other Adjustments due to MLR calculations - Claims 5.3 Rebates paid 5.4 Estimated rebates unpaid prior year 5.5 Estimated rebates unpaid current year 5.6 Fee for service and co-pay revenue 5.7 Net incurred claims after reinsurance (Lines 5.0 + 5.1 + 5.2 + 5.3 - 5.4 + 5.5 - 5.6) Improving Health Care Quality Expenses Incurred: 6.1 Improve health outcomes 6.2 Activities to prevent hospital readmissions 6.3 Improve patient safety and reduce medical errors 6.4 Wellness and health promotion activities 6.5 Health Information Technology expenses related to health improvement 6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5) Preliminary Medical Loss Ratio: MLR ((Lines 4 + 5.0 + 6.6 - Footnote 2.0)/Line 1.8 Claims Adjustment Expenses: 8.1 Cost containment expenses not included in quality of care expenses in Line 6.6 8.2 All other claims adjustment expenses 8.3 Total claims adjustment expenses (Lines 8.1 + 8.2) Claims Adjustment Expense Ratio (Line 8.3/Line 1.8) 2 Small Group Employer 3 Large Group Employer 4 5 Small Group Employer Individual Expatriate Plans 6 Large Group Employer 7 11 Government Business (excluded by statute) Other Health Business 9 8 Small Group 10 Student Health Plans Large Group 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 79413 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 1,823,021 0 (742) 125,911,509 0 (1,360) 194,710,742 0 (27,459) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 119,417,887 0 56,721 45,089,145 0 0 486,952,304 0 27,160 XXX XXX XXX 1,822,279 (37,784) 125,910,150 6,726,919 194,683,282 5,151,054 0 0 0 0 0 0 0 0 0 0 0 0 0 0 119,474,608 864,702 45,089,145 2,304,784 486,979,464 15,009,674 XXX 30,948 0 288 1,828,827 0 0 0 1,828,827 2,635,260 0 (2,384) 116,550,355 0 34,364 0 116,584,719 3,782,455 0 (15,132) 185,764,905 (27,580,437) 801,715 0 158,986,183 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,017,162 0 (24,906) 116,617,651 (135,818) 1,837 0 116,483,670 5,781 0 0 42,778,580 0 501,699 0 43,280,280 8,471,606 0 (42,135) 463,540,318 (27,716,255) 1,339,616 0 437,163,679 XXX XXX XXX XXX XXX 8,471,606 0 (42,135) 463,540,318 (27,716,255) 1,339,616 0 437,163,679 1,751,737 269,912 79,848 74,477,912 20,920,026 6,769,293 142,711,586 36,116,103 11,825,691 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 91,016,248 4,758,498 20,441 2,312,216 66,753,730 38,280,791 312,269,700 128,818,271 56,976,063 XXX XXX XXX 312,269,700 128,818,271 56,976,063 0 0 0 1,941,802 0 0 0 0 0 0 1,941,802 17,429 90,518 4,014 88,719,163 0 (3,026,312) 1,377,428 0 1,648,884 0 88,719,163 22,163 523,657 28,009 167,525,656 (23,978,094) (14,169) 14,169 0 0 0 143,547,562 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 95,754,306 (18,416) 0 XXX XXX XXX 0 95,735,891 0 (13,595) 25 30,771,561 0 0 0 0 0 0 30,771,561 39,592 600,580 32,048 384,712,488 (23,996,509) (3,040,481) 1,391,597 0 1,648,884 0 360,715,978 XXX XXX 39,592 600,580 32,048 384,712,488 (23,996,509) (3,040,481) 1,391,597 0 1,648,884 0 360,715,978 14,584 0 0 0 0 1,007,292 0 0 0 0 1,557,686 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 14,584 1.070 1,007,292 0.770 1,557,686 0.910 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 12,396 25,022 37,418 0.020 1,386,664 2,091,100 3,477,764 0.030 2,324,570 3,196,324 5,520,894 0.030 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 XXX XXX XXX 0 0 0 0 0 0 0 307,564 119,210 92,730 881,170 63,600 0 1,464,274 XXX 368,628 0.728 4,412,464 XXX 126,418 1,713,799 1,840,217 0.016 662,394 3,197,526 3,859,920 0.090 4,512,443 10,223,770 14,736,213 XXX XXX 0 0 0 0.000 72,535 19,854 154,107 (31,130) 153,261 486,952,304 0 27,160 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 2,959,661 139,064 246,838 850,040 216,861 0 0 0 0 0 2,959,661 139,064 246,838 850,040 216,861 0 4,412,464 XXX 0 0 0 4,512,443 10,223,770 14,736,213 XXX XXX XXX 486,979,464 15,009,674 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 (Continued) Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 10. General and Administrative (G&A) Expenses: 10.1 Direct sales salaries and benefits 10.2 Agents and brokers fees and commissions 10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below) 10.4 Other general and administrative expenses 10.4a Community Benefit Expenditures (informational only) 10.5 Total general and administrative (Lines 10.1 +10.2 + 10.3 + 10.4) 3 Large Group Employer 2 Small Group Employer 3,906 39,910 862 80,515 0 125,192 462,795 4,541,195 105,897 6,177,388 0 11,287,275 4 5 Small Group Employer Individual 964,416 1,110,946 217,532 5,725,877 0 8,018,771 0 0 0 0 0 0 Expatriate Plans 6 Large Group Employer 0 0 0 0 0 0 7 8 Small Group 0 0 0 0 0 0 Student Health Plans Large Group 0 0 0 0 0 0 10 11 Government Business (excluded by statute) Other Health Business 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 240,896 4,454,190 213,002 10,864,528 0 15,772,616 92,937 347,825 97,691 3,062,594 0 3,601,047 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 1,764,951 10,494,066 634,983 25,910,902 0 38,804,902 0 0 0 0 0 0 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) 12. Income from fees of uninsured plans XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 13. Net investment and other gain/(loss) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 14. Federal income taxes (excluding taxes on Line 1.5 above) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 15. Net gain or (loss) (Lines 11 + 12 + 13 - 14) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 16. ICD-10 Implementation Expenses (informational only; already included in general expenses and line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16. 16a ICD-10 Implementation Expenses (informational only; already included in line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (290,169) 12,093,225 341,270 0 0 0 0 0 0 0 1,670,673 4,679,124 18,494,123 XXX 1,764,951 10,494,066 634,983 25,910,902 0 38,804,902 XXX 18,494,123 0 6,813,306 (229,058) 25,536,487 XXX 0 6,813,306 XXX (229,058) XXX 25,536,486 OTHER INDICATORS: 216-2.OK 1. Number of certificates/policies 135 10,855 20,679 0 0 0 0 0 0 0 75,009 39,946 146,624 0 146,624 2. Number of Covered Lives 222 19,342 38,090 0 0 0 0 0 0 0 98,876 39,946 196,476 0 196,476 3. Number of Groups 1,688 389 0 0 0 0 0 0 1,152 4 3,233 0 3,233 4. Member Months 2,754 258,582 494,736 0 0 0 0 0 0 1,200,253 485,779 2,442,104 0 2,442,104 XXX Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ XXX 0 ] If yes, show the amount of premiums and claims included. Premiums $ 0 Claims $ 0 AFFORDABLE CARE ACT (ACA) RECEIPTS, PAYMENTS, RECEIVABLES and PAYABLES Current Year Prior Year Comprehensive Health Coverage Comprehensive Health Coverage 1 2 3 4 Small Group Small Group Employer Plans Employer Plans Individual Plans Individual Plans ACA Receivables and Payables 1. Permanent ACA Risk Adjustment Program 1.0 Premium adjustments receivable/(payable) 2. Transitional ACA Reinsurance Program 2.0 Total amounts recoverable for claims (paid & unpaid) 0 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 0 0 78,308 (1,040,038) XXX (287,679) 0 0 0 (4,249,542) XXX 0 0 0 0 ACA Receipts and Payments 4. Permanent ACA Risk Adjustment Program 4.0 Premium adjustments receipts/(payments) 5. Transitional ACA Reinsurance Program 5.0 Amounts received for claims 0 6. Temporary ACA Risk Corridors Program 6.1 Retrospective premium received 6.2 Rate credits or policy experience refunds paid 0 0 (63,530) (1,535,539) XXX 14,775 0 0 0 0 0 (337,237) XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF 185 Asylum Street Hartford, CT 061033408 DURING THE YEAR Oklahoma Comprehensive Health Coverage 1 2 3 Individual Small Group Employer Large Group Employer Small Group Employer Individual Expatriate Plans: 7 8 6 Large Group Employer Small Group 10 11 Government Business (excluded by statute) Other Health Business 9 Student Health Plans Large Group 79413 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.OK Health Premiums Earned: 1,823,021 125,925,836 1.1 Direct premiums written 0 25,481 1.2 Unearned premium prior year 0 5,444 1.3 Unearned premium current year 0 20,037 1.4 Change in unearned premium (Lines 1.2 - 1.3) (410,606) 1,377,428 1.5 Paid rate credits 0 1,648,884 1.6 Reserve for rate credits current year 0 0 1.7 Reserve for rate credits prior year 0 1,648,884 1.8 Change in reserve for rate credits (Lines 1.6 - 1.7) 0 34,364 1.9 Premium balances written off 0 0 1.10 Group conversion charge 1,823,021 125,911,509 1.11 Total direct premiums earned (Lines 1.1 + 1.4 - 1.9 + 1.10) 0 0 1.12 Assumed premiums earned from non-affiliates 0 0 1.13 Net Assumed less Ceded premiums earned from affiliates 0 0 1.14 Ceded premiums earned to non-affiliates 0 34,364 1.15 Other Adjustments due to MLR calculation - Premiums 2,233,627 122,919,561 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 2,545,671 85,037,456 2.1 Paid claims during the year 73,095 11,765,887 2.2 Direct claim liability current year 148,267 11,187,384 2.3 Direct claim liability prior year 15,226 311,001 2.4 Direct claim reserves current year 10,381 268,946 2.5 Direct claim reserves prior year 223,994 0 2.6 Direct contract reserves current year 345,405 0 2.7 Direct contract reserves prior year (410,606) 1,377,428 2.8 Paid rate credits 0 1,648,884 2.9 Reserve for rate credits current year 0 0 2.10 Reserve for rate credits prior year 0 90,518 2.11 Incurred medical incentive pools and bonuses (Lines 2.11a + 2.11b - 2.11c) 0 10,964 2.11a Paid medical incentive pools and bonuses current year 0 182,477 2.11b Accrued medical incentive pools and bonuses current year 0 102,923 2.11c Accrued medical incentive pools and bonuses prior year 1,525 55,682 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 1,525 3,002,928 2.12a Healthcare receivables current year 0 2,947,246 2.12b Healthcare receivables prior year 0 0 2.13 Group conversion charge 0 0 2.14 Multi-option coverage blended rate adjustment 2.15 Total incurred claims (Lines 2.1 + 2.2 - 2.3 + 2.4 - 2.5 + 2.6 - 2.7 + 2.8 + 2.9 1,941,802 88,719,163 2.10 + 2.11 - 2.12 + 2.13 + 2.14) 0 0 2.16 Assumed incurred claims from non-affiliates 0 0 2.17 Net assumed less ceded incurred claims from affiliates 0 0 2.18 Ceded incurred claims to non-affiliates 0 0 2.19 Other adjustments due to MLR calculation - Claims 2,352,408 85,692,851 2.20 Net Incurred Claims (Lines 2.15 - 2.8 - 2.9 + 2.10 + 2.16 + 2.17 - 2.18 + 2.19) 3. Fraud and Abuse Recoveries that Reduced PAID Claims in Line 2.1 above 0 4,014 (informational only) 6,615,353 for stand-alone dental and $ (a) Column 13, Line 1.1 includes direct written premium of $ 4 Business Subject to MLR Mini-Med Plans 5 (LOCATION) NAIC Company Code 2018 195,512,457 0 0 0 11,056 0 0 0 801,715 0 194,710,741 0 0 27,580,437 801,715 167,920,963 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 163,744,467 20,133,390 17,601,148 516,913 448,038 0 0 11,056 0 0 523,657 56,691 581,224 114,258 (645,359) 4,185,036 4,830,396 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 167,525,656 0 0 23,978,094 0 143,536,506 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 28,009 0 0 1,169,824 for stand-alone vision policies. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 119,419,454 3,141 2,870 271 (6,905,109) 103,106 123,062 (19,956) 1,837 0 119,417,887 0 0 135,818 1,837 126,208,972 45,590,845 0 0 0 1,123,095 1,588,078 1,447,561 140,517 501,699 0 45,089,145 0 0 0 501,699 44,327,233 488,271,612 28,622 8,315 20,307 (4,804,137) 3,340,068 1,570,623 1,769,445 1,339,616 0 486,952,304 0 0 27,716,255 1,339,616 463,610,357 101,596,602 13,104,070 12,283,123 4,318,007 4,048,547 49,811 51,877 (6,905,109) 103,106 123,062 0 0 0 0 5,571 9,105 3,534 0 0 31,102,116 1,401,737 3,046,160 260 304 0 0 1,123,095 1,588,078 1,447,561 (13,595) 0 0 13,595 (63,895) 14,615,381 14,679,275 0 0 384,058,645 46,445,846 44,266,082 5,161,407 4,776,216 273,805 397,282 (4,804,137) 3,340,068 1,570,623 600,580 67,655 763,701 230,775 (646,476) 21,813,974 22,460,451 0 0 0 0 0 0 0 0 95,754,306 0 0 18,416 0 102,660,956 30,771,561 0 0 0 0 29,507,949 384,712,488 0 0 23,996,509 0 363,750,670 0 0 25 32,048 32,333 (32,333) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF DURING THE YEAR Oklahoma Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities All Expenses 1 Improve Health Outcomes 1. Individual Comprehensive Coverage Expenses: 42,050 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 2,377 for affiliated services) 1.3 EDP Equipment and Software (incl $ 228 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 25 for affiliated services) 1.5 Accreditation and Certification (incl $ 70,075 for affiliated services) 1.6 Other Expenses (incl $ 1.7 Subtotal before Reimbursements and Taxes (Lines 1.1 to 1.6) 1.8 Reimbursements by uninsured plans and fiscal intermediaries 1.9 Taxes, Licenses and Fees (in total, for tying purposes) 1.10 Total (1.7 to 1.9) 1.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 2. 216-4.OK Small Group Comprehensive Coverage Expenses: 3,080,952 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 220,018 for affiliated services) 2.3 EDP Equipment and Software (incl $ 21,119 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 2,293 for affiliated services) 2.5 Accreditation and Certification (incl $ 6,884,111 for affiliated services) 2.6 Other Expenses (incl $ 2.7 Subtotal before Reimbursements and Taxes (Lines 2.1 to 2.6) 2.8 Reimbursements by uninsured plans and fiscal intermediaries 2.9 Taxes, Licenses and Fees (in total, for tying purposes) 2.10 Total (2.7 to 2.9) 2.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 3. Large Group Comprehensive Coverage Expenses: 4,275,993 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 279,428 for affiliated services) 3.3 EDP Equipment and Software (incl $ 26,822 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 2,912 for affiliated services) 3.5 Accreditation and Certification (incl $ 9,595,313 for affiliated services) 3.6 Other Expenses (incl $ 3.7 Subtotal before Reimbursements and Taxes (Lines 3.1 to 3.6) 3.8 Reimbursements by uninsured plans and fiscal intermediaries 3.9 Taxes, Licenses and Fees (in total, for tying purposes) 3.10 Total (3.7 to 3.9) 3.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 185 Asylum Street Hartford, CT 061033408 0 0 0 0 0 14,584 14,584 0 XXX 2 Activities to Prevent Hospital Readmissions 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX Total (1 to 5) 0 0 0 0 0 14,584 14,584 0 XXX 0 0 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 0 0 0 0 0 0 0 XXX (LOCATION) NAIC Company Code 2018 XXX 3,484 433 291 28 3 7,793 12,032 0 XXX 9,226 677 485 47 5 14,195 24,634 0 XXX 14,584 0 0 0 0 0 0 0 0 0 14,584 0 12,032 3,144 24,634 0 0 0 0 0 0 1,007,292 1,007,292 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,007,292 1,007,292 0 363,392 108,180 30,345 2,913 316 838,472 1,343,618 0 593,962 68,069 49,599 4,761 517 1,328,435 2,045,342 0 XXX 1,007,292 0 0 0 0 0 0 1,557,686 1,557,686 0 XXX 1,557,686 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 1,007,292 0 XXX 1,343,618 371,867 XXX 2,045,342 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,557,686 1,557,686 0 610,550 179,795 50,984 4,894 531 1,404,858 2,251,611 0 909,622 104,245 75,958 7,291 792 2,034,431 3,132,338 0 1,557,686 0 XXX 2,251,611 670,351 XXX 3,132,338 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 79413 9 10 General Administrative Expenses Total Expenses (6 to 9) 29,340 2,165 1,601 138 17 90,793 124,054 0 33,126 157,180 0 42,050 3,276 2,377 212 25 127,365 175,305 0 33,126 208,430 3,144 2,123,598 237,592 140,075 13,446 1,460 8,632,507 11,148,677 0 2,860,278 14,008,955 0 3,080,952 413,841 220,018 21,119 2,293 11,806,706 15,544,929 0 2,860,278 18,405,207 371,867 2,755,821 298,179 152,487 14,637 1,589 4,514,953 7,737,665 0 4,185,373 11,923,039 0 4,275,993 582,218 279,428 26,822 2,912 9,511,927 14,679,301 0 4,185,373 18,864,674 670,351 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 4. 5. 216-5.OK 6. Individual Mini-Med Plans Expenses: 0 for affiliated services) 4.1 Salaries (including $ 4.2 Outsourced Services 0 for affiliated services) 4.3 EDP Equipment and Software (incl $ 0 for affiliated services) 4.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 4.5 Accreditation and Certification (incl $ 0 for affiliated services) 4.6 Other Expenses (incl $ 4.7 Subtotal before Reimbursements and Taxes (Lines 4.1 to 4.6) 4.8 Reimbursements by uninsured plans and fiscal intermediaries 4.9 Taxes, Licenses and Fees (in total, for tying purposes) 4.10 Total (4.7 to 4.9) 4.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Mini-Med Plans Expenses: 0 for affiliated services) 5.1 Salaries (including $ 5.2 Outsourced Services 0 for affiliated services) 5.3 EDP Equipment and Software (incl $ 0 for affiliated services) 5.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 5.5 Accreditation and Certification (incl $ 0 for affiliated services) 5.6 Other Expenses (incl $ 5.7 Subtotal before Reimbursements and Taxes (Lines 5.1 to 5.6) 5.8 Reimbursements by uninsured plans and fiscal intermediaries 5.9 Taxes, Licenses and Fees (in total, for tying purposes) 5.10 Total (5.7 to 5.9) 5.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Mini-Med Plans Expenses: 0 for affiliated services) 6.1 Salaries (including $ 6.2 Outsourced Services 0 for affiliated services) 6.3 EDP Equipment and Software (incl $ 0 for affiliated services) 6.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 6.5 Accreditation and Certification (incl $ 0 for affiliated services) 6.6 Other Expenses (incl $ 6.7 Subtotal before Reimbursements and Taxes (Lines 6.1 to 6.6) 6.8 Reimbursements by uninsured plans and fiscal intermediaries 6.9 Taxes, Licenses and Fees (in total, for tying purposes) 6.10 Total (6.7 to 6.9) 6.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 7. 8. 216-6.OK 9. Small Group Expatriate Plans Expenses: 0 for affiliated services) 7.1 Salaries (including $ 7.2 Outsourced Services 0 for affiliated services) 7.3 EDP Equipment and Software (incl $ 0 for affiliated services) 7.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 7.5 Accreditation and Certification (incl $ 0 for affiliated services) 7.6 Other Expenses (incl $ 7.7 Subtotal before Reimbursements and Taxes (Lines 7.1 to 7.6) 7.8 Reimbursements by uninsured plans and fiscal intermediaries 7.9 Taxes, Licenses and Fees (in total, for tying purposes) 7.10 Total (7.7 to 7.9) 7.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Expatriate Plans Expenses: 0 for affiliated services) 8.1 Salaries (including $ 8.2 Outsourced Services 0 for affiliated services) 8.3 EDP Equipment and Software (incl $ 0 for affiliated services) 8.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 8.5 Accreditation and Certification (incl $ 0 for affiliated services) 8.6 Other Expenses (incl $ 8.7 Subtotal before Reimbursements and Taxes (Lines 8.1 to 8.6) 8.8 Reimbursements by uninsured plans and fiscal intermediaries 8.9 Taxes, Licenses and Fees (in total, for tying purposes) 8.10 Total (8.7 to 8.9) 8.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Student Health Plans Expenses: 0 for affiliated services) 9.1 Salaries (including $ 9.2 Outsourced Services 0 for affiliated services) 9.3 EDP Equipment and Software (incl $ 0 for affiliated services) 9.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 9.5 Accreditation and Certification (incl $ 0 for affiliated services) 9.6 Other Expenses (incl $ 9.7 Subtotal before Reimbursements and Taxes (Lines 9.1 to 9.6) 9.8 Reimbursements by uninsured plans and fiscal intermediaries 9.9 Taxes, Licenses and Fees (in total, for tying purposes) 9.10 Total (9.7 to 9.9) 9.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 *79413201821638100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes - See Cautionary Statement at http://www.naic.org/documents/committees_e_app_blanks_related_shce_cautionary_statement.pdf) UnitedHealthcare Insurance Company 2. 185 Asylum Street Hartford, CT 061033408 (LOCATION) BUSINESS IN THE STATE OF Oregon DURING THE YEAR 2018 NAIC Company Code Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 1. 216-1.OR 2. 3. 4. 5. 6. 7. 8. 9. Premium: 1.1 Health premiums earned (From Part 2, Line 1.11) 1.2 Federal high risk pools 1.3 State high risk pools 1.4 Premiums earned including state and federal high risk programs (Lines 1.1 + 1.2 + 1.3) 1.5 Federal taxes and federal assessments 1.6 State insurance, premium and other taxes (Similar local taxes of 2,679,319 ) $ 1.6a Community Benefit Expenditures (informational only) 1.7 Regulatory authority licenses and fees 1.8 Adjusted Premiums Earned (Lines 1.4 - 1.5 - 1.6 - 1.7) 1.9 Net Assumed less Ceded reinsurance premiums earned 1.10 Other Adjustments due to MLR calculations - Premiums 1.11 Risk Revenue 1.12 Net adjusted premiums earned after reinsurance (Lines 1.8 + 1.9 + 1.10 + 1.11) Claims: 2.1 Incurred claims excluding prescription drugs 2.2 Prescription drugs 2.3 Pharmaceutical rebates 2.4 State stop loss, market stabilization and claim/census based assessments (informational only) Incurred medical incentive pools and bonuses Deductible Fraud and Abuse Detection/Recovery Expenses (for MLR use only) 5.0 Total Incurred Claims (Lines 2.1 + 2.2 - 2.3 + 3) (From Part 2, Line 2.15) 5.1 Net Assumed less Ceded reinsurance claims incurred 5.2 Other Adjustments due to MLR calculations - Claims 5.3 Rebates paid 5.4 Estimated rebates unpaid prior year 5.5 Estimated rebates unpaid current year 5.6 Fee for service and co-pay revenue 5.7 Net incurred claims after reinsurance (Lines 5.0 + 5.1 + 5.2 + 5.3 - 5.4 + 5.5 - 5.6) Improving Health Care Quality Expenses Incurred: 6.1 Improve health outcomes 6.2 Activities to prevent hospital readmissions 6.3 Improve patient safety and reduce medical errors 6.4 Wellness and health promotion activities 6.5 Health Information Technology expenses related to health improvement 6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5) Preliminary Medical Loss Ratio: MLR ((Lines 4 + 5.0 + 6.6 - Footnote 2.0)/Line 1.8 Claims Adjustment Expenses: 8.1 Cost containment expenses not included in quality of care expenses in Line 6.6 8.2 All other claims adjustment expenses 8.3 Total claims adjustment expenses (Lines 8.1 + 8.2) Claims Adjustment Expense Ratio (Line 8.3/Line 1.8) 2 Small Group Employer 3 Large Group Employer 4 5 Small Group Employer Individual Expatriate Plans 6 Large Group Employer 7 11 Government Business (excluded by statute) Other Health Business 9 8 Small Group 10 Student Health Plans Large Group 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 79413 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 825,163 0 (3,023) 94,982,079 0 (680,355) 168,742,186 0 (1,117,177) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 143,924,406 0 18,701 183,144,562 0 0 591,618,395 0 (1,781,854) XXX XXX XXX 822,140 124,078 94,301,724 2,118,947 167,625,009 4,210,296 0 0 0 0 0 0 0 0 0 0 0 0 0 0 143,943,107 822,947 183,144,562 7,579,675 589,836,542 14,855,943 XXX 40,958 0 86 657,017 0 0 0 657,017 1,320,467 0 19,190 90,843,121 0 4,294 0 90,847,415 2,428,424 0 9,648 160,976,641 (23,809,551) 5 0 137,167,094 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,414,241 0 (26,304) 140,732,223 (158,088) 54 0 140,574,189 1,487,179 0 0 174,077,708 0 394,964 0 174,472,671 7,691,270 0 2,619 567,286,709 (23,967,639) 399,317 0 543,718,386 XXX XXX XXX XXX XXX 7,691,270 0 2,619 567,286,709 (23,967,639) 399,317 0 543,718,386 148,382 36,158 11,429 67,385,902 14,212,362 4,529,715 123,637,805 25,253,571 8,189,996 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 113,627,716 1,949,709 29,005 104,735,568 76,947,120 40,305,484 409,535,373 118,398,920 53,065,630 XXX XXX XXX 409,535,373 118,398,920 53,065,630 3 0 24 173,111 0 0 0 0 0 0 173,111 59,571 22,863 10,438 77,091,412 0 0 0 0 0 0 77,091,412 50,655 129,451 151,409 140,830,830 (19,247,649) 0 0 0 0 0 121,583,182 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 0 0 115,548,420 (247,745) 0 XXX XXX XXX 0 115,300,675 0 707,745 13,440 142,084,948 0 0 0 0 0 0 142,084,948 110,233 860,059 175,310 475,728,721 (19,495,393) 0 0 0 0 0 456,233,328 XXX XXX 110,233 860,059 175,310 475,728,721 (19,495,393) 0 0 0 0 0 456,233,328 6,601 0 0 0 0 759,857 0 0 0 0 1,349,937 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6,601 0.274 759,857 0.857 1,349,937 0.884 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 4,754 7,492 12,246 0.019 1,153,023 1,699,402 2,852,425 0.031 2,092,163 2,672,028 4,764,191 0.030 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 XXX XXX XXX 0 0 0 0 0 0 0 381,993 215,455 163,423 965,020 83,099 1,031,892 264,492 270,275 396,358 546,566 3,530,281 479,947 433,699 1,361,378 629,665 0 1,808,991 XXX 2,509,584 0.831 6,434,970 XXX 113,023 1,917,858 2,030,881 0.014 1,144,834 3,539,951 4,684,785 0.027 4,507,796 9,836,732 14,344,528 XXX XXX 0 0 0 0.000 591,618,395 0 (1,781,854) 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 3,530,281 479,947 433,699 1,361,378 629,665 0 6,434,970 XXX 0 0 0 4,507,796 9,836,732 14,344,528 XXX XXX XXX 589,836,542 14,855,943 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 (Continued) Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 10. General and Administrative (G&A) Expenses: 10.1 Direct sales salaries and benefits 10.2 Agents and brokers fees and commissions 10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below) 10.4 Other general and administrative expenses 10.4a Community Benefit Expenditures (informational only) 10.5 Total general and administrative (Lines 10.1 +10.2 + 10.3 + 10.4) 3 Large Group Employer 2 Small Group Employer 1,707 13,010 (458) 20,288 0 34,547 407,027 3,072,897 143,060 5,343,089 0 8,966,073 4 5 Small Group Employer Individual 884,778 1,988,396 216,023 5,138,025 0 8,227,222 0 0 0 0 0 0 Expatriate Plans 6 Large Group Employer 0 0 0 0 0 0 7 8 Small Group 0 0 0 0 0 0 Student Health Plans Large Group 0 0 0 0 0 0 10 11 Government Business (excluded by statute) Other Health Business 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 213,940 5,625,960 139,727 13,045,266 0 19,024,893 304,708 2,198,833 266,352 8,610,151 0 11,380,045 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 1,812,160 12,899,096 764,704 32,156,820 0 47,632,780 0 0 0 0 0 0 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) 13,813,310 19,072,780 12. Income from fees of uninsured plans XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 13. Net investment and other gain/(loss) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 14. Federal income taxes (excluding taxes on Line 1.5 above) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 15. Net gain or (loss) (Lines 11 + 12 + 13 - 14) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 16. ICD-10 Implementation Expenses (informational only; already included in general expenses and line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16. 16a ICD-10 Implementation Expenses (informational only; already included in line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 430,511 1,177,648 1,242,563 0 0 0 0 0 0 0 2,408,748 XXX 1,812,160 12,899,096 764,704 32,156,820 0 47,632,780 19,072,780 0 0 8,244,967 XXX XXX 483,181 XXX 483,181 XXX 26,834,566 XXX 26,834,566 8,244,967 OTHER INDICATORS: 216-2.OR 1. Number of certificates/policies 50 12,240 20,398 0 0 0 0 0 0 0 95,415 46,751 174,854 0 174,854 2. Number of Covered Lives 81 19,716 34,448 0 0 0 0 0 0 0 128,728 46,751 229,724 0 229,724 3. Number of Groups 1,836 471 0 0 0 0 0 0 1,517 0 3,824 0 3,824 4. Member Months 227,870 429,432 0 0 0 0 0 0 1,551,428 561,004 2,770,689 0 2,770,689 XXX 955 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ XXX 0 ] If yes, show the amount of premiums and claims included. Premiums $ 0 Claims $ 0 AFFORDABLE CARE ACT (ACA) RECEIPTS, PAYMENTS, RECEIVABLES and PAYABLES Current Year Prior Year Comprehensive Health Coverage Comprehensive Health Coverage 1 2 3 4 Small Group Small Group Employer Plans Employer Plans Individual Plans Individual Plans ACA Receivables and Payables 1. Permanent ACA Risk Adjustment Program 1.0 Premium adjustments receivable/(payable) 2. Transitional ACA Reinsurance Program 2.0 Total amounts recoverable for claims (paid & unpaid) 0 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 0 0 0 0 0 0 0 0 38,562 1,241,057 17,898 9,563 423,986 (289,834) XXX 53,546 0 (603,581) XXX ACA Receipts and Payments 4. Permanent ACA Risk Adjustment Program 4.0 Premium adjustments receipts/(payments) 5. Transitional ACA Reinsurance Program 5.0 Amounts received for claims 0 6. Temporary ACA Risk Corridors Program 6.1 Retrospective premium received 6.2 Rate credits or policy experience refunds paid 0 0 XXX 0 0 0 0 0 XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF 185 Asylum Street Hartford, CT 061033408 Oregon DURING THE YEAR Comprehensive Health Coverage 1 2 3 Individual Small Group Employer Large Group Employer Small Group Employer Individual Expatriate Plans: 7 8 6 Large Group Employer Small Group 10 11 Government Business (excluded by statute) Other Health Business 9 Student Health Plans Large Group 79413 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.OR Health Premiums Earned: 825,163 94,987,092 1.1 Direct premiums written 0 1,496 1.2 Unearned premium prior year 0 2,216 1.3 Unearned premium current year 0 (719) 1.4 Change in unearned premium (Lines 1.2 - 1.3) 70 0 1.5 Paid rate credits 0 0 1.6 Reserve for rate credits current year 0 0 1.7 Reserve for rate credits prior year 0 0 1.8 Change in reserve for rate credits (Lines 1.6 - 1.7) 0 4,294 1.9 Premium balances written off 0 0 1.10 Group conversion charge 825,163 94,982,079 1.11 Total direct premiums earned (Lines 1.1 + 1.4 - 1.9 + 1.10) 0 0 1.12 Assumed premiums earned from non-affiliates 0 0 1.13 Net Assumed less Ceded premiums earned from affiliates 0 0 1.14 Ceded premiums earned to non-affiliates 0 4,294 1.15 Other Adjustments due to MLR calculation - Premiums 825,093 94,986,373 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 173,040 73,325,861 2.1 Paid claims during the year 23 10,813,527 2.2 Direct claim liability current year 21 6,725,962 2.3 Direct claim liability prior year 0 268,805 2.4 Direct claim reserves current year 0 175,635 2.5 Direct claim reserves prior year 0 0 2.6 Direct contract reserves current year 0 0 2.7 Direct contract reserves prior year 70 0 2.8 Paid rate credits 0 0 2.9 Reserve for rate credits current year 0 0 2.10 Reserve for rate credits prior year 0 22,863 2.11 Incurred medical incentive pools and bonuses (Lines 2.11a + 2.11b - 2.11c) 0 10,230 2.11a Paid medical incentive pools and bonuses current year 0 61,083 2.11b Accrued medical incentive pools and bonuses current year 0 48,451 2.11c Accrued medical incentive pools and bonuses prior year 0 438,048 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 0 1,962,985 2.12a Healthcare receivables current year 0 1,524,937 2.12b Healthcare receivables prior year 0 0 2.13 Group conversion charge 0 0 2.14 Multi-option coverage blended rate adjustment 2.15 Total incurred claims (Lines 2.1 + 2.2 - 2.3 + 2.4 - 2.5 + 2.6 - 2.7 + 2.8 + 2.9 173,111 77,091,412 2.10 + 2.11 - 2.12 + 2.13 + 2.14) 0 0 2.16 Assumed incurred claims from non-affiliates 0 0 2.17 Net assumed less ceded incurred claims from affiliates 0 0 2.18 Ceded incurred claims to non-affiliates 0 0 2.19 Other adjustments due to MLR calculation - Claims 173,041 77,091,412 2.20 Net Incurred Claims (Lines 2.15 - 2.8 - 2.9 + 2.10 + 2.16 + 2.17 - 2.18 + 2.19) 3. Fraud and Abuse Recoveries that Reduced PAID Claims in Line 2.1 above 24 10,438 (informational only) 5,322,488 for stand-alone dental and $ (a) Column 13, Line 1.1 includes direct written premium of $ 4 Business Subject to MLR Mini-Med Plans 5 (LOCATION) NAIC Company Code 2018 168,742,191 0 0 0 (70) 160,521 59,867 100,654 5 0 168,742,186 0 0 23,809,551 5 144,832,056 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 144,477,150 (552,374) 317 (552,691) (3,064,837) 770,078 886,070 (115,991) 54 0 143,924,406 0 0 158,088 54 146,947,200 183,539,525 0 0 0 418,181 589,518 2,173,906 (1,584,388) 394,964 0 183,144,562 0 0 0 394,964 184,705,732 592,571,122 (550,877) 2,532 (553,410) (2,646,657) 1,520,117 3,119,842 (1,599,725) 399,317 0 591,618,395 0 0 23,967,639 399,317 572,296,454 139,905,183 14,186,041 13,545,041 355,452 333,379 0 0 (70) 160,521 59,867 129,451 21,741 248,434 140,725 (32,539) 2,967,887 3,000,426 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 115,336,160 13,668,823 11,912,373 6,585,634 4,883,453 134,162 190,945 (3,064,837) 770,078 886,070 0 0 0 0 8,759 8,994 235 0 0 142,047,617 4,595,930 4,217,768 2,309 1,869 0 0 418,181 589,518 2,173,906 707,745 415,498 736,399 444,153 (117,192) 14,180,383 14,297,574 0 0 470,787,861 43,264,343 36,401,165 7,212,200 5,394,336 134,162 190,945 (2,646,657) 1,520,117 3,119,842 860,059 447,470 1,045,917 633,329 297,076 19,120,249 18,823,172 0 0 140,830,830 (231) 0 19,247,418 0 121,482,597 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 115,548,420 0 0 247,745 0 118,481,504 142,084,948 0 0 0 0 143,251,155 475,728,721 (231) 0 19,495,163 0 460,479,709 151,409 0 0 1,430,680 for stand-alone vision policies. 0 0 0 0 0 0 13,440 175,310 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF Oregon DURING THE YEAR All Expenses 1 Improve Health Outcomes 1. Individual Comprehensive Coverage Expenses: 11,544 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 827 for affiliated services) 1.3 EDP Equipment and Software (incl $ 79 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 9 for affiliated services) 1.5 Accreditation and Certification (incl $ 26,151 for affiliated services) 1.6 Other Expenses (incl $ 1.7 Subtotal before Reimbursements and Taxes (Lines 1.1 to 1.6) 1.8 Reimbursements by uninsured plans and fiscal intermediaries 1.9 Taxes, Licenses and Fees (in total, for tying purposes) 1.10 Total (1.7 to 1.9) 1.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 2. 216-4.OR 3. 0 0 0 0 0 6,601 6,601 0 XXX Small Group Comprehensive Coverage Expenses: 2,592,145 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 183,690 for affiliated services) 2.3 EDP Equipment and Software (incl $ 17,632 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 1,915 for affiliated services) 2.5 Accreditation and Certification (incl $ 5,943,198 for affiliated services) 2.6 Other Expenses (incl $ 2.7 Subtotal before Reimbursements and Taxes (Lines 2.1 to 2.6) 2.8 Reimbursements by uninsured plans and fiscal intermediaries 2.9 Taxes, Licenses and Fees (in total, for tying purposes) 2.10 Total (2.7 to 2.9) 2.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Comprehensive Coverage Expenses: 3,937,281 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 257,555 for affiliated services) 3.3 EDP Equipment and Software (incl $ 24,722 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 2,684 for affiliated services) 3.5 Accreditation and Certification (incl $ 8,710,157 for affiliated services) 3.6 Other Expenses (incl $ 3.7 Subtotal before Reimbursements and Taxes (Lines 3.1 to 3.6) 3.8 Reimbursements by uninsured plans and fiscal intermediaries 3.9 Taxes, Licenses and Fees (in total, for tying purposes) 3.10 Total (3.7 to 3.9) 3.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 185 Asylum Street Hartford, CT 061033408 Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX Total (1 to 5) 0 0 0 0 0 6,601 6,601 0 XXX 0 0 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 0 0 0 0 0 0 0 XXX (LOCATION) NAIC Company Code 2018 XXX 1,334 153 111 11 1 2,984 4,595 0 XXX 2,127 244 178 17 2 4,756 7,323 0 XXX 6,601 0 0 0 0 0 0 0 0 0 6,601 0 4,595 1,373 7,323 0 0 0 0 0 0 759,857 759,857 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 759,857 759,857 0 316,730 38,235 26,448 2,539 276 730,815 1,115,043 0 481,762 55,211 40,229 3,862 419 1,077,492 1,658,975 0 XXX XXX XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 759,857 0 XXX 1,115,043 328,003 XXX 1,658,975 0 0 0 0 0 0 1,349,937 1,349,937 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,349,937 1,349,937 0 553,930 144,526 46,256 4,440 482 1,275,408 2,025,042 0 758,799 86,960 63,363 6,082 660 1,697,104 2,612,969 0 1,349,937 0 XXX 2,025,042 615,999 XXX 2,612,969 0 XXX XXX 0 0 0 759,857 0 XXX 1,349,937 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 79413 9 10 General Administrative Expenses Total Expenses (6 to 9) 8,083 738 538 52 6 25,469 34,884 0 41,035 75,919 0 11,544 1,134 827 79 9 39,811 53,404 0 41,035 94,439 1,373 1,793,653 171,469 117,012 11,232 1,220 6,699,647 8,794,232 0 1,589,904 10,384,136 0 2,592,145 264,914 183,690 17,632 1,915 9,267,811 12,328,107 0 1,589,904 13,918,011 328,003 2,624,552 231,264 147,936 14,200 1,542 4,933,463 7,952,958 0 2,838,517 10,791,474 0 3,937,281 462,750 257,555 24,722 2,684 9,255,913 13,940,906 0 2,838,517 16,779,423 615,999 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 4. 5. 216-5.OR 6. Individual Mini-Med Plans Expenses: 0 for affiliated services) 4.1 Salaries (including $ 4.2 Outsourced Services 0 for affiliated services) 4.3 EDP Equipment and Software (incl $ 0 for affiliated services) 4.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 4.5 Accreditation and Certification (incl $ 0 for affiliated services) 4.6 Other Expenses (incl $ 4.7 Subtotal before Reimbursements and Taxes (Lines 4.1 to 4.6) 4.8 Reimbursements by uninsured plans and fiscal intermediaries 4.9 Taxes, Licenses and Fees (in total, for tying purposes) 4.10 Total (4.7 to 4.9) 4.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Mini-Med Plans Expenses: 0 for affiliated services) 5.1 Salaries (including $ 5.2 Outsourced Services 0 for affiliated services) 5.3 EDP Equipment and Software (incl $ 0 for affiliated services) 5.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 5.5 Accreditation and Certification (incl $ 0 for affiliated services) 5.6 Other Expenses (incl $ 5.7 Subtotal before Reimbursements and Taxes (Lines 5.1 to 5.6) 5.8 Reimbursements by uninsured plans and fiscal intermediaries 5.9 Taxes, Licenses and Fees (in total, for tying purposes) 5.10 Total (5.7 to 5.9) 5.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Mini-Med Plans Expenses: 0 for affiliated services) 6.1 Salaries (including $ 6.2 Outsourced Services 0 for affiliated services) 6.3 EDP Equipment and Software (incl $ 0 for affiliated services) 6.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 6.5 Accreditation and Certification (incl $ 0 for affiliated services) 6.6 Other Expenses (incl $ 6.7 Subtotal before Reimbursements and Taxes (Lines 6.1 to 6.6) 6.8 Reimbursements by uninsured plans and fiscal intermediaries 6.9 Taxes, Licenses and Fees (in total, for tying purposes) 6.10 Total (6.7 to 6.9) 6.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 7. 8. 216-6.OR 9. Small Group Expatriate Plans Expenses: 0 for affiliated services) 7.1 Salaries (including $ 7.2 Outsourced Services 0 for affiliated services) 7.3 EDP Equipment and Software (incl $ 0 for affiliated services) 7.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 7.5 Accreditation and Certification (incl $ 0 for affiliated services) 7.6 Other Expenses (incl $ 7.7 Subtotal before Reimbursements and Taxes (Lines 7.1 to 7.6) 7.8 Reimbursements by uninsured plans and fiscal intermediaries 7.9 Taxes, Licenses and Fees (in total, for tying purposes) 7.10 Total (7.7 to 7.9) 7.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Expatriate Plans Expenses: 0 for affiliated services) 8.1 Salaries (including $ 8.2 Outsourced Services 0 for affiliated services) 8.3 EDP Equipment and Software (incl $ 0 for affiliated services) 8.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 8.5 Accreditation and Certification (incl $ 0 for affiliated services) 8.6 Other Expenses (incl $ 8.7 Subtotal before Reimbursements and Taxes (Lines 8.1 to 8.6) 8.8 Reimbursements by uninsured plans and fiscal intermediaries 8.9 Taxes, Licenses and Fees (in total, for tying purposes) 8.10 Total (8.7 to 8.9) 8.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Student Health Plans Expenses: 0 for affiliated services) 9.1 Salaries (including $ 9.2 Outsourced Services 0 for affiliated services) 9.3 EDP Equipment and Software (incl $ 0 for affiliated services) 9.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 9.5 Accreditation and Certification (incl $ 0 for affiliated services) 9.6 Other Expenses (incl $ 9.7 Subtotal before Reimbursements and Taxes (Lines 9.1 to 9.6) 9.8 Reimbursements by uninsured plans and fiscal intermediaries 9.9 Taxes, Licenses and Fees (in total, for tying purposes) 9.10 Total (9.7 to 9.9) 9.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 *79413201821639100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes - See Cautionary Statement at http://www.naic.org/documents/committees_e_app_blanks_related_shce_cautionary_statement.pdf) UnitedHealthcare Insurance Company 2. 185 Asylum Street Hartford, CT 061033408 (LOCATION) BUSINESS IN THE STATE OF Pennsylvania DURING THE YEAR 2018 NAIC Company Code Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 1. 216-1.PA 2. 3. 4. 5. 6. 7. 8. 9. Premium: 1.1 Health premiums earned (From Part 2, Line 1.11) 1.2 Federal high risk pools 1.3 State high risk pools 1.4 Premiums earned including state and federal high risk programs (Lines 1.1 + 1.2 + 1.3) 1.5 Federal taxes and federal assessments 1.6 State insurance, premium and other taxes (Similar local taxes of 157,742 ) $ 1.6a Community Benefit Expenditures (informational only) 1.7 Regulatory authority licenses and fees 1.8 Adjusted Premiums Earned (Lines 1.4 - 1.5 - 1.6 - 1.7) 1.9 Net Assumed less Ceded reinsurance premiums earned 1.10 Other Adjustments due to MLR calculations - Premiums 1.11 Risk Revenue 1.12 Net adjusted premiums earned after reinsurance (Lines 1.8 + 1.9 + 1.10 + 1.11) Claims: 2.1 Incurred claims excluding prescription drugs 2.2 Prescription drugs 2.3 Pharmaceutical rebates 2.4 State stop loss, market stabilization and claim/census based assessments (informational only) Incurred medical incentive pools and bonuses Deductible Fraud and Abuse Detection/Recovery Expenses (for MLR use only) 5.0 Total Incurred Claims (Lines 2.1 + 2.2 - 2.3 + 3) (From Part 2, Line 2.15) 5.1 Net Assumed less Ceded reinsurance claims incurred 5.2 Other Adjustments due to MLR calculations - Claims 5.3 Rebates paid 5.4 Estimated rebates unpaid prior year 5.5 Estimated rebates unpaid current year 5.6 Fee for service and co-pay revenue 5.7 Net incurred claims after reinsurance (Lines 5.0 + 5.1 + 5.2 + 5.3 - 5.4 + 5.5 - 5.6) Improving Health Care Quality Expenses Incurred: 6.1 Improve health outcomes 6.2 Activities to prevent hospital readmissions 6.3 Improve patient safety and reduce medical errors 6.4 Wellness and health promotion activities 6.5 Health Information Technology expenses related to health improvement 6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5) Preliminary Medical Loss Ratio: MLR ((Lines 4 + 5.0 + 6.6 - Footnote 2.0)/Line 1.8 Claims Adjustment Expenses: 8.1 Cost containment expenses not included in quality of care expenses in Line 6.6 8.2 All other claims adjustment expenses 8.3 Total claims adjustment expenses (Lines 8.1 + 8.2) Claims Adjustment Expense Ratio (Line 8.3/Line 1.8) 2 Small Group Employer 3 Large Group Employer 4 5 Small Group Employer Individual Expatriate Plans 6 Large Group Employer 7 11 Government Business (excluded by statute) Other Health Business 9 8 Small Group 10 Student Health Plans Large Group 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 79413 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 1,997,090 0 (607) 159,608,999 0 (6,565) 487,648,921 0 (64,924) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 546,911,690 0 296,157 389,972,189 0 0 1,586,138,889 0 224,061 XXX XXX XXX 1,996,483 (68,013) 159,602,435 4,994,015 487,583,998 19,215,666 0 0 0 0 0 0 0 0 0 0 0 0 0 246,637 547,207,847 3,903,770 389,972,189 15,137,103 1,586,362,950 43,429,177 XXX 22,580 0 349 2,041,567 1,194 0 0 2,042,761 2,976,339 0 13,606 151,618,474 0 62,990 0 151,681,463 7,781,335 0 143,840 460,443,157 (54,529,388) 109 0 405,913,877 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (246,637) 1,237,862 0 0 991,226 9,049,238 0 (122,235) 534,377,074 22,767 1,662 0 534,401,503 (324,744) 0 0 375,159,830 116,694 1,430,572 0 376,707,096 19,504,749 0 35,560 1,523,393,465 (53,150,872) 1,495,332 0 1,471,737,925 XXX XXX XXX XXX XXX 19,504,749 0 35,560 1,523,393,465 (53,150,872) 1,495,332 0 1,471,737,925 1,808,415 567,153 178,469 108,990,741 22,761,812 7,467,446 342,914,457 82,521,581 26,388,581 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 430,547,419 1,295,163 117,878 187,905,131 261,134,421 144,067,243 1,072,166,164 368,280,130 178,219,617 XXX XXX XXX 1,072,166,164 368,280,130 178,219,617 9 0 0 2,197,099 0 0 0 0 0 0 2,197,099 321,668 62,131 4,160 124,347,238 0 0 0 0 0 0 124,347,238 682,255 50,864 108,033 399,098,321 (44,423,894) 0 0 0 0 0 354,674,427 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 597,818 37,845 305,570,127 0 0 0 0 0 0 305,570,127 1,004,179 710,812 150,038 1,262,937,490 (45,016,031) 0 0 0 0 0 1,217,921,459 XXX XXX 0 0 246 0 0 431,724,705 (592,137) 0 XXX XXX XXX 0 431,132,567 1,004,179 710,812 150,038 1,262,937,490 (45,016,031) 0 0 0 0 0 1,217,921,459 15,977 0 0 0 0 1,276,872 0 0 0 0 3,901,191 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,066,996 282,812 218,736 4,338,091 1,337,261 235,359 356,652 854,303 217,764 1,031,990 7,496,394 639,464 1,073,039 4,555,855 2,369,252 15,977 1.084 1,276,872 0.829 3,901,191 0.875 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 8,243,896 XXX 2,696,068 0.822 16,134,004 XXX 15,634 28,679 44,312 0.022 1,948,129 2,760,099 4,708,228 0.031 5,241,150 6,386,564 11,627,714 0.025 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 368,463 22,768,920 23,137,383 0.043 4,026,442 15,983,250 20,009,692 0.053 11,599,818 47,927,513 59,527,330 XXX XXX XXX XXX XXX 0 0 0 0.000 1,586,138,889 0 224,061 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 7,496,394 639,464 1,073,039 4,555,855 2,369,252 0 16,134,004 XXX 0 0 0 11,599,818 47,927,513 59,527,330 XXX XXX XXX 1,586,362,950 43,429,177 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 (Continued) Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 10. General and Administrative (G&A) Expenses: 10.1 Direct sales salaries and benefits 10.2 Agents and brokers fees and commissions 10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below) 10.4 Other general and administrative expenses 10.4a Community Benefit Expenditures (informational only) 10.5 Total general and administrative (Lines 10.1 +10.2 + 10.3 + 10.4) 3 Large Group Employer 2 Small Group Employer 5,223 45,297 (5,684) 82,005 0 126,842 641,154 5,421,622 167,176 8,264,601 0 14,494,552 4 5 Small Group Employer Individual 1,778,137 1,588,096 688,787 12,694,948 0 16,749,968 0 0 0 0 0 0 Expatriate Plans 6 Large Group Employer 0 0 0 0 0 0 7 8 Small Group 0 0 0 0 0 0 Student Health Plans Large Group 0 0 0 0 0 0 10 11 Government Business (excluded by statute) Other Health Business 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 800,198 20,578,157 968,259 35,369,007 0 57,715,621 605,404 2,634,130 698,494 23,077,209 0 27,015,238 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 3,830,116 30,267,302 2,517,032 79,487,771 0 116,102,221 0 0 0 0 0 0 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) 14,172,035 21,415,970 62,052,910 12. Income from fees of uninsured plans XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 13. Net investment and other gain/(loss) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 21,189,547 XXX 14. Federal income taxes (excluding taxes on Line 1.5 above) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 1,221,346 XXX 1,221,346 15. Net gain or (loss) (Lines 11 + 12 + 13 - 14) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 82,021,111 XXX 82,021,111 16. ICD-10 Implementation Expenses (informational only; already included in general expenses and line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16. 16a ICD-10 Implementation Expenses (informational only; already included in line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (341,470) 6,854,572 18,960,576 0 0 0 0 0 0 991,226 XXX 3,830,116 30,267,302 2,517,032 79,487,771 0 116,102,221 62,052,910 0 0 21,189,547 OTHER INDICATORS: 216-2.PA 1. Number of certificates/policies 163 17,556 48,318 0 0 0 0 0 0 0 358,933 158,562 583,532 0 583,532 2. Number of Covered Lives 288 32,396 86,468 0 0 0 0 0 0 0 464,550 158,562 742,264 0 742,264 3. Number of Groups 2,919 708 0 0 0 0 0 0 2,515 7 6,149 0 6,149 4. Member Months 3,365 361,711 1,127,723 0 0 0 0 0 0 5,400,574 1,918,240 8,811,613 0 8,811,613 XXX Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ XXX 0 ] If yes, show the amount of premiums and claims included. Premiums $ 0 Claims $ 0 AFFORDABLE CARE ACT (ACA) RECEIPTS, PAYMENTS, RECEIVABLES and PAYABLES Current Year Prior Year Comprehensive Health Coverage Comprehensive Health Coverage 1 2 3 4 Small Group Small Group Employer Plans Employer Plans Individual Plans Individual Plans ACA Receivables and Payables 1. Permanent ACA Risk Adjustment Program 1.0 Premium adjustments receivable/(payable) 2. Transitional ACA Reinsurance Program 2.0 Total amounts recoverable for claims (paid & unpaid) 0 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 0 0 372,391 (10,385,499) XXX (332,050) 0 0 0 (4,726,930) XXX 0 0 0 0 ACA Receipts and Payments 4. Permanent ACA Risk Adjustment Program 4.0 Premium adjustments receipts/(payments) 5. Transitional ACA Reinsurance Program 5.0 Amounts received for claims 0 6. Temporary ACA Risk Corridors Program 6.1 Retrospective premium received 6.2 Rate credits or policy experience refunds paid 0 0 (378,838) (3,417,131) XXX 115,902 0 0 0 0 0 (6,484,441) XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF 185 Asylum Street Hartford, CT 061033408 Pennsylvania DURING THE YEAR Comprehensive Health Coverage 1 2 3 Individual Small Group Employer Large Group Employer Small Group Employer Individual Expatriate Plans: 7 8 6 Large Group Employer Small Group 10 11 Government Business (excluded by statute) Other Health Business 9 Student Health Plans Large Group 79413 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.PA Health Premiums Earned: 1,997,090 159,641,193 1.1 Direct premiums written 0 51,519 1.2 Unearned premium prior year 0 20,723 1.3 Unearned premium current year 0 30,796 1.4 Change in unearned premium (Lines 1.2 - 1.3) 164,754 0 1.5 Paid rate credits 0 0 1.6 Reserve for rate credits current year 0 0 1.7 Reserve for rate credits prior year 0 0 1.8 Change in reserve for rate credits (Lines 1.6 - 1.7) 0 62,990 1.9 Premium balances written off 0 0 1.10 Group conversion charge 1,997,090 159,608,999 1.11 Total direct premiums earned (Lines 1.1 + 1.4 - 1.9 + 1.10) 0 0 1.12 Assumed premiums earned from non-affiliates 1,194 0 1.13 Net Assumed less Ceded premiums earned from affiliates 0 0 1.14 Ceded premiums earned to non-affiliates 0 62,990 1.15 Other Adjustments due to MLR calculation - Premiums 1,833,530 159,671,989 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 2,134,642 119,564,319 2.1 Paid claims during the year 22,057 19,783,389 2.2 Direct claim liability current year 47,945 14,676,175 2.3 Direct claim liability prior year 1,614 425,529 2.4 Direct claim reserves current year 4,700 319,285 2.5 Direct claim reserves prior year 198,660 0 2.6 Direct contract reserves current year 270,473 0 2.7 Direct contract reserves prior year 164,754 0 2.8 Paid rate credits 0 0 2.9 Reserve for rate credits current year 0 0 2.10 Reserve for rate credits prior year 0 62,131 2.11 Incurred medical incentive pools and bonuses (Lines 2.11a + 2.11b - 2.11c) 0 18,446 2.11a Paid medical incentive pools and bonuses current year 0 125,960 2.11b Accrued medical incentive pools and bonuses current year 0 82,275 2.11c Accrued medical incentive pools and bonuses prior year 1,508 492,669 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 1,508 3,463,125 2.12a Healthcare receivables current year 0 2,970,457 2.12b Healthcare receivables prior year 0 0 2.13 Group conversion charge 0 0 2.14 Multi-option coverage blended rate adjustment 2.15 Total incurred claims (Lines 2.1 + 2.2 - 2.3 + 2.4 - 2.5 + 2.6 - 2.7 + 2.8 + 2.9 2,197,099 124,347,238 2.10 + 2.11 - 2.12 + 2.13 + 2.14) 0 0 2.16 Assumed incurred claims from non-affiliates 0 0 2.17 Net assumed less ceded incurred claims from affiliates 0 0 2.18 Ceded incurred claims to non-affiliates 0 0 2.19 Other adjustments due to MLR calculation - Claims 2,032,346 124,347,238 2.20 Net Incurred Claims (Lines 2.15 - 2.8 - 2.9 + 2.10 + 2.16 + 2.17 - 2.18 + 2.19) 3. Fraud and Abuse Recoveries that Reduced PAID Claims in Line 2.1 above 0 4,160 (informational only) 10,920,234 for stand-alone dental and $ (a) Column 13, Line 1.1 includes direct written premium of $ 4 Business Subject to MLR Mini-Med Plans 5 (LOCATION) NAIC Company Code 2018 487,645,645 3,221 (164) 3,385 (1,711,356) (188,660) (642,300) 453,640 109 0 487,648,921 0 1 54,529,389 109 434,377,358 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 403,480,913 53,468,606 59,380,548 1,265,719 1,354,921 0 0 (1,711,356) (188,660) (642,300) 50,864 230,971 625,609 805,716 (2,825,404) 10,456,206 13,281,611 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 399,098,321 (33,060) 0 44,390,833 0 355,932,144 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 108,033 0 0 8,304,153 for stand-alone vision policies. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,237,862 0 0 1,237,862 546,961,913 38,790 87,351 (48,561) 3,747,255 328,881 244,650 84,231 1,662 0 546,911,690 512,765 0 489,998 1,662 543,104,633 391,402,760 0 0 0 12,792,862 5,768,828 12,087,971 (6,319,143) 1,430,572 0 389,972,188 0 116,694 0 1,430,572 385,045,734 1,587,648,601 93,531 107,911 (14,380) 14,993,515 5,909,049 11,690,321 (5,781,272) 1,495,332 0 1,586,138,889 512,765 1,355,750 55,019,387 1,495,332 1,525,271,106 425,165,227 48,007,658 44,217,411 18,784,378 16,282,864 81,497,293 85,025,770 3,747,255 328,881 244,650 0 0 0 0 35,292 38,108 2,816 0 0 286,736,324 15,474,840 23,787,434 17,775 13,423 0 0 12,792,862 5,768,828 12,087,971 597,818 380,783 564,217 347,183 (20,070,508) 39,976,027 60,046,535 0 0 1,236,798,952 136,301,176 141,371,667 20,495,014 17,975,193 81,695,953 85,296,244 14,993,515 5,909,049 11,690,321 710,812 630,201 1,315,786 1,235,175 (22,366,443) 53,934,976 76,301,419 0 0 0 0 0 0 0 0 431,724,705 504,896 0 1,097,033 0 427,301,082 305,570,127 0 0 0 0 299,096,407 1,262,937,490 471,835 0 45,487,866 0 1,208,709,216 0 0 37,845 150,038 (282,474) (455,372) (737,846) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF Pennsylvania DURING THE YEAR All Expenses 1 Improve Health Outcomes 1. Individual Comprehensive Coverage Expenses: 44,793 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 2,682 for affiliated services) 1.3 EDP Equipment and Software (incl $ 257 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 28 for affiliated services) 1.5 Accreditation and Certification (incl $ 81,385 for affiliated services) 1.6 Other Expenses (incl $ 1.7 Subtotal before Reimbursements and Taxes (Lines 1.1 to 1.6) 1.8 Reimbursements by uninsured plans and fiscal intermediaries 1.9 Taxes, Licenses and Fees (in total, for tying purposes) 1.10 Total (1.7 to 1.9) 1.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 2. 216-4.PA Small Group Comprehensive Coverage Expenses: 4,143,871 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 294,419 for affiliated services) 2.3 EDP Equipment and Software (incl $ 28,261 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 3,069 for affiliated services) 2.5 Accreditation and Certification (incl $ 9,271,258 for affiliated services) 2.6 Other Expenses (incl $ 2.7 Subtotal before Reimbursements and Taxes (Lines 2.1 to 2.6) 2.8 Reimbursements by uninsured plans and fiscal intermediaries 2.9 Taxes, Licenses and Fees (in total, for tying purposes) 2.10 Total (2.7 to 2.9) 2.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 3. Large Group Comprehensive Coverage Expenses: 9,232,406 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 627,806 for affiliated services) 3.3 EDP Equipment and Software (incl $ 60,262 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 6,543 for affiliated services) 3.5 Accreditation and Certification (incl $ 21,003,314 for affiliated services) 3.6 Other Expenses (incl $ 3.7 Subtotal before Reimbursements and Taxes (Lines 3.1 to 3.6) 3.8 Reimbursements by uninsured plans and fiscal intermediaries 3.9 Taxes, Licenses and Fees (in total, for tying purposes) 3.10 Total (3.7 to 3.9) 3.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 185 Asylum Street Hartford, CT 061033408 0 0 0 0 0 15,977 15,977 0 XXX Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX Total (1 to 5) 0 0 0 0 0 15,977 15,977 0 XXX 0 0 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 0 0 0 0 0 0 0 XXX (LOCATION) NAIC Company Code 2018 XXX 4,399 504 367 35 4 9,838 15,147 0 XXX 9,600 804 579 56 6 17,116 28,161 0 XXX 15,977 0 0 0 0 0 0 0 0 0 15,977 0 15,147 4,202 28,161 0 0 0 0 0 0 1,276,872 1,276,872 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,276,872 1,276,872 0 500,149 188,679 41,765 4,009 435 1,153,327 1,888,364 0 783,046 89,739 65,388 6,276 682 1,751,335 2,696,465 0 XXX 1,276,872 0 0 0 0 0 0 3,901,191 3,901,191 0 XXX 3,901,191 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 1,276,872 0 XXX 1,888,364 515,967 XXX 2,696,465 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3,901,191 3,901,191 0 1,307,200 646,514 109,157 10,478 1,138 3,009,290 5,083,777 0 1,815,782 208,092 151,626 14,554 1,580 4,061,116 6,252,751 0 3,901,191 0 XXX 5,083,777 1,453,201 XXX 6,252,751 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 79413 9 10 General Administrative Expenses Total Expenses (6 to 9) 30,795 2,363 1,735 154 18 97,091 132,156 0 18,620 150,776 0 44,793 3,672 2,682 245 28 140,021 191,440 0 18,620 210,060 4,202 2,860,676 327,095 187,266 17,975 1,952 10,887,058 14,282,021 0 3,325,876 17,607,896 0 4,143,871 605,513 294,419 28,261 3,069 15,068,591 20,143,723 0 3,325,876 23,469,598 515,967 6,109,424 679,557 367,022 35,230 3,825 8,739,456 15,934,516 0 9,031,814 24,966,330 0 9,232,406 1,534,164 627,806 60,262 6,543 19,711,054 31,172,234 1 9,031,814 40,204,049 1,453,201 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 4. 5. 216-5.PA 6. Individual Mini-Med Plans Expenses: 0 for affiliated services) 4.1 Salaries (including $ 4.2 Outsourced Services 0 for affiliated services) 4.3 EDP Equipment and Software (incl $ 0 for affiliated services) 4.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 4.5 Accreditation and Certification (incl $ 0 for affiliated services) 4.6 Other Expenses (incl $ 4.7 Subtotal before Reimbursements and Taxes (Lines 4.1 to 4.6) 4.8 Reimbursements by uninsured plans and fiscal intermediaries 4.9 Taxes, Licenses and Fees (in total, for tying purposes) 4.10 Total (4.7 to 4.9) 4.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Mini-Med Plans Expenses: 0 for affiliated services) 5.1 Salaries (including $ 5.2 Outsourced Services 0 for affiliated services) 5.3 EDP Equipment and Software (incl $ 0 for affiliated services) 5.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 5.5 Accreditation and Certification (incl $ 0 for affiliated services) 5.6 Other Expenses (incl $ 5.7 Subtotal before Reimbursements and Taxes (Lines 5.1 to 5.6) 5.8 Reimbursements by uninsured plans and fiscal intermediaries 5.9 Taxes, Licenses and Fees (in total, for tying purposes) 5.10 Total (5.7 to 5.9) 5.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Mini-Med Plans Expenses: 0 for affiliated services) 6.1 Salaries (including $ 6.2 Outsourced Services 0 for affiliated services) 6.3 EDP Equipment and Software (incl $ 0 for affiliated services) 6.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 6.5 Accreditation and Certification (incl $ 0 for affiliated services) 6.6 Other Expenses (incl $ 6.7 Subtotal before Reimbursements and Taxes (Lines 6.1 to 6.6) 6.8 Reimbursements by uninsured plans and fiscal intermediaries 6.9 Taxes, Licenses and Fees (in total, for tying purposes) 6.10 Total (6.7 to 6.9) 6.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 7. 8. 216-6.PA 9. Small Group Expatriate Plans Expenses: 0 for affiliated services) 7.1 Salaries (including $ 7.2 Outsourced Services 0 for affiliated services) 7.3 EDP Equipment and Software (incl $ 0 for affiliated services) 7.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 7.5 Accreditation and Certification (incl $ 0 for affiliated services) 7.6 Other Expenses (incl $ 7.7 Subtotal before Reimbursements and Taxes (Lines 7.1 to 7.6) 7.8 Reimbursements by uninsured plans and fiscal intermediaries 7.9 Taxes, Licenses and Fees (in total, for tying purposes) 7.10 Total (7.7 to 7.9) 7.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Expatriate Plans Expenses: 0 for affiliated services) 8.1 Salaries (including $ 8.2 Outsourced Services 0 for affiliated services) 8.3 EDP Equipment and Software (incl $ 0 for affiliated services) 8.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 8.5 Accreditation and Certification (incl $ 0 for affiliated services) 8.6 Other Expenses (incl $ 8.7 Subtotal before Reimbursements and Taxes (Lines 8.1 to 8.6) 8.8 Reimbursements by uninsured plans and fiscal intermediaries 8.9 Taxes, Licenses and Fees (in total, for tying purposes) 8.10 Total (8.7 to 8.9) 8.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Student Health Plans Expenses: 0 for affiliated services) 9.1 Salaries (including $ 9.2 Outsourced Services 0 for affiliated services) 9.3 EDP Equipment and Software (incl $ 0 for affiliated services) 9.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 9.5 Accreditation and Certification (incl $ 0 for affiliated services) 9.6 Other Expenses (incl $ 9.7 Subtotal before Reimbursements and Taxes (Lines 9.1 to 9.6) 9.8 Reimbursements by uninsured plans and fiscal intermediaries 9.9 Taxes, Licenses and Fees (in total, for tying purposes) 9.10 Total (9.7 to 9.9) 9.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 *79413201821640100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes - See Cautionary Statement at http://www.naic.org/documents/committees_e_app_blanks_related_shce_cautionary_statement.pdf) UnitedHealthcare Insurance Company 2. 185 Asylum Street Hartford, CT 061033408 (LOCATION) BUSINESS IN THE STATE OF Rhode Island DURING THE YEAR 2018 NAIC Company Code Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 1. 216-1.RI 2. 3. 4. 5. 6. 7. 8. 9. Premium: 1.1 Health premiums earned (From Part 2, Line 1.11) 1.2 Federal high risk pools 1.3 State high risk pools 1.4 Premiums earned including state and federal high risk programs (Lines 1.1 + 1.2 + 1.3) 1.5 Federal taxes and federal assessments 1.6 State insurance, premium and other taxes (Similar local taxes of 29,972 ) $ 1.6a Community Benefit Expenditures (informational only) 1.7 Regulatory authority licenses and fees 1.8 Adjusted Premiums Earned (Lines 1.4 - 1.5 - 1.6 - 1.7) 1.9 Net Assumed less Ceded reinsurance premiums earned 1.10 Other Adjustments due to MLR calculations - Premiums 1.11 Risk Revenue 1.12 Net adjusted premiums earned after reinsurance (Lines 1.8 + 1.9 + 1.10 + 1.11) Claims: 2.1 Incurred claims excluding prescription drugs 2.2 Prescription drugs 2.3 Pharmaceutical rebates 2.4 State stop loss, market stabilization and claim/census based assessments (informational only) Incurred medical incentive pools and bonuses Deductible Fraud and Abuse Detection/Recovery Expenses (for MLR use only) 5.0 Total Incurred Claims (Lines 2.1 + 2.2 - 2.3 + 3) (From Part 2, Line 2.15) 5.1 Net Assumed less Ceded reinsurance claims incurred 5.2 Other Adjustments due to MLR calculations - Claims 5.3 Rebates paid 5.4 Estimated rebates unpaid prior year 5.5 Estimated rebates unpaid current year 5.6 Fee for service and co-pay revenue 5.7 Net incurred claims after reinsurance (Lines 5.0 + 5.1 + 5.2 + 5.3 - 5.4 + 5.5 - 5.6) Improving Health Care Quality Expenses Incurred: 6.1 Improve health outcomes 6.2 Activities to prevent hospital readmissions 6.3 Improve patient safety and reduce medical errors 6.4 Wellness and health promotion activities 6.5 Health Information Technology expenses related to health improvement 6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5) Preliminary Medical Loss Ratio: MLR ((Lines 4 + 5.0 + 6.6 - Footnote 2.0)/Line 1.8 Claims Adjustment Expenses: 8.1 Cost containment expenses not included in quality of care expenses in Line 6.6 8.2 All other claims adjustment expenses 8.3 Total claims adjustment expenses (Lines 8.1 + 8.2) Claims Adjustment Expense Ratio (Line 8.3/Line 1.8) 2 Small Group Employer 3 Large Group Employer 4 5 Small Group Employer Individual Expatriate Plans 6 Large Group Employer 7 11 Government Business (excluded by statute) Other Health Business 9 8 Small Group 10 Student Health Plans Large Group 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 79413 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 505,214 0 (9) 15,790,835 0 (415) 115,826,109 0 (8,134) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 25,378,644 0 0 59,394,806 0 24,876 74,674,751 0 0 291,570,359 0 16,319 XXX XXX XXX 505,205 (44,815) 15,790,420 1,231,036 115,817,976 4,102,996 0 0 0 0 0 0 0 0 0 0 0 0 25,378,644 498,266 59,419,682 (192,181) 74,674,751 3,137,861 291,586,677 8,733,163 XXX 7,813 0 1,656 540,551 169,563 0 0 710,114 255,375 0 47,652 14,256,357 5,525,696 5,605 0 19,787,658 2,128,048 0 76,066 109,510,865 (14,497,439) 24,268 0 95,037,693 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 511,879 0 0 24,368,498 1,533,664 0 0 25,902,162 1,019,907 0 (3,081) 58,595,037 (95,557) 161 0 58,499,641 7,343 0 0 71,529,547 235,270 117,386 0 71,882,202 3,930,366 0 122,293 278,800,856 (7,128,805) 147,419 0 271,819,470 XXX XXX XXX XXX XXX 3,930,366 0 122,293 278,800,856 (7,128,805) 147,419 0 271,819,470 220,517 369,589 84,552 7,553,254 2,672,790 619,318 75,543,384 19,535,680 6,279,749 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 22,801,975 0 0 50,123,231 419,474 8,955 51,285,064 23,904,004 13,003,994 207,527,423 46,901,537 19,996,568 XXX XXX XXX 207,527,423 46,901,537 19,996,568 0 0 0 505,555 232,102 0 0 0 0 0 737,657 262,614 370,283 3,534 9,977,009 4,577,283 0 0 0 0 0 14,554,292 1,487,000 1,875,325 17,941 90,674,639 (11,665,173) 0 0 0 0 0 79,009,467 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 22,801,975 952,735 0 XXX XXX XXX 0 23,754,709 693 0 0 50,533,749 (334,445) 0 XXX XXX XXX 0 50,199,304 0 (1,442) 31,558 62,183,632 70,328 (5,804,016) 2,418,164 2,198,331 5,584,183 0 62,253,959 1,750,308 2,244,166 53,033 236,676,559 (6,167,171) (5,804,016) 2,418,164 2,198,331 5,584,183 0 230,509,388 XXX XXX 1,750,308 2,244,166 53,033 236,676,559 (6,167,171) (5,804,016) 2,418,164 2,198,331 5,584,183 0 230,509,388 4,042 0 0 0 0 126,327 0 0 0 0 926,609 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 32,870 12,642 25,285 2,528 30,342 188,231 137,245 103,651 370,126 41,829 380,067 90,391 99,595 261,835 195,603 1,658,146 240,278 228,532 634,490 267,774 4,042 0.943 126,327 0.709 926,609 0.837 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 103,668 XXX 841,083 XXX 1,027,490 0.884 3,029,219 XXX 4,328 6,793 11,121 0.021 157,984 212,870 370,854 0.026 1,318,962 1,704,592 3,023,554 0.028 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 346,402 611,396 957,798 0.039 52,121 735,511 787,632 0.013 578,162 2,248,256 2,826,418 0.040 2,457,959 5,519,418 7,977,377 XXX 291,570,359 0 16,319 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 1,658,146 240,278 228,532 634,490 267,774 0 3,029,219 XXX 0 0 0 2,457,959 5,519,418 7,977,377 XXX XXX XXX 291,586,677 8,733,163 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 (Continued) Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 10. General and Administrative (G&A) Expenses: 10.1 Direct sales salaries and benefits 10.2 Agents and brokers fees and commissions 10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below) 10.4 Other general and administrative expenses 10.4a Community Benefit Expenditures (informational only) 10.5 Total general and administrative (Lines 10.1 +10.2 + 10.3 + 10.4) 3 Large Group Employer 2 Small Group Employer 1,463 9,921 (1,320) 148,742 0 158,805 48,968 325,633 (29,336) 1,649,354 0 1,994,620 4 5 Small Group Employer Individual 499,348 1,312,362 208,263 3,828,693 0 5,848,666 0 0 0 0 0 0 Expatriate Plans 6 Large Group Employer 0 0 0 0 0 0 7 8 Small Group 0 0 0 0 0 0 Student Health Plans Large Group 0 0 0 0 0 0 10 11 Government Business (excluded by statute) Other Health Business 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 9 0 0 0 0 0 0 0 0 0 0 0 0 237,695 0 44,554 1,182,919 0 1,465,168 85,535 2,497,474 111,427 5,133,618 0 7,828,053 88,270 1,272,770 99,247 3,238,236 0 4,698,523 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 961,278 5,418,160 432,836 15,181,561 0 21,993,834 0 0 0 0 0 0 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) 12. Income from fees of uninsured plans XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 13. Net investment and other gain/(loss) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 14. Federal income taxes (excluding taxes on Line 1.5 above) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 15. Net gain or (loss) (Lines 11 + 12 + 13 - 14) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 16. ICD-10 Implementation Expenses (informational only; already included in general expenses and line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16. 16a ICD-10 Implementation Expenses (informational only; already included in line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (201,510) 2,741,565 6,229,398 0 0 0 0 0 0 (379,181) (1,156,431) 1,075,811 8,309,652 XXX 961,278 5,418,160 432,836 15,181,561 0 21,993,834 XXX 8,309,652 0 4,182,190 (961,524) 13,453,366 XXX 0 4,182,190 XXX (961,524) XXX 13,453,366 OTHER INDICATORS: 216-2.RI 1. Number of certificates/policies 34 1,095 10,623 0 0 0 0 0 0 113,196 44,149 14,247 183,344 0 183,344 2. Number of Covered Lives 69 1,921 20,637 0 0 0 0 0 0 113,196 67,356 14,247 217,426 0 217,426 3. Number of Groups 299 275 0 0 0 0 0 1 560 1 1,136 0 1,136 4. Member Months 819 27,057 246,024 0 0 0 0 0 1,330,091 817,941 175,297 2,597,229 0 2,597,229 XXX Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ XXX 0 ] If yes, show the amount of premiums and claims included. Premiums $ 0 Claims $ 0 AFFORDABLE CARE ACT (ACA) RECEIPTS, PAYMENTS, RECEIVABLES and PAYABLES Current Year Prior Year Comprehensive Health Coverage Comprehensive Health Coverage 1 2 3 4 Small Group Small Group Employer Plans Employer Plans Individual Plans Individual Plans ACA Receivables and Payables 1. Permanent ACA Risk Adjustment Program 1.0 Premium adjustments receivable/(payable) 2. Transitional ACA Reinsurance Program 2.0 Total amounts recoverable for claims (paid & unpaid) 0 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 0 0 (5,554) 324,278 XXX (107,990) 0 0 0 (636,303) XXX 0 0 0 0 ACA Receipts and Payments 4. Permanent ACA Risk Adjustment Program 4.0 Premium adjustments receipts/(payments) 5. Transitional ACA Reinsurance Program 5.0 Amounts received for claims 0 6. Temporary ACA Risk Corridors Program 6.1 Retrospective premium received 6.2 Rate credits or policy experience refunds paid 0 0 (64,170) 266,773 XXX (22,089) 0 0 0 0 0 (1,853,198) XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF 185 Asylum Street Hartford, CT 061033408 Rhode Island DURING THE YEAR Comprehensive Health Coverage 1 2 3 Individual Small Group Employer Large Group Employer Small Group Employer Individual Expatriate Plans: 7 8 6 Large Group Employer Small Group 10 11 Government Business (excluded by statute) Other Health Business 9 Student Health Plans Large Group 79413 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.RI Health Premiums Earned: 505,214 15,794,189 1.1 Direct premiums written 0 3,043 1.2 Unearned premium prior year 0 792 1.3 Unearned premium current year 0 2,251 1.4 Change in unearned premium (Lines 1.2 - 1.3) 0 0 1.5 Paid rate credits 0 0 1.6 Reserve for rate credits current year 0 0 1.7 Reserve for rate credits prior year 0 0 1.8 Change in reserve for rate credits (Lines 1.6 - 1.7) 0 5,605 1.9 Premium balances written off 0 0 1.10 Group conversion charge 505,214 15,790,835 1.11 Total direct premiums earned (Lines 1.1 + 1.4 - 1.9 + 1.10) 0 0 1.12 Assumed premiums earned from non-affiliates 169,563 5,525,696 1.13 Net Assumed less Ceded premiums earned from affiliates 0 0 1.14 Ceded premiums earned to non-affiliates 0 5,605 1.15 Other Adjustments due to MLR calculation - Premiums 674,777 21,322,136 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 505,556 10,328,493 2.1 Paid claims during the year 728 1,440,711 2.2 Direct claim liability current year 730 2,315,450 2.3 Direct claim liability prior year 0 23,566 2.4 Direct claim reserves current year 0 32,038 2.5 Direct claim reserves prior year 0 0 2.6 Direct contract reserves current year 0 0 2.7 Direct contract reserves prior year 0 0 2.8 Paid rate credits 0 0 2.9 Reserve for rate credits current year 0 0 2.10 Reserve for rate credits prior year 0 370,283 2.11 Incurred medical incentive pools and bonuses (Lines 2.11a + 2.11b - 2.11c) 0 173,785 2.11a Paid medical incentive pools and bonuses current year 0 307,170 2.11b Accrued medical incentive pools and bonuses current year 0 110,672 2.11c Accrued medical incentive pools and bonuses prior year 0 (161,443) 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 0 233,989 2.12a Healthcare receivables current year 0 395,433 2.12b Healthcare receivables prior year 0 0 2.13 Group conversion charge 0 0 2.14 Multi-option coverage blended rate adjustment 2.15 Total incurred claims (Lines 2.1 + 2.2 - 2.3 + 2.4 - 2.5 + 2.6 - 2.7 + 2.8 + 2.9 505,555 9,977,009 2.10 + 2.11 - 2.12 + 2.13 + 2.14) 0 0 2.16 Assumed incurred claims from non-affiliates 232,102 4,577,283 2.17 Net assumed less ceded incurred claims from affiliates 0 0 2.18 Ceded incurred claims to non-affiliates 0 0 2.19 Other adjustments due to MLR calculation - Claims 737,657 14,554,292 2.20 Net Incurred Claims (Lines 2.15 - 2.8 - 2.9 + 2.10 + 2.16 + 2.17 - 2.18 + 2.19) 3. Fraud and Abuse Recoveries that Reduced PAID Claims in Line 2.1 above 0 3,534 (informational only) 2,649,198 for stand-alone dental and $ (a) Column 13, Line 1.1 includes direct written premium of $ 4 Business Subject to MLR Mini-Med Plans 5 (LOCATION) NAIC Company Code 2018 115,850,377 0 0 0 0 0 0 0 24,268 0 115,826,109 450,789 79,006 15,027,234 24,268 101,352,937 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 25,378,644 0 0 0 0 0 0 0 0 0 25,378,644 0 1,533,664 0 0 26,912,307 59,394,956 12 0 12 141,633 455,545 393,306 62,239 161 0 59,394,806 0 0 95,557 161 59,095,538 74,792,137 0 0 0 1,738,304 5,772,114 2,467,849 3,304,264 117,386 0 74,674,751 0 235,270 0 117,386 69,984,838 291,715,515 3,055 792 2,263 1,879,937 6,227,659 2,861,155 3,366,504 147,419 0 291,570,359 450,789 7,543,198 15,122,791 147,419 279,342,533 89,361,345 13,175,332 13,730,682 222,478 238,064 0 0 0 0 0 1,875,325 799,214 1,561,175 485,064 (8,905) 2,544,205 2,553,110 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 22,711,941 341,848 251,814 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 49,118,877 6,240,625 5,787,581 3,549,095 2,787,601 17,388 18,139 141,633 455,545 393,306 0 0 0 0 2,787 2,837 50 0 0 50,929,766 2,070,008 (109,190) 554 1,649 0 0 1,738,304 5,772,114 2,467,849 (1,442) 5,780 77,510 84,732 (4,034,636) 7,781,564 11,816,200 0 0 222,955,979 23,269,251 21,977,066 3,795,694 3,059,351 17,388 18,139 1,879,937 6,227,659 2,861,155 2,244,166 978,779 1,945,855 680,468 (4,202,197) 10,562,594 14,764,792 0 0 90,674,639 249,107 5,202 11,919,482 0 79,009,467 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 22,801,975 0 952,735 0 0 23,754,709 50,533,749 0 0 334,445 0 49,995,432 62,183,632 0 70,328 0 0 57,211,391 236,676,559 249,107 5,837,649 12,253,927 0 225,262,947 17,941 0 0 541,547 for stand-alone vision policies. 0 0 0 0 0 0 51,691 73,167 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF Rhode Island DURING THE YEAR All Expenses 1 Improve Health Outcomes 1. Individual Comprehensive Coverage Expenses: 10,840 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 787 for affiliated services) 1.3 EDP Equipment and Software (incl $ 76 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 8 for affiliated services) 1.5 Accreditation and Certification (incl $ 25,095 for affiliated services) 1.6 Other Expenses (incl $ 1.7 Subtotal before Reimbursements and Taxes (Lines 1.1 to 1.6) 1.8 Reimbursements by uninsured plans and fiscal intermediaries 1.9 Taxes, Licenses and Fees (in total, for tying purposes) 1.10 Total (1.7 to 1.9) 1.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 2. 216-4.RI 3. 0 0 0 0 0 4,042 4,042 0 XXX Small Group Comprehensive Coverage Expenses: 339,693 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 24,424 for affiliated services) 2.3 EDP Equipment and Software (incl $ 2,344 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 255 for affiliated services) 2.5 Accreditation and Certification (incl $ 783,894 for affiliated services) 2.6 Other Expenses (incl $ 2.7 Subtotal before Reimbursements and Taxes (Lines 2.1 to 2.6) 2.8 Reimbursements by uninsured plans and fiscal intermediaries 2.9 Taxes, Licenses and Fees (in total, for tying purposes) 2.10 Total (2.7 to 2.9) 2.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX Total (1 to 5) 0 0 0 0 0 4,042 4,042 0 XXX 0 0 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 0 0 0 0 0 0 0 XXX (LOCATION) NAIC Company Code 2018 XXX 1,217 140 102 10 1 2,722 4,192 0 XXX 1,930 221 161 15 2 4,317 6,647 0 XXX 4,042 0 0 0 0 0 0 0 0 0 4,042 0 4,192 1,184 6,647 0 0 0 0 0 0 126,327 126,327 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 126,327 126,327 0 39,730 18,813 3,318 318 35 91,286 153,499 0 60,449 6,928 5,048 485 53 135,198 208,160 0 XXX Large Group Comprehensive Coverage Expenses: 2,433,949 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 163,048 for affiliated services) 3.3 EDP Equipment and Software (incl $ 15,651 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 1,699 for affiliated services) 3.5 Accreditation and Certification (incl $ 5,574,352 for affiliated services) 3.6 Other Expenses (incl $ 3.7 Subtotal before Reimbursements and Taxes (Lines 3.1 to 3.6) 3.8 Reimbursements by uninsured plans and fiscal intermediaries 3.9 Taxes, Licenses and Fees (in total, for tying purposes) 3.10 Total (3.7 to 3.9) 3.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 185 Asylum Street Hartford, CT 061033408 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX XXX XXX 126,327 0 0 0 0 0 0 0 0 0 126,327 0 153,499 39,064 208,160 0 0 0 0 0 0 926,609 926,609 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 926,609 926,609 0 341,745 120,949 28,537 2,739 297 785,859 1,280,127 0 484,817 55,561 40,485 3,886 422 1,084,326 1,669,497 0 926,609 0 XXX 1,280,127 355,096 XXX 1,669,497 0 XXX XXX XXX 0 0 0 XXX 926,609 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 79413 9 10 General Administrative Expenses Total Expenses (6 to 9) 7,692 720 525 50 5 151,029 160,021 0 8,533 168,555 0 10,840 1,081 787 76 8 162,110 174,902 0 8,533 183,436 1,184 239,514 24,250 16,059 1,541 167 1,738,983 2,020,515 0 286,327 2,306,842 0 339,693 49,990 24,424 2,344 255 2,091,795 2,508,501 0 286,327 2,794,828 39,064 1,607,386 181,090 94,026 9,025 980 3,714,765 5,607,273 0 2,519,437 8,126,710 0 2,433,949 357,600 163,048 15,651 1,699 6,511,559 9,483,506 0 2,519,437 12,002,943 355,096 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 4. 5. 216-5.RI 6. Individual Mini-Med Plans Expenses: 0 for affiliated services) 4.1 Salaries (including $ 4.2 Outsourced Services 0 for affiliated services) 4.3 EDP Equipment and Software (incl $ 0 for affiliated services) 4.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 4.5 Accreditation and Certification (incl $ 0 for affiliated services) 4.6 Other Expenses (incl $ 4.7 Subtotal before Reimbursements and Taxes (Lines 4.1 to 4.6) 4.8 Reimbursements by uninsured plans and fiscal intermediaries 4.9 Taxes, Licenses and Fees (in total, for tying purposes) 4.10 Total (4.7 to 4.9) 4.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Mini-Med Plans Expenses: 0 for affiliated services) 5.1 Salaries (including $ 5.2 Outsourced Services 0 for affiliated services) 5.3 EDP Equipment and Software (incl $ 0 for affiliated services) 5.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 5.5 Accreditation and Certification (incl $ 0 for affiliated services) 5.6 Other Expenses (incl $ 5.7 Subtotal before Reimbursements and Taxes (Lines 5.1 to 5.6) 5.8 Reimbursements by uninsured plans and fiscal intermediaries 5.9 Taxes, Licenses and Fees (in total, for tying purposes) 5.10 Total (5.7 to 5.9) 5.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Mini-Med Plans Expenses: 0 for affiliated services) 6.1 Salaries (including $ 6.2 Outsourced Services 0 for affiliated services) 6.3 EDP Equipment and Software (incl $ 0 for affiliated services) 6.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 6.5 Accreditation and Certification (incl $ 0 for affiliated services) 6.6 Other Expenses (incl $ 6.7 Subtotal before Reimbursements and Taxes (Lines 6.1 to 6.6) 6.8 Reimbursements by uninsured plans and fiscal intermediaries 6.9 Taxes, Licenses and Fees (in total, for tying purposes) 6.10 Total (6.7 to 6.9) 6.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 7. 8. 216-6.RI 9. Small Group Expatriate Plans Expenses: 0 for affiliated services) 7.1 Salaries (including $ 7.2 Outsourced Services 0 for affiliated services) 7.3 EDP Equipment and Software (incl $ 0 for affiliated services) 7.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 7.5 Accreditation and Certification (incl $ 0 for affiliated services) 7.6 Other Expenses (incl $ 7.7 Subtotal before Reimbursements and Taxes (Lines 7.1 to 7.6) 7.8 Reimbursements by uninsured plans and fiscal intermediaries 7.9 Taxes, Licenses and Fees (in total, for tying purposes) 7.10 Total (7.7 to 7.9) 7.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Expatriate Plans Expenses: 0 for affiliated services) 8.1 Salaries (including $ 8.2 Outsourced Services 0 for affiliated services) 8.3 EDP Equipment and Software (incl $ 0 for affiliated services) 8.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 8.5 Accreditation and Certification (incl $ 0 for affiliated services) 8.6 Other Expenses (incl $ 8.7 Subtotal before Reimbursements and Taxes (Lines 8.1 to 8.6) 8.8 Reimbursements by uninsured plans and fiscal intermediaries 8.9 Taxes, Licenses and Fees (in total, for tying purposes) 8.10 Total (8.7 to 8.9) 8.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Student Health Plans Expenses: 0 for affiliated services) 9.1 Salaries (including $ 9.2 Outsourced Services 0 for affiliated services) 9.3 EDP Equipment and Software (incl $ 0 for affiliated services) 9.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 9.5 Accreditation and Certification (incl $ 0 for affiliated services) 9.6 Other Expenses (incl $ 9.7 Subtotal before Reimbursements and Taxes (Lines 9.1 to 9.6) 9.8 Reimbursements by uninsured plans and fiscal intermediaries 9.9 Taxes, Licenses and Fees (in total, for tying purposes) 9.10 Total (9.7 to 9.9) 9.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 *79413201821641100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes - See Cautionary Statement at http://www.naic.org/documents/committees_e_app_blanks_related_shce_cautionary_statement.pdf) UnitedHealthcare Insurance Company 2. 185 Asylum Street Hartford, CT 061033408 (LOCATION) BUSINESS IN THE STATE OF South Carolina DURING THE YEAR 2018 NAIC Company Code Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 1. 216-1.SC 2. 3. 4. 5. 6. 7. 8. 9. Premium: 1.1 Health premiums earned (From Part 2, Line 1.11) 1.2 Federal high risk pools 1.3 State high risk pools 1.4 Premiums earned including state and federal high risk programs (Lines 1.1 + 1.2 + 1.3) 1.5 Federal taxes and federal assessments 1.6 State insurance, premium and other taxes (Similar local taxes of 217,327 ) $ 1.6a Community Benefit Expenditures (informational only) 1.7 Regulatory authority licenses and fees 1.8 Adjusted Premiums Earned (Lines 1.4 - 1.5 - 1.6 - 1.7) 1.9 Net Assumed less Ceded reinsurance premiums earned 1.10 Other Adjustments due to MLR calculations - Premiums 1.11 Risk Revenue 1.12 Net adjusted premiums earned after reinsurance (Lines 1.8 + 1.9 + 1.10 + 1.11) Claims: 2.1 Incurred claims excluding prescription drugs 2.2 Prescription drugs 2.3 Pharmaceutical rebates 2.4 State stop loss, market stabilization and claim/census based assessments (informational only) Incurred medical incentive pools and bonuses Deductible Fraud and Abuse Detection/Recovery Expenses (for MLR use only) 5.0 Total Incurred Claims (Lines 2.1 + 2.2 - 2.3 + 3) (From Part 2, Line 2.15) 5.1 Net Assumed less Ceded reinsurance claims incurred 5.2 Other Adjustments due to MLR calculations - Claims 5.3 Rebates paid 5.4 Estimated rebates unpaid prior year 5.5 Estimated rebates unpaid current year 5.6 Fee for service and co-pay revenue 5.7 Net incurred claims after reinsurance (Lines 5.0 + 5.1 + 5.2 + 5.3 - 5.4 + 5.5 - 5.6) Improving Health Care Quality Expenses Incurred: 6.1 Improve health outcomes 6.2 Activities to prevent hospital readmissions 6.3 Improve patient safety and reduce medical errors 6.4 Wellness and health promotion activities 6.5 Health Information Technology expenses related to health improvement 6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5) Preliminary Medical Loss Ratio: MLR ((Lines 4 + 5.0 + 6.6 - Footnote 2.0)/Line 1.8 Claims Adjustment Expenses: 8.1 Cost containment expenses not included in quality of care expenses in Line 6.6 8.2 All other claims adjustment expenses 8.3 Total claims adjustment expenses (Lines 8.1 + 8.2) Claims Adjustment Expense Ratio (Line 8.3/Line 1.8) 2 Small Group Employer 3 Large Group Employer 4 5 Small Group Employer Individual Expatriate Plans 6 Large Group Employer 7 11 Government Business (excluded by statute) Other Health Business 9 8 Small Group 10 Student Health Plans Large Group 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 79413 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 717,934 0 (1,091) 29,453,950 0 (14,888) 76,140,910 0 (13,335) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 187,599,123 0 101,441 1,868,269,208 0 0 2,162,181,124 0 72,128 XXX XXX XXX 716,842 58,686 29,439,062 1,630,864 76,127,575 2,061,736 0 0 0 0 0 0 0 0 0 0 0 0 0 0 187,700,565 1,524,517 1,868,269,208 90,729,985 2,162,253,252 96,005,788 XXX 3,414 0 428 654,315 0 0 0 654,315 487,142 0 4,234 27,316,821 0 8,482 0 27,325,303 1,213,961 0 6,453 72,845,426 (8,016,493) 0 0 64,828,933 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3,023,357 0 (42,265) 183,194,957 (70,711) 9,639 0 183,133,885 187,990 0 0 1,777,351,233 0 2,688,656 0 1,780,039,889 4,915,864 0 (31,151) 2,061,362,752 (8,087,204) 2,706,777 0 2,055,982,325 XXX XXX XXX XXX XXX 4,915,864 0 (31,151) 2,061,362,752 (8,087,204) 2,706,777 0 2,055,982,325 380,518 49,554 8,138 18,202,365 3,846,394 1,007,558 54,825,462 13,312,450 4,353,440 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 144,922,882 980,579 90,943 1,308,087,700 330,660,006 211,929,955 1,526,418,927 348,848,983 217,390,033 XXX XXX XXX 1,526,418,927 348,848,983 217,390,033 1 0 0 421,934 0 0 0 0 0 0 421,934 16,508 8,515 12,225 21,049,716 0 (609,363) 553,826 0 55,537 0 21,049,716 45,796 28,584 5,577 63,813,056 (6,178,454) 0 0 0 0 0 57,634,603 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,492,321 74,890 1,428,310,071 0 (1,267,468) 91,344 60,896 1,237,020 0 1,428,310,071 95,497 1,529,420 92,692 1,659,407,297 (6,109,139) (1,876,831) 645,170 60,896 1,292,556 0 1,653,298,157 XXX XXX 0 0 33,192 0 0 145,812,518 69,315 0 XXX XXX XXX 0 145,881,833 95,497 1,529,420 92,692 1,659,407,297 (6,109,139) (1,876,831) 645,170 60,896 1,292,556 0 1,653,298,157 0 0 0 0 0 517,488 213,493 161,022 1,535,854 106,133 12,447,862 4,455,673 3,760,410 1,076,340 5,388,504 13,815,852 4,669,166 3,921,432 2,612,194 5,494,637 0 2,533,989 XXX 27,128,789 0.819 30,513,280 XXX 123,659 2,951,423 3,075,082 0.017 15,149,202 30,535,239 45,684,441 0.026 16,414,074 35,080,624 51,494,697 XXX 5,743 0 0 0 0 235,632 0 0 0 0 609,127 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5,743 0.651 235,632 0.780 609,127 0.884 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 3,213 8,811 12,024 0.018 306,680 440,606 747,286 0.027 831,320 1,144,545 1,975,865 0.027 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 XXX XXX XXX XXX 0 0 0 0.000 2,162,181,124 0 72,128 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 13,815,852 4,669,166 3,921,432 2,612,194 5,494,637 0 30,513,280 XXX 0 0 0 16,414,074 35,080,624 51,494,697 XXX XXX XXX 2,162,253,252 96,005,787 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 (Continued) Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 10. General and Administrative (G&A) Expenses: 10.1 Direct sales salaries and benefits 10.2 Agents and brokers fees and commissions 10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below) 10.4 Other general and administrative expenses 10.4a Community Benefit Expenditures (informational only) 10.5 Total general and administrative (Lines 10.1 +10.2 + 10.3 + 10.4) 3 Large Group Employer 2 Small Group Employer 692 6,480 (1,658) 36,879 0 42,393 100,348 861,694 (8,120) 1,486,885 0 2,440,807 4 5 Small Group Employer Individual 307,162 3,019,020 86,817 2,118,354 0 5,531,353 0 0 0 0 0 0 Expatriate Plans 6 Large Group Employer 0 0 0 0 0 0 7 8 Small Group 0 0 0 0 0 0 Student Health Plans Large Group 0 0 0 0 0 0 10 11 Government Business (excluded by statute) Other Health Business 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 303,385 7,424,230 361,659 19,030,692 0 27,119,966 2,675,193 2,733,977 2,517,395 75,094,201 0 83,020,766 3,386,779 14,045,402 2,956,093 97,767,011 0 118,155,285 4,523,016 0 0 0 0 0 0 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) 195,895,822 202,520,905 12. Income from fees of uninsured plans XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 13. Net investment and other gain/(loss) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 31,855,788 XXX 14. Federal income taxes (excluding taxes on Line 1.5 above) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 1,460,402 XXX 1,460,402 15. Net gain or (loss) (Lines 11 + 12 + 13 - 14) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 232,916,292 XXX 232,916,291 16. ICD-10 Implementation Expenses (informational only; already included in general expenses and line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16. 16a ICD-10 Implementation Expenses (informational only; already included in line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 172,220 2,851,862 (922,015) 0 0 0 0 0 0 0 XXX 3,386,779 14,045,402 2,956,093 97,767,011 0 118,155,285 202,520,905 0 0 31,855,788 OTHER INDICATORS: 216-2.SC 1. Number of certificates/policies 64 2,602 8,374 0 0 0 0 0 0 0 114,088 190,055 315,183 0 315,183 2. Number of Covered Lives 72 4,444 13,063 0 0 0 0 0 0 0 128,570 190,055 336,204 0 336,204 3. Number of Groups 357 151 0 0 0 0 0 0 1,029 2 1,539 0 1,539 4. Member Months 56,156 173,198 0 0 0 0 0 0 1,550,631 2,248,595 4,029,518 0 4,029,518 XXX 938 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ XXX 0 ] If yes, show the amount of premiums and claims included. Premiums $ 0 Claims $ 0 AFFORDABLE CARE ACT (ACA) RECEIPTS, PAYMENTS, RECEIVABLES and PAYABLES Current Year Prior Year Comprehensive Health Coverage Comprehensive Health Coverage 1 2 3 4 Small Group Small Group Employer Plans Employer Plans Individual Plans Individual Plans ACA Receivables and Payables 1. Permanent ACA Risk Adjustment Program 1.0 Premium adjustments receivable/(payable) 2. Transitional ACA Reinsurance Program 2.0 Total amounts recoverable for claims (paid & unpaid) 1,487 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 0 0 0 0 0 0 0 0 219,250 1,338,740 519,684 227,780 38,141 603,066 XXX 201,691 51,777 1,128,242 XXX ACA Receipts and Payments 4. Permanent ACA Risk Adjustment Program 4.0 Premium adjustments receipts/(payments) 5. Transitional ACA Reinsurance Program 5.0 Amounts received for claims 6. Temporary ACA Risk Corridors Program 6.1 Retrospective premium received 6.2 Rate credits or policy experience refunds paid 50,290 0 0 XXX 254,976 0 0 0 0 XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF 185 Asylum Street Hartford, CT 061033408 South Carolina DURING THE YEAR Comprehensive Health Coverage 1 2 3 Individual Small Group Employer Large Group Employer Small Group Employer Individual Expatriate Plans: 7 8 6 Large Group Employer Small Group 10 11 Government Business (excluded by statute) Other Health Business 9 Student Health Plans Large Group 79413 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.SC Health Premiums Earned: 717,934 29,454,082 1.1 Direct premiums written 0 29,490 1.2 Unearned premium prior year 0 21,140 1.3 Unearned premium current year 0 8,349 1.4 Change in unearned premium (Lines 1.2 - 1.3) 192,755 553,826 1.5 Paid rate credits 0 55,537 1.6 Reserve for rate credits current year 0 0 1.7 Reserve for rate credits prior year 0 55,537 1.8 Change in reserve for rate credits (Lines 1.6 - 1.7) 0 8,482 1.9 Premium balances written off 0 0 1.10 Group conversion charge 717,934 29,453,950 1.11 Total direct premiums earned (Lines 1.1 + 1.4 - 1.9 + 1.10) 0 0 1.12 Assumed premiums earned from non-affiliates 0 0 1.13 Net Assumed less Ceded premiums earned from affiliates 0 0 1.14 Ceded premiums earned to non-affiliates 0 8,482 1.15 Other Adjustments due to MLR calculation - Premiums 525,179 28,853,069 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 332,188 20,393,462 2.1 Paid claims during the year 24,308 2,524,681 2.2 Direct claim liability current year 53,511 2,592,715 2.3 Direct claim liability prior year 2,399 61,582 2.4 Direct claim reserves current year 3,624 53,411 2.5 Direct claim reserves prior year 193,496 0 2.6 Direct contract reserves current year 266,026 0 2.7 Direct contract reserves prior year 192,755 553,826 2.8 Paid rate credits 0 55,537 2.9 Reserve for rate credits current year 0 0 2.10 Reserve for rate credits prior year 0 8,515 2.11 Incurred medical incentive pools and bonuses (Lines 2.11a + 2.11b - 2.11c) 0 5,612 2.11a Paid medical incentive pools and bonuses current year 0 10,745 2.11b Accrued medical incentive pools and bonuses current year 0 7,842 2.11c Accrued medical incentive pools and bonuses prior year 51 (98,239) 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 1,495 434,524 2.12a Healthcare receivables current year 1,444 532,764 2.12b Healthcare receivables prior year 0 0 2.13 Group conversion charge 0 0 2.14 Multi-option coverage blended rate adjustment 2.15 Total incurred claims (Lines 2.1 + 2.2 - 2.3 + 2.4 - 2.5 + 2.6 - 2.7 + 2.8 + 2.9 421,934 21,049,716 2.10 + 2.11 - 2.12 + 2.13 + 2.14) 0 0 2.16 Assumed incurred claims from non-affiliates 0 0 2.17 Net assumed less ceded incurred claims from affiliates 0 0 2.18 Ceded incurred claims to non-affiliates 0 0 2.19 Other adjustments due to MLR calculation - Claims 229,179 20,440,353 2.20 Net Incurred Claims (Lines 2.15 - 2.8 - 2.9 + 2.10 + 2.16 + 2.17 - 2.18 + 2.19) 3. Fraud and Abuse Recoveries that Reduced PAID Claims in Line 2.1 above 0 12,225 (informational only) 3,394,734 for stand-alone dental and $ (a) Column 13, Line 1.1 includes direct written premium of $ 4 Business Subject to MLR Mini-Med Plans 5 (LOCATION) NAIC Company Code 2018 76,141,269 (359) 0 (359) (3,890) 0 0 0 0 0 76,140,910 0 0 8,016,493 0 68,128,307 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 187,864,106 989,774 1,245,118 (255,344) (3,187,779) 105,387 46,781 58,606 9,639 0 187,599,123 0 0 70,711 9,639 190,667,225 1,870,957,865 0 0 0 279,112 6,000,072 5,215,118 784,955 2,688,656 0 1,868,269,209 0 0 0 2,688,656 1,869,893,798 2,165,135,256 1,018,905 1,266,259 (247,354) (2,165,975) 6,160,996 5,261,899 899,097 2,706,777 0 2,162,181,125 0 0 8,087,204 2,706,777 2,158,067,577 65,784,290 8,175,836 10,534,251 186,148 287,997 0 0 (3,890) 0 0 28,584 15,417 39,569 26,403 (464,336) 1,621,827 2,086,163 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 148,185,335 20,132,474 18,871,333 5,394,678 5,890,608 36,328 30,300 (3,187,779) 105,387 46,781 0 0 0 0 14,882 36,774 21,892 0 0 1,439,458,130 216,459,095 212,462,203 289,940 271,770 0 0 279,112 6,000,072 5,215,118 1,492,321 2,984,990 1,764,128 3,256,797 17,719,509 95,961,489 78,241,981 0 0 1,674,153,405 247,316,394 244,514,013 5,934,746 6,507,410 229,824 296,326 (2,165,975) 6,160,996 5,261,899 1,529,420 3,006,020 1,814,442 3,291,041 17,171,866 98,056,110 80,884,244 0 0 63,813,056 0 0 6,178,454 0 57,638,492 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 145,812,518 0 0 (69,315) 0 149,011,006 1,428,310,072 0 0 0 0 1,427,246,004 1,659,407,297 0 0 6,109,139 0 1,654,565,036 5,577 0 0 1,659,905 for stand-alone vision policies. 0 0 0 0 0 74,890 92,692 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF South Carolina DURING THE YEAR All Expenses 1 Improve Health Outcomes 1. Individual Comprehensive Coverage Expenses: 17,796 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 635 for affiliated services) 1.3 EDP Equipment and Software (incl $ 61 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 7 for affiliated services) 1.5 Accreditation and Certification (incl $ 17,196 for affiliated services) 1.6 Other Expenses (incl $ 1.7 Subtotal before Reimbursements and Taxes (Lines 1.1 to 1.6) 1.8 Reimbursements by uninsured plans and fiscal intermediaries 1.9 Taxes, Licenses and Fees (in total, for tying purposes) 1.10 Total (1.7 to 1.9) 1.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 2. 216-4.SC 3. 0 0 0 0 0 5,743 5,743 0 XXX Small Group Comprehensive Coverage Expenses: 661,368 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 47,149 for affiliated services) 2.3 EDP Equipment and Software (incl $ 4,526 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 491 for affiliated services) 2.5 Accreditation and Certification (incl $ 1,478,724 for affiliated services) 2.6 Other Expenses (incl $ 2.7 Subtotal before Reimbursements and Taxes (Lines 2.1 to 2.6) 2.8 Reimbursements by uninsured plans and fiscal intermediaries 2.9 Taxes, Licenses and Fees (in total, for tying purposes) 2.10 Total (2.7 to 2.9) 2.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX Total (1 to 5) 0 0 0 0 0 5,743 5,743 0 XXX 0 0 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 0 0 0 0 0 0 0 XXX (LOCATION) NAIC Company Code 2018 XXX 911 111 76 7 1 2,042 3,149 0 XXX 4,549 153 103 10 1 3,927 8,742 0 XXX 5,743 0 0 0 0 0 0 0 0 0 5,743 0 3,149 556 8,742 0 0 0 0 0 0 235,632 235,632 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 235,632 235,632 0 78,329 31,303 6,541 628 68 180,457 297,326 0 125,059 14,332 10,443 1,002 109 279,702 430,647 0 XXX Large Group Comprehensive Coverage Expenses: 1,562,418 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 105,742 for affiliated services) 3.3 EDP Equipment and Software (incl $ 10,150 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 1,102 for affiliated services) 3.5 Accreditation and Certification (incl $ 3,553,918 for affiliated services) 3.6 Other Expenses (incl $ 3.7 Subtotal before Reimbursements and Taxes (Lines 3.1 to 3.6) 3.8 Reimbursements by uninsured plans and fiscal intermediaries 3.9 Taxes, Licenses and Fees (in total, for tying purposes) 3.10 Total (3.7 to 3.9) 3.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 185 Asylum Street Hartford, CT 061033408 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX XXX XXX 235,632 0 0 0 0 0 0 0 0 0 235,632 0 297,326 80,748 430,647 0 0 0 0 0 0 609,127 609,127 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 609,127 609,127 0 220,499 56,450 18,413 1,767 192 507,679 805,000 0 325,625 37,317 27,191 2,610 283 728,282 1,121,309 0 805,000 240,785 XXX 1,121,309 0 XXX XXX XXX 0 0 0 XXX 609,127 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 609,127 0 79413 9 10 General Administrative Expenses Total Expenses (6 to 9) 12,337 604 456 29 5 30,572 44,002 0 2,365 46,368 0 17,796 868 635 46 7 42,285 61,637 0 2,365 64,002 556 457,981 51,455 30,165 2,896 314 1,899,020 2,441,831 0 509,667 2,951,497 0 661,368 97,090 47,149 4,526 491 2,594,810 3,405,435 0 509,667 3,915,101 80,748 1,016,295 87,573 60,138 5,773 627 4,252,746 5,423,151 0 1,378,171 6,801,322 0 1,562,418 181,340 105,742 10,150 1,102 6,097,835 7,958,588 0 1,378,171 9,336,759 240,785 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 4. 5. 216-5.SC 6. Individual Mini-Med Plans Expenses: 0 for affiliated services) 4.1 Salaries (including $ 4.2 Outsourced Services 0 for affiliated services) 4.3 EDP Equipment and Software (incl $ 0 for affiliated services) 4.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 4.5 Accreditation and Certification (incl $ 0 for affiliated services) 4.6 Other Expenses (incl $ 4.7 Subtotal before Reimbursements and Taxes (Lines 4.1 to 4.6) 4.8 Reimbursements by uninsured plans and fiscal intermediaries 4.9 Taxes, Licenses and Fees (in total, for tying purposes) 4.10 Total (4.7 to 4.9) 4.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Mini-Med Plans Expenses: 0 for affiliated services) 5.1 Salaries (including $ 5.2 Outsourced Services 0 for affiliated services) 5.3 EDP Equipment and Software (incl $ 0 for affiliated services) 5.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 5.5 Accreditation and Certification (incl $ 0 for affiliated services) 5.6 Other Expenses (incl $ 5.7 Subtotal before Reimbursements and Taxes (Lines 5.1 to 5.6) 5.8 Reimbursements by uninsured plans and fiscal intermediaries 5.9 Taxes, Licenses and Fees (in total, for tying purposes) 5.10 Total (5.7 to 5.9) 5.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Mini-Med Plans Expenses: 0 for affiliated services) 6.1 Salaries (including $ 6.2 Outsourced Services 0 for affiliated services) 6.3 EDP Equipment and Software (incl $ 0 for affiliated services) 6.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 6.5 Accreditation and Certification (incl $ 0 for affiliated services) 6.6 Other Expenses (incl $ 6.7 Subtotal before Reimbursements and Taxes (Lines 6.1 to 6.6) 6.8 Reimbursements by uninsured plans and fiscal intermediaries 6.9 Taxes, Licenses and Fees (in total, for tying purposes) 6.10 Total (6.7 to 6.9) 6.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 7. 8. 216-6.SC 9. Small Group Expatriate Plans Expenses: 0 for affiliated services) 7.1 Salaries (including $ 7.2 Outsourced Services 0 for affiliated services) 7.3 EDP Equipment and Software (incl $ 0 for affiliated services) 7.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 7.5 Accreditation and Certification (incl $ 0 for affiliated services) 7.6 Other Expenses (incl $ 7.7 Subtotal before Reimbursements and Taxes (Lines 7.1 to 7.6) 7.8 Reimbursements by uninsured plans and fiscal intermediaries 7.9 Taxes, Licenses and Fees (in total, for tying purposes) 7.10 Total (7.7 to 7.9) 7.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Expatriate Plans Expenses: 0 for affiliated services) 8.1 Salaries (including $ 8.2 Outsourced Services 0 for affiliated services) 8.3 EDP Equipment and Software (incl $ 0 for affiliated services) 8.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 8.5 Accreditation and Certification (incl $ 0 for affiliated services) 8.6 Other Expenses (incl $ 8.7 Subtotal before Reimbursements and Taxes (Lines 8.1 to 8.6) 8.8 Reimbursements by uninsured plans and fiscal intermediaries 8.9 Taxes, Licenses and Fees (in total, for tying purposes) 8.10 Total (8.7 to 8.9) 8.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Student Health Plans Expenses: 0 for affiliated services) 9.1 Salaries (including $ 9.2 Outsourced Services 0 for affiliated services) 9.3 EDP Equipment and Software (incl $ 0 for affiliated services) 9.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 9.5 Accreditation and Certification (incl $ 0 for affiliated services) 9.6 Other Expenses (incl $ 9.7 Subtotal before Reimbursements and Taxes (Lines 9.1 to 9.6) 9.8 Reimbursements by uninsured plans and fiscal intermediaries 9.9 Taxes, Licenses and Fees (in total, for tying purposes) 9.10 Total (9.7 to 9.9) 9.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 *79413201821642100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes - See Cautionary Statement at http://www.naic.org/documents/committees_e_app_blanks_related_shce_cautionary_statement.pdf) UnitedHealthcare Insurance Company 2. 185 Asylum Street Hartford, CT 061033408 (LOCATION) BUSINESS IN THE STATE OF South Dakota DURING THE YEAR 2018 NAIC Company Code Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 2 Small Group Employer Individual 1. 216-1.SD 2. 3. 4. 5. 6. 7. 8. 9. Premium: 1.1 Health premiums earned (From Part 2, Line 1.11) 1.2 Federal high risk pools 1.3 State high risk pools 1.4 Premiums earned including state and federal high risk programs (Lines 1.1 + 1.2 + 1.3) 1.5 Federal taxes and federal assessments 1.6 State insurance, premium and other taxes (Similar local taxes of 1,817 ) $ 1.6a Community Benefit Expenditures (informational only) 1.7 Regulatory authority licenses and fees 1.8 Adjusted Premiums Earned (Lines 1.4 - 1.5 - 1.6 - 1.7) 1.9 Net Assumed less Ceded reinsurance premiums earned 1.10 Other Adjustments due to MLR calculations - Premiums 1.11 Risk Revenue 1.12 Net adjusted premiums earned after reinsurance (Lines 1.8 + 1.9 + 1.10 + 1.11) Claims: 2.1 Incurred claims excluding prescription drugs 2.2 Prescription drugs 2.3 Pharmaceutical rebates 2.4 State stop loss, market stabilization and claim/census based assessments (informational only) Incurred medical incentive pools and bonuses Deductible Fraud and Abuse Detection/Recovery Expenses (for MLR use only) 5.0 Total Incurred Claims (Lines 2.1 + 2.2 - 2.3 + 3) (From Part 2, Line 2.15) 5.1 Net Assumed less Ceded reinsurance claims incurred 5.2 Other Adjustments due to MLR calculations - Claims 5.3 Rebates paid 5.4 Estimated rebates unpaid prior year 5.5 Estimated rebates unpaid current year 5.6 Fee for service and co-pay revenue 5.7 Net incurred claims after reinsurance (Lines 5.0 + 5.1 + 5.2 + 5.3 - 5.4 + 5.5 - 5.6) Improving Health Care Quality Expenses Incurred: 6.1 Improve health outcomes 6.2 Activities to prevent hospital readmissions 6.3 Improve patient safety and reduce medical errors 6.4 Wellness and health promotion activities 6.5 Health Information Technology expenses related to health improvement 6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5) Preliminary Medical Loss Ratio: MLR ((Lines 4 + 5.0 + 6.6 - Footnote 2.0)/Line 1.8 Claims Adjustment Expenses: 8.1 Cost containment expenses not included in quality of care expenses in Line 6.6 8.2 All other claims adjustment expenses 8.3 Total claims adjustment expenses (Lines 8.1 + 8.2) Claims Adjustment Expense Ratio (Line 8.3/Line 1.8) 3 Large Group Employer 4 5 Small Group Employer Individual Expatriate Plans 6 Large Group Employer 7 11 Government Business (excluded by statute) Other Health Business 9 8 Small Group 10 Student Health Plans Large Group 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 79413 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 0 0 0 0 0 (858) 6,176 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 12,487,516 0 7,283 4,634,325 0 0 17,128,017 0 6,425 XXX XXX XXX 0 48 (858) 398 6,176 1,554 0 0 0 0 0 0 0 0 0 0 0 0 0 0 12,494,799 113,265 4,634,325 (19,196) 17,134,443 96,069 XXX (57) 0 0 4,679 0 0 0 4,679 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 225,245 0 (3,086) 12,159,376 0 229 0 12,159,604 679 0 0 4,652,841 0 49,265 0 4,702,106 225,693 0 (3,088) 16,815,770 0 49,494 0 16,865,264 XXX XXX XXX XXX XXX 225,693 0 (3,088) 16,815,770 0 49,494 0 16,865,264 0 0 0 (48) 0 0 0 (48) (174) 0 (3) (1,078) 0 0 0 (1,078) 17,128,017 0 6,425 0 0 0 0 17,134,443 96,069 58 0 0 0 0 0 (141) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 9,418,617 3,975 1,158 (85,761) 10,492,475 6,041,643 9,332,773 10,496,450 6,042,802 XXX XXX XXX 9,332,773 10,496,450 6,042,802 0 0 0 58 0 0 0 0 0 0 58 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (141) 0 0 0 0 0 0 (141) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4,365,071 0 0 0 0 0 0 4,365,071 0 0 0 13,786,421 0 0 0 0 0 0 13,786,421 XXX XXX 0 0 0 0 0 9,421,433 0 0 XXX XXX XXX 0 9,421,433 0 0 0 13,786,421 0 0 0 0 0 0 13,786,421 0 0 0 0 0 0 0 0 0 0 49 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 70,060 60,180 44,747 102,724 14,634 0 292,345 XXX 0 (1.204) 0 0.000 49 (0.020) 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0 0 0.000 0 0 0 0.000 0 61 61 0.013 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 XXX XXX XXX XXX 0 0 0 0.000 3,252 191,262 194,514 0.016 3,837 2,840 1,573 (4,148) 6,867 0 XXX XXX XXX XXX XXX XXX XXX XXX 73,947 63,021 46,320 98,576 21,500 10,969 0.941 303,364 XXX (20,861) 61,053 40,191 0.009 (17,610) 252,376 234,766 XXX 0 0 0 0 0 73,947 63,021 46,320 98,576 21,500 0 303,364 XXX 0 0 0 (17,610) 252,376 234,766 XXX XXX XXX SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 (Continued) Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 10. General and Administrative (G&A) Expenses: 10.1 Direct sales salaries and benefits 10.2 Agents and brokers fees and commissions 10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below) 10.4 Other general and administrative expenses 10.4a Community Benefit Expenditures (informational only) 10.5 Total general and administrative (Lines 10.1 +10.2 + 10.3 + 10.4) 3 Large Group Employer 2 Small Group Employer 0 0 (297) 0 0 (297) 0 0 (2,679) 0 0 (2,679) 4 5 Small Group Employer Individual 0 0 (36) 240 0 204 0 0 0 0 0 0 Expatriate Plans 6 Large Group Employer 0 0 0 0 0 0 7 8 Small Group 0 0 0 0 0 0 Student Health Plans Large Group 0 0 0 0 0 0 10 11 Government Business (excluded by statute) Other Health Business 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16,464 467,907 23,436 1,278,397 0 1,786,204 15,764 56,451 10,549 307,338 0 390,102 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 32,229 524,358 30,973 1,585,975 0 2,173,534 0 0 0 0 0 0 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) 12. Income from fees of uninsured plans XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 13. Net investment and other gain/(loss) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 14. Federal income taxes (excluding taxes on Line 1.5 above) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 15. Net gain or (loss) (Lines 11 + 12 + 13 - 14) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 16. ICD-10 Implementation Expenses (informational only; already included in general expenses and line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16. 16a ICD-10 Implementation Expenses (informational only; already included in line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 192 1,601 4,506 0 0 0 0 0 0 0 465,108 (104,228) 367,179 XXX 32,229 524,358 30,973 1,585,975 0 2,173,534 XXX 367,179 0 0 185,241 XXX XXX 10,781 XXX 10,781 XXX 541,639 XXX 541,639 185,241 OTHER INDICATORS: 216-2.SD 1. Number of certificates/policies 0 0 0 0 0 0 0 0 0 0 6,624 7,002 13,626 0 13,626 2. Number of Covered Lives 0 0 0 0 0 0 0 0 0 0 7,066 7,002 14,068 0 14,068 3. Number of Groups 0 0 0 0 0 0 19 0 19 0 19 4. Member Months 0 0 0 0 0 0 84,408 83,770 169,708 0 169,708 XXX 0 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ 0 0 0 1,530 XXX 0 ] If yes, show the amount of premiums and claims included. Premiums $ 0 Claims $ 0 AFFORDABLE CARE ACT (ACA) RECEIPTS, PAYMENTS, RECEIVABLES and PAYABLES Current Year Prior Year Comprehensive Health Coverage Comprehensive Health Coverage 1 2 3 4 Small Group Small Group Employer Plans Employer Plans Individual Plans Individual Plans ACA Receivables and Payables 1. Permanent ACA Risk Adjustment Program 1.0 Premium adjustments receivable/(payable) 0 2. Transitional ACA Reinsurance Program 2.0 Total amounts recoverable for claims (paid & unpaid) 0 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 0 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 XXX ACA Receipts and Payments 4. Permanent ACA Risk Adjustment Program 4.0 Premium adjustments receipts/(payments) 0 5. Transitional ACA Reinsurance Program 5.0 Amounts received for claims 0 6. Temporary ACA Risk Corridors Program 6.1 Retrospective premium received 6.2 Rate credits or policy experience refunds paid 0 0 XXX 0 0 0 0 0 XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF 185 Asylum Street Hartford, CT 061033408 South Dakota DURING THE YEAR Comprehensive Health Coverage 1 2 3 Individual Small Group Employer Large Group Employer Small Group Employer Individual Expatriate Plans: 7 8 6 Large Group Employer Small Group 10 11 Government Business (excluded by statute) Other Health Business 9 Student Health Plans Large Group 79413 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.SD Health Premiums Earned: 0 1.1 Direct premiums written 0 1.2 Unearned premium prior year 0 1.3 Unearned premium current year 0 1.4 Change in unearned premium (Lines 1.2 - 1.3) 58 1.5 Paid rate credits 0 1.6 Reserve for rate credits current year 0 1.7 Reserve for rate credits prior year 0 1.8 Change in reserve for rate credits (Lines 1.6 - 1.7) 0 1.9 Premium balances written off 0 1.10 Group conversion charge 0 1.11 Total direct premiums earned (Lines 1.1 + 1.4 - 1.9 + 1.10) 0 1.12 Assumed premiums earned from non-affiliates 0 1.13 Net Assumed less Ceded premiums earned from affiliates 0 1.14 Ceded premiums earned to non-affiliates 0 1.15 Other Adjustments due to MLR calculation - Premiums (58) 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 0 2.1 Paid claims during the year 0 2.2 Direct claim liability current year 0 2.3 Direct claim liability prior year 0 2.4 Direct claim reserves current year 0 2.5 Direct claim reserves prior year 0 2.6 Direct contract reserves current year 0 2.7 Direct contract reserves prior year 58 2.8 Paid rate credits 0 2.9 Reserve for rate credits current year 0 2.10 Reserve for rate credits prior year 0 2.11 Incurred medical incentive pools and bonuses (Lines 2.11a + 2.11b - 2.11c) 0 2.11a Paid medical incentive pools and bonuses current year 0 2.11b Accrued medical incentive pools and bonuses current year 0 2.11c Accrued medical incentive pools and bonuses prior year 0 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 0 2.12a Healthcare receivables current year 0 2.12b Healthcare receivables prior year 0 2.13 Group conversion charge 0 2.14 Multi-option coverage blended rate adjustment 2.15 Total incurred claims (Lines 2.1 + 2.2 - 2.3 + 2.4 - 2.5 + 2.6 - 2.7 + 2.8 + 2.9 58 2.10 + 2.11 - 2.12 + 2.13 + 2.14) 0 2.16 Assumed incurred claims from non-affiliates 0 2.17 Net assumed less ceded incurred claims from affiliates 0 2.18 Ceded incurred claims to non-affiliates 0 2.19 Other adjustments due to MLR calculation - Claims 0 2.20 Net Incurred Claims (Lines 2.15 - 2.8 - 2.9 + 2.10 + 2.16 + 2.17 - 2.18 + 2.19) 3. Fraud and Abuse Recoveries that Reduced PAID Claims in Line 2.1 above 0 (informational only) 41,231 for stand-alone dental and $ (a) Column 13, Line 1.1 includes direct written premium of $ 4 Business Subject to MLR Mini-Med Plans 5 (LOCATION) NAIC Company Code 2018 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6,176 0 0 0 (58) 0 0 0 0 0 6,176 0 0 0 0 6,234 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 12,487,745 0 0 0 (844,015) 0 0 0 229 0 12,487,516 0 0 0 229 13,331,760 4,683,590 0 0 0 0 272,523 358,151 (85,629) 49,265 0 4,634,325 0 0 0 49,265 4,769,218 17,177,511 0 0 0 (844,015) 272,523 358,151 (85,629) 49,494 0 17,128,017 0 0 0 49,494 18,107,155 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 83 0 0 0 0 (58) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10,451,498 1,516,429 1,715,823 349,520 334,992 15,206 16,035 (844,015) 0 0 0 0 0 0 355 355 0 0 0 3,174,938 461,782 369,307 0 0 0 0 0 272,523 358,151 0 0 0 0 (1,183,287) 1,582,678 2,765,965 0 0 13,626,436 1,978,211 2,085,213 349,520 334,992 15,206 16,035 (844,015) 272,523 358,151 0 0 0 0 (1,182,932) 1,583,033 2,765,965 0 0 0 0 0 0 0 0 (141) 0 0 0 0 (83) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 9,421,433 0 0 0 0 10,265,448 4,365,071 0 0 0 0 4,450,700 13,786,421 0 0 0 0 14,716,064 0 0 0 0 24,119 for stand-alone vision policies. 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF South Dakota DURING THE YEAR Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities All Expenses 1 2 Activities to Prevent Hospital Readmissions Improve Health Outcomes 1. 2. 216-4.SD 3. Individual Comprehensive Coverage Expenses: 0 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 0 for affiliated services) 1.3 EDP Equipment and Software (incl $ 0 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 1.5 Accreditation and Certification (incl $ 0 for affiliated services) 1.6 Other Expenses (incl $ 1.7 Subtotal before Reimbursements and Taxes (Lines 1.1 to 1.6) 1.8 Reimbursements by uninsured plans and fiscal intermediaries 1.9 Taxes, Licenses and Fees (in total, for tying purposes) 1.10 Total (1.7 to 1.9) 1.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Comprehensive Coverage Expenses: 0 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 0 for affiliated services) 2.3 EDP Equipment and Software (incl $ 0 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 2.5 Accreditation and Certification (incl $ 0 for affiliated services) 2.6 Other Expenses (incl $ 2.7 Subtotal before Reimbursements and Taxes (Lines 2.1 to 2.6) 2.8 Reimbursements by uninsured plans and fiscal intermediaries 2.9 Taxes, Licenses and Fees (in total, for tying purposes) 2.10 Total (2.7 to 2.9) 2.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 0 0 0 0 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX Total (1 to 5) 0 0 0 0 0 0 0 0 XXX 0 0 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 0 0 0 0 0 0 0 XXX (LOCATION) NAIC Company Code 2018 XXX 0 0 0 0 0 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX Large Group Comprehensive Coverage Expenses: 25 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 2 for affiliated services) 3.3 EDP Equipment and Software (incl $ 0 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 3.5 Accreditation and Certification (incl $ 307 for affiliated services) 3.6 Other Expenses (incl $ 3.7 Subtotal before Reimbursements and Taxes (Lines 3.1 to 3.6) 3.8 Reimbursements by uninsured plans and fiscal intermediaries 3.9 Taxes, Licenses and Fees (in total, for tying purposes) 3.10 Total (3.7 to 3.9) 3.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 185 Asylum Street Hartford, CT 061033408 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 49 49 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 49 49 0 0 0 0 0 0 0 0 0 17 2 1 0 0 38 59 0 XXX XXX XXX 0 0 0 XXX 49 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 49 0 XXX 0 0 59 0 79413 9 10 General Administrative Expenses Total Expenses (6 to 9) 0 0 0 0 0 0 0 0 (297) (297) 0 0 0 0 0 0 0 0 0 (297) (297) 0 0 0 0 0 0 0 0 0 (2,856) (2,856) 0 0 0 0 0 0 0 0 0 (2,856) (2,856) 0 8 1 1 0 0 221 231 0 (82) 149 0 25 3 2 0 0 309 339 0 (82) 257 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 4. 5. 216-5.SD 6. Individual Mini-Med Plans Expenses: 0 for affiliated services) 4.1 Salaries (including $ 4.2 Outsourced Services 0 for affiliated services) 4.3 EDP Equipment and Software (incl $ 0 for affiliated services) 4.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 4.5 Accreditation and Certification (incl $ 0 for affiliated services) 4.6 Other Expenses (incl $ 4.7 Subtotal before Reimbursements and Taxes (Lines 4.1 to 4.6) 4.8 Reimbursements by uninsured plans and fiscal intermediaries 4.9 Taxes, Licenses and Fees (in total, for tying purposes) 4.10 Total (4.7 to 4.9) 4.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Mini-Med Plans Expenses: 0 for affiliated services) 5.1 Salaries (including $ 5.2 Outsourced Services 0 for affiliated services) 5.3 EDP Equipment and Software (incl $ 0 for affiliated services) 5.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 5.5 Accreditation and Certification (incl $ 0 for affiliated services) 5.6 Other Expenses (incl $ 5.7 Subtotal before Reimbursements and Taxes (Lines 5.1 to 5.6) 5.8 Reimbursements by uninsured plans and fiscal intermediaries 5.9 Taxes, Licenses and Fees (in total, for tying purposes) 5.10 Total (5.7 to 5.9) 5.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Mini-Med Plans Expenses: 0 for affiliated services) 6.1 Salaries (including $ 6.2 Outsourced Services 0 for affiliated services) 6.3 EDP Equipment and Software (incl $ 0 for affiliated services) 6.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 6.5 Accreditation and Certification (incl $ 0 for affiliated services) 6.6 Other Expenses (incl $ 6.7 Subtotal before Reimbursements and Taxes (Lines 6.1 to 6.6) 6.8 Reimbursements by uninsured plans and fiscal intermediaries 6.9 Taxes, Licenses and Fees (in total, for tying purposes) 6.10 Total (6.7 to 6.9) 6.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 7. 8. 216-6.SD 9. Small Group Expatriate Plans Expenses: 0 for affiliated services) 7.1 Salaries (including $ 7.2 Outsourced Services 0 for affiliated services) 7.3 EDP Equipment and Software (incl $ 0 for affiliated services) 7.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 7.5 Accreditation and Certification (incl $ 0 for affiliated services) 7.6 Other Expenses (incl $ 7.7 Subtotal before Reimbursements and Taxes (Lines 7.1 to 7.6) 7.8 Reimbursements by uninsured plans and fiscal intermediaries 7.9 Taxes, Licenses and Fees (in total, for tying purposes) 7.10 Total (7.7 to 7.9) 7.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Expatriate Plans Expenses: 0 for affiliated services) 8.1 Salaries (including $ 8.2 Outsourced Services 0 for affiliated services) 8.3 EDP Equipment and Software (incl $ 0 for affiliated services) 8.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 8.5 Accreditation and Certification (incl $ 0 for affiliated services) 8.6 Other Expenses (incl $ 8.7 Subtotal before Reimbursements and Taxes (Lines 8.1 to 8.6) 8.8 Reimbursements by uninsured plans and fiscal intermediaries 8.9 Taxes, Licenses and Fees (in total, for tying purposes) 8.10 Total (8.7 to 8.9) 8.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Student Health Plans Expenses: 0 for affiliated services) 9.1 Salaries (including $ 9.2 Outsourced Services 0 for affiliated services) 9.3 EDP Equipment and Software (incl $ 0 for affiliated services) 9.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 9.5 Accreditation and Certification (incl $ 0 for affiliated services) 9.6 Other Expenses (incl $ 9.7 Subtotal before Reimbursements and Taxes (Lines 9.1 to 9.6) 9.8 Reimbursements by uninsured plans and fiscal intermediaries 9.9 Taxes, Licenses and Fees (in total, for tying purposes) 9.10 Total (9.7 to 9.9) 9.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 *79413201821643100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes - See Cautionary Statement at http://www.naic.org/documents/committees_e_app_blanks_related_shce_cautionary_statement.pdf) UnitedHealthcare Insurance Company 2. 185 Asylum Street Hartford, CT 061033408 (LOCATION) BUSINESS IN THE STATE OF Tennessee DURING THE YEAR 2018 NAIC Company Code Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 1. 216-1.TN 2. 3. 4. 5. 6. 7. 8. 9. Premium: 1.1 Health premiums earned (From Part 2, Line 1.11) 1.2 Federal high risk pools 1.3 State high risk pools 1.4 Premiums earned including state and federal high risk programs (Lines 1.1 + 1.2 + 1.3) 1.5 Federal taxes and federal assessments 1.6 State insurance, premium and other taxes (Similar local taxes of 48,345 ) $ 1.6a Community Benefit Expenditures (informational only) 1.7 Regulatory authority licenses and fees 1.8 Adjusted Premiums Earned (Lines 1.4 - 1.5 - 1.6 - 1.7) 1.9 Net Assumed less Ceded reinsurance premiums earned 1.10 Other Adjustments due to MLR calculations - Premiums 1.11 Risk Revenue 1.12 Net adjusted premiums earned after reinsurance (Lines 1.8 + 1.9 + 1.10 + 1.11) Claims: 2.1 Incurred claims excluding prescription drugs 2.2 Prescription drugs 2.3 Pharmaceutical rebates 2.4 State stop loss, market stabilization and claim/census based assessments (informational only) Incurred medical incentive pools and bonuses Deductible Fraud and Abuse Detection/Recovery Expenses (for MLR use only) 5.0 Total Incurred Claims (Lines 2.1 + 2.2 - 2.3 + 3) (From Part 2, Line 2.15) 5.1 Net Assumed less Ceded reinsurance claims incurred 5.2 Other Adjustments due to MLR calculations - Claims 5.3 Rebates paid 5.4 Estimated rebates unpaid prior year 5.5 Estimated rebates unpaid current year 5.6 Fee for service and co-pay revenue 5.7 Net incurred claims after reinsurance (Lines 5.0 + 5.1 + 5.2 + 5.3 - 5.4 + 5.5 - 5.6) Improving Health Care Quality Expenses Incurred: 6.1 Improve health outcomes 6.2 Activities to prevent hospital readmissions 6.3 Improve patient safety and reduce medical errors 6.4 Wellness and health promotion activities 6.5 Health Information Technology expenses related to health improvement 6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5) Preliminary Medical Loss Ratio: MLR ((Lines 4 + 5.0 + 6.6 - Footnote 2.0)/Line 1.8 Claims Adjustment Expenses: 8.1 Cost containment expenses not included in quality of care expenses in Line 6.6 8.2 All other claims adjustment expenses 8.3 Total claims adjustment expenses (Lines 8.1 + 8.2) Claims Adjustment Expense Ratio (Line 8.3/Line 1.8) 2 Small Group Employer 3 Large Group Employer 4 5 Small Group Employer Individual Expatriate Plans 6 Large Group Employer 7 11 Government Business (excluded by statute) Other Health Business 9 8 Small Group 10 Student Health Plans Large Group 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 79413 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 902,339 0 (1,081) 57,285,754 0 (10,555) 135,085,223 0 (71,926) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 171,926,513 0 84,800 62,866,073 0 0 428,065,902 0 1,237 XXX XXX XXX 901,258 243,569 57,275,199 3,258,662 135,013,297 5,527,608 0 0 0 0 0 0 0 0 0 0 0 0 0 396,542 172,011,312 2,417,894 62,866,073 3,814,432 428,067,140 15,658,707 XXX 4,522 0 460 652,707 3 82,011 0 734,720 856,849 0 4,753 53,154,935 2,307 8,110 0 53,165,352 2,123,511 0 16,969 127,345,210 (20,499,661) 21 0 106,845,570 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (396,542) 1,997,623 0 0 1,601,081 2,827,904 0 (33,143) 166,798,656 (252,812) 10,132 0 166,555,976 8,978 0 0 59,042,664 1,629,330 496,644 0 61,168,638 5,821,763 0 (10,961) 406,597,630 (17,123,211) 596,918 0 390,071,337 XXX XXX XXX XXX XXX 5,821,763 0 (10,961) 406,597,630 (17,123,211) 596,918 0 390,071,337 61,034 121,131 25,186 34,818,928 10,664,558 3,379,391 87,648,094 26,894,194 8,102,006 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7,991 0 0 128,526,550 1,107,293 36,493 (3,174,286) 104,461,380 59,788,718 247,888,310 143,248,555 71,331,794 XXX XXX XXX 247,888,310 143,248,555 71,331,794 10 1,168 27 158,147 489 0 0 0 0 0 158,636 54,180 19,839 40,450 42,123,933 161,417 (2,639,447) 1,228,342 1,050,589 2,461,694 0 42,285,350 47,493 62,025 25,467 106,502,307 (16,463,995) 0 0 0 0 0 90,038,312 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7,991 0 0 104 0 0 129,597,349 (359,440) 0 XXX XXX XXX 0 129,237,909 0 0 0 41,498,376 774 0 0 0 0 0 41,499,150 101,787 83,031 65,944 319,888,103 (16,660,755) (2,639,447) 1,228,342 1,050,589 2,461,694 0 303,227,348 XXX XXX 101,787 83,031 65,944 319,888,103 (16,660,755) (2,639,447) 1,228,342 1,050,589 2,461,694 0 303,227,348 7,219 0 0 0 0 458,286 0 0 0 0 1,080,682 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7,219 0.206 458,286 0.802 1,080,682 0.845 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 6,154 24,951 31,105 0.048 620,507 946,614 1,567,121 0.029 1,639,001 2,226,821 3,865,822 0.030 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 XXX XXX XXX 0 7,991 0 0 0 0 0 357,280 108,476 86,660 1,193,044 79,655 40,670 30,167 16,209 (60,656) 60,134 1,944,137 138,642 102,869 1,132,388 139,789 0 1,825,114 XXX 86,524 0.704 3,457,825 XXX 263,831 2,667,802 2,931,633 0.018 (305,780) 736,349 430,569 0.007 2,223,713 6,602,537 8,826,250 XXX XXX 0 0 0 0.000 428,065,902 0 1,237 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 1,944,137 138,642 102,869 1,132,388 139,789 0 3,457,825 XXX 0 0 0 2,223,713 6,602,537 8,826,250 XXX XXX XXX 428,067,140 15,658,707 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 (Continued) Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 10. General and Administrative (G&A) Expenses: 10.1 Direct sales salaries and benefits 10.2 Agents and brokers fees and commissions 10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below) 10.4 Other general and administrative expenses 10.4a Community Benefit Expenditures (informational only) 10.5 Total general and administrative (Lines 10.1 +10.2 + 10.3 + 10.4) 3 Large Group Employer 2 Small Group Employer 1,340 11,223 (5,261) 197,883 0 205,186 198,622 1,839,259 (19,969) 2,725,436 0 4,743,349 4 5 Small Group Employer Individual 643,105 514,984 173,675 4,721,237 0 6,053,001 0 0 0 0 0 0 Expatriate Plans 6 Large Group Employer 0 0 0 0 0 0 7 8 Small Group 0 0 0 0 0 0 Student Health Plans Large Group 0 0 0 0 0 0 10 11 Government Business (excluded by statute) Other Health Business 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (601) 0 (601) 340,865 7,290,664 322,703 16,441,426 0 24,395,658 168,373 303,564 147,041 4,551,541 0 5,170,518 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 1,352,306 9,959,694 618,190 28,636,922 0 40,567,111 0 0 0 0 0 0 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) 13,981,877 33,992,803 12. Income from fees of uninsured plans XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 13. Net investment and other gain/(loss) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 14. Federal income taxes (excluding taxes on Line 1.5 above) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 15. Net gain or (loss) (Lines 11 + 12 + 13 - 14) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 16. ICD-10 Implementation Expenses (informational only; already included in general expenses and line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16. 16a ICD-10 Implementation Expenses (informational only; already included in line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 79 5,184 14,430 0 0 0 0 0 0 0 151,766 73,517 244,976 0 244,976 112 8,811 24,627 0 0 0 0 0 0 0 219,728 73,517 326,795 0 326,795 778 210 0 0 0 0 0 0 3,210 0 4,198 0 4,198 111,151 311,190 0 0 0 0 0 0 2,676,224 894,205 3,994,209 0 3,994,209 332,576 4,111,246 5,807,753 0 0 0 0 0 0 1,593,691 8,165,661 XXX 1,352,306 9,959,694 618,190 28,636,922 0 40,567,111 33,992,803 0 5,620,517 (216,670) 39,829,990 XXX 0 5,620,517 XXX (216,670) XXX 39,829,990 OTHER INDICATORS: 216-2.TN 1. Number of certificates/policies 2. Number of Covered Lives 3. Number of Groups 4. Member Months XXX 1,439 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ XXX 0 ] If yes, show the amount of premiums and claims included. Premiums $ 0 Claims $ 0 AFFORDABLE CARE ACT (ACA) RECEIPTS, PAYMENTS, RECEIVABLES and PAYABLES Current Year Prior Year Comprehensive Health Coverage Comprehensive Health Coverage 1 2 3 4 Small Group Small Group Employer Plans Employer Plans Individual Plans Individual Plans ACA Receivables and Payables 1. Permanent ACA Risk Adjustment Program 1.0 Premium adjustments receivable/(payable) 2. Transitional ACA Reinsurance Program 2.0 Total amounts recoverable for claims (paid & unpaid) 31,054 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 0 0 0 0 216,179 1,490,420 (51,164) 1,591,762 XXX (5,346) 1,081,044 1,658,490 XXX 0 0 0 0 ACA Receipts and Payments 4. Permanent ACA Risk Adjustment Program 4.0 Premium adjustments receipts/(payments) 5. Transitional ACA Reinsurance Program 5.0 Amounts received for claims 6. Temporary ACA Risk Corridors Program 6.1 Retrospective premium received 6.2 Rate credits or policy experience refunds paid 1,049,991 0 0 XXX (11,996,901) 5,323,558 0 0 0 0 135,503 XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF 185 Asylum Street Hartford, CT 061033408 Tennessee DURING THE YEAR Comprehensive Health Coverage 1 2 3 Individual Small Group Employer Large Group Employer Small Group Employer Individual Expatriate Plans: 7 8 6 Large Group Employer Small Group 10 11 Government Business (excluded by statute) Other Health Business 9 Student Health Plans Large Group 79413 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.TN Health Premiums Earned: 984,350 57,296,595 1.1 Direct premiums written 0 48,435 1.2 Unearned premium prior year 0 51,165 1.3 Unearned premium current year 0 (2,731) 1.4 Change in unearned premium (Lines 1.2 - 1.3) 227,629 1,228,342 1.5 Paid rate credits 0 2,461,694 1.6 Reserve for rate credits current year 0 1,050,589 1.7 Reserve for rate credits prior year 0 1,411,105 1.8 Change in reserve for rate credits (Lines 1.6 - 1.7) 82,011 8,110 1.9 Premium balances written off 0 0 1.10 Group conversion charge 902,339 57,285,754 1.11 Total direct premiums earned (Lines 1.1 + 1.4 - 1.9 + 1.10) 0 0 1.12 Assumed premiums earned from non-affiliates 3 2,307 1.13 Net Assumed less Ceded premiums earned from affiliates 0 0 1.14 Ceded premiums earned to non-affiliates 82,011 8,110 1.15 Other Adjustments due to MLR calculation - Premiums 756,724 54,656,723 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 94,233 38,063,540 2.1 Paid claims during the year 11,951 5,154,663 2.2 Direct claim liability current year 166,912 4,249,889 2.3 Direct claim liability prior year 2,585 236,159 2.4 Direct claim reserves current year 5,358 137,009 2.5 Direct claim reserves prior year 278,049 0 2.6 Direct contract reserves current year 362,191 0 2.7 Direct contract reserves prior year 227,629 1,228,342 2.8 Paid rate credits 0 2,461,694 2.9 Reserve for rate credits current year 0 1,050,589 2.10 Reserve for rate credits prior year 1,168 19,839 2.11 Incurred medical incentive pools and bonuses (Lines 2.11a + 2.11b - 2.11c) 1,168 8,695 2.11a Paid medical incentive pools and bonuses current year 0 39,911 2.11b Accrued medical incentive pools and bonuses current year 0 28,767 2.11c Accrued medical incentive pools and bonuses prior year (76,993) (397,184) 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 1,550 1,344,011 2.12a Healthcare receivables current year 78,543 1,741,195 2.12b Healthcare receivables prior year 0 0 2.13 Group conversion charge 0 0 2.14 Multi-option coverage blended rate adjustment 2.15 Total incurred claims (Lines 2.1 + 2.2 - 2.3 + 2.4 - 2.5 + 2.6 - 2.7 + 2.8 + 2.9 158,147 42,123,933 2.10 + 2.11 - 2.12 + 2.13 + 2.14) 0 0 2.16 Assumed incurred claims from non-affiliates 489 161,417 2.17 Net assumed less ceded incurred claims from affiliates 0 0 2.18 Ceded incurred claims to non-affiliates 0 0 2.19 Other adjustments due to MLR calculation - Claims (68,993) 39,645,903 2.20 Net Incurred Claims (Lines 2.15 - 2.8 - 2.9 + 2.10 + 2.16 + 2.17 - 2.18 + 2.19) 3. Fraud and Abuse Recoveries that Reduced PAID Claims in Line 2.1 above 27 40,450 (informational only) 9,808,032 for stand-alone dental and $ (a) Column 13, Line 1.1 includes direct written premium of $ 4 Business Subject to MLR Mini-Med Plans 5 (LOCATION) NAIC Company Code 2018 135,086,901 (22,882) (21,225) (1,657) 102,134 27,302 29,660 (2,358) 21 0 135,085,223 0 768 20,500,429 21 114,485,807 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,997,623 0 0 1,997,623 171,955,762 256,905 276,022 (19,117) (293,690) 149,257 220,216 (70,958) 10,132 0 171,926,513 0 0 252,812 10,132 172,048,481 63,362,717 0 0 0 0 (467,863) 2,682,797 (3,150,659) 496,644 0 62,866,073 0 1,629,330 0 496,644 68,142,707 428,686,325 282,458 305,963 (23,505) 1,264,415 2,170,390 3,983,261 (1,812,870) 596,918 0 428,065,902 0 3,630,030 20,753,241 596,918 412,088,065 106,867,652 12,356,450 13,801,822 147,756 354,795 0 0 102,134 27,302 29,660 62,025 21,396 120,791 80,162 (1,125,265) 3,095,538 4,220,804 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (3,097,959) 1,922,331 (1,183,618) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 129,391,859 18,274,082 17,686,287 7,866,979 7,946,691 164,523 91,096 (293,690) 149,257 220,216 0 0 0 0 11,371 11,457 86 0 0 45,523,653 3,578,604 4,526,238 0 0 0 0 0 (467,863) 2,682,797 0 0 0 0 (73,017) 23,810,106 23,883,122 0 0 316,842,978 41,298,080 39,247,530 8,253,478 8,443,853 442,573 453,287 1,264,415 2,170,390 3,983,261 83,031 31,259 160,701 108,929 (1,661,088) 28,262,661 29,923,749 0 0 106,502,307 0 31,963 16,495,958 0 89,938,536 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7,991 0 0 0 0 7,991 129,597,349 0 0 359,440 0 129,602,557 41,498,376 0 774 0 0 44,649,809 319,888,103 0 194,643 16,855,398 0 303,775,804 25,467 0 0 6,661,997 for stand-alone vision policies. 0 0 0 0 0 0 0 65,944 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF Tennessee DURING THE YEAR All Expenses 1 Improve Health Outcomes 1. Individual Comprehensive Coverage Expenses: 27,029 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 1,124 for affiliated services) 1.3 EDP Equipment and Software (incl $ 108 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 12 for affiliated services) 1.5 Accreditation and Certification (incl $ 33,990 for affiliated services) 1.6 Other Expenses (incl $ 1.7 Subtotal before Reimbursements and Taxes (Lines 1.1 to 1.6) 1.8 Reimbursements by uninsured plans and fiscal intermediaries 1.9 Taxes, Licenses and Fees (in total, for tying purposes) 1.10 Total (1.7 to 1.9) 1.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 2. 216-4.TN 3. 0 0 0 0 0 7,219 7,219 0 XXX Small Group Comprehensive Coverage Expenses: 1,995,709 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 142,008 for affiliated services) 2.3 EDP Equipment and Software (incl $ 13,631 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 1,480 for affiliated services) 2.5 Accreditation and Certification (incl $ 2,415,879 for affiliated services) 2.6 Other Expenses (incl $ 2.7 Subtotal before Reimbursements and Taxes (Lines 2.1 to 2.6) 2.8 Reimbursements by uninsured plans and fiscal intermediaries 2.9 Taxes, Licenses and Fees (in total, for tying purposes) 2.10 Total (2.7 to 2.9) 2.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Comprehensive Coverage Expenses: 2,596,615 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 173,712 for affiliated services) 3.3 EDP Equipment and Software (incl $ 16,674 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 1,811 for affiliated services) 3.5 Accreditation and Certification (incl $ 7,991,169 for affiliated services) 3.6 Other Expenses (incl $ 3.7 Subtotal before Reimbursements and Taxes (Lines 3.1 to 3.6) 3.8 Reimbursements by uninsured plans and fiscal intermediaries 3.9 Taxes, Licenses and Fees (in total, for tying purposes) 3.10 Total (3.7 to 3.9) 3.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 185 Asylum Street Hartford, CT 061033408 Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX Total (1 to 5) 0 0 0 0 0 7,219 7,219 0 XXX 0 0 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 0 0 0 0 0 0 0 XXX (LOCATION) NAIC Company Code 2018 XXX 1,644 554 137 13 1 3,678 6,029 0 XXX 9,797 648 461 44 5 13,863 24,818 0 XXX 7,219 0 0 0 0 0 0 0 0 0 7,219 0 6,029 1,082 24,818 0 0 0 0 0 0 458,286 458,286 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 458,286 458,286 0 251,008 54,952 20,960 2,012 218 272,842 601,992 0 408,047 46,763 34,074 3,271 355 434,391 926,901 0 XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX XXX XXX 458,286 0 0 0 0 0 0 0 0 0 458,286 0 601,992 160,468 926,901 0 0 0 0 0 0 1,080,682 1,080,682 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,080,682 1,080,682 0 337,289 142,922 28,165 2,704 294 1,079,779 1,591,153 4 495,840 56,824 41,405 3,974 432 1,587,213 2,185,688 3 1,080,682 0 XXX 1,591,156 443,793 XXX 2,185,691 0 XXX 1,080,682 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 79413 9 10 General Administrative Expenses Total Expenses (6 to 9) 15,588 299 526 31 5 193,903 210,352 0 74 210,425 0 27,029 1,500 1,124 88 12 218,663 248,417 0 74 248,491 1,082 1,336,654 134,855 86,973 8,348 906 3,181,534 4,749,271 0 893,906 5,643,178 0 1,995,709 236,569 142,008 13,631 1,480 4,347,054 6,736,451 0 893,906 7,630,358 160,468 1,763,486 202,788 104,142 9,996 1,085 3,755,737 5,837,235 17 2,445,205 8,282,456 0 2,596,615 402,534 173,712 16,674 1,811 7,503,410 10,694,757 23 2,445,205 13,139,985 443,793 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 4. 5. 216-5.TN 6. Individual Mini-Med Plans Expenses: 0 for affiliated services) 4.1 Salaries (including $ 4.2 Outsourced Services 0 for affiliated services) 4.3 EDP Equipment and Software (incl $ 0 for affiliated services) 4.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 4.5 Accreditation and Certification (incl $ 0 for affiliated services) 4.6 Other Expenses (incl $ 4.7 Subtotal before Reimbursements and Taxes (Lines 4.1 to 4.6) 4.8 Reimbursements by uninsured plans and fiscal intermediaries 4.9 Taxes, Licenses and Fees (in total, for tying purposes) 4.10 Total (4.7 to 4.9) 4.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Mini-Med Plans Expenses: 0 for affiliated services) 5.1 Salaries (including $ 5.2 Outsourced Services 0 for affiliated services) 5.3 EDP Equipment and Software (incl $ 0 for affiliated services) 5.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 5.5 Accreditation and Certification (incl $ 0 for affiliated services) 5.6 Other Expenses (incl $ 5.7 Subtotal before Reimbursements and Taxes (Lines 5.1 to 5.6) 5.8 Reimbursements by uninsured plans and fiscal intermediaries 5.9 Taxes, Licenses and Fees (in total, for tying purposes) 5.10 Total (5.7 to 5.9) 5.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Mini-Med Plans Expenses: 0 for affiliated services) 6.1 Salaries (including $ 6.2 Outsourced Services 0 for affiliated services) 6.3 EDP Equipment and Software (incl $ 0 for affiliated services) 6.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 6.5 Accreditation and Certification (incl $ 0 for affiliated services) 6.6 Other Expenses (incl $ 6.7 Subtotal before Reimbursements and Taxes (Lines 6.1 to 6.6) 6.8 Reimbursements by uninsured plans and fiscal intermediaries 6.9 Taxes, Licenses and Fees (in total, for tying purposes) 6.10 Total (6.7 to 6.9) 6.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 7. 8. 216-6.TN 9. Small Group Expatriate Plans Expenses: 0 for affiliated services) 7.1 Salaries (including $ 7.2 Outsourced Services 0 for affiliated services) 7.3 EDP Equipment and Software (incl $ 0 for affiliated services) 7.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 7.5 Accreditation and Certification (incl $ 0 for affiliated services) 7.6 Other Expenses (incl $ 7.7 Subtotal before Reimbursements and Taxes (Lines 7.1 to 7.6) 7.8 Reimbursements by uninsured plans and fiscal intermediaries 7.9 Taxes, Licenses and Fees (in total, for tying purposes) 7.10 Total (7.7 to 7.9) 7.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Expatriate Plans Expenses: 0 for affiliated services) 8.1 Salaries (including $ 8.2 Outsourced Services 0 for affiliated services) 8.3 EDP Equipment and Software (incl $ 0 for affiliated services) 8.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 8.5 Accreditation and Certification (incl $ 0 for affiliated services) 8.6 Other Expenses (incl $ 8.7 Subtotal before Reimbursements and Taxes (Lines 8.1 to 8.6) 8.8 Reimbursements by uninsured plans and fiscal intermediaries 8.9 Taxes, Licenses and Fees (in total, for tying purposes) 8.10 Total (8.7 to 8.9) 8.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Student Health Plans Expenses: 0 for affiliated services) 9.1 Salaries (including $ 9.2 Outsourced Services 0 for affiliated services) 9.3 EDP Equipment and Software (incl $ 0 for affiliated services) 9.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 9.5 Accreditation and Certification (incl $ 0 for affiliated services) 9.6 Other Expenses (incl $ 9.7 Subtotal before Reimbursements and Taxes (Lines 9.1 to 9.6) 9.8 Reimbursements by uninsured plans and fiscal intermediaries 9.9 Taxes, Licenses and Fees (in total, for tying purposes) 9.10 Total (9.7 to 9.9) 9.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 *79413201821644100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes - See Cautionary Statement at http://www.naic.org/documents/committees_e_app_blanks_related_shce_cautionary_statement.pdf) UnitedHealthcare Insurance Company 2. 185 Asylum Street Hartford, CT 061033408 (LOCATION) BUSINESS IN THE STATE OF Texas DURING THE YEAR 2018 NAIC Company Code Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 1. 216-1.TX 2. 3. 4. 5. 6. 7. 8. 9. Premium: 1.1 Health premiums earned (From Part 2, Line 1.11) 1.2 Federal high risk pools 1.3 State high risk pools 1.4 Premiums earned including state and federal high risk programs (Lines 1.1 + 1.2 + 1.3) 1.5 Federal taxes and federal assessments 1.6 State insurance, premium and other taxes (Similar local taxes of 801,941 ) $ 1.6a Community Benefit Expenditures (informational only) 1.7 Regulatory authority licenses and fees 1.8 Adjusted Premiums Earned (Lines 1.4 - 1.5 - 1.6 - 1.7) 1.9 Net Assumed less Ceded reinsurance premiums earned 1.10 Other Adjustments due to MLR calculations - Premiums 1.11 Risk Revenue 1.12 Net adjusted premiums earned after reinsurance (Lines 1.8 + 1.9 + 1.10 + 1.11) Claims: 2.1 Incurred claims excluding prescription drugs 2.2 Prescription drugs 2.3 Pharmaceutical rebates 2.4 State stop loss, market stabilization and claim/census based assessments (informational only) Incurred medical incentive pools and bonuses Deductible Fraud and Abuse Detection/Recovery Expenses (for MLR use only) 5.0 Total Incurred Claims (Lines 2.1 + 2.2 - 2.3 + 3) (From Part 2, Line 2.15) 5.1 Net Assumed less Ceded reinsurance claims incurred 5.2 Other Adjustments due to MLR calculations - Claims 5.3 Rebates paid 5.4 Estimated rebates unpaid prior year 5.5 Estimated rebates unpaid current year 5.6 Fee for service and co-pay revenue 5.7 Net incurred claims after reinsurance (Lines 5.0 + 5.1 + 5.2 + 5.3 - 5.4 + 5.5 - 5.6) Improving Health Care Quality Expenses Incurred: 6.1 Improve health outcomes 6.2 Activities to prevent hospital readmissions 6.3 Improve patient safety and reduce medical errors 6.4 Wellness and health promotion activities 6.5 Health Information Technology expenses related to health improvement 6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5) Preliminary Medical Loss Ratio: MLR ((Lines 4 + 5.0 + 6.6 - Footnote 2.0)/Line 1.8 Claims Adjustment Expenses: 8.1 Cost containment expenses not included in quality of care expenses in Line 6.6 8.2 All other claims adjustment expenses 8.3 Total claims adjustment expenses (Lines 8.1 + 8.2) Claims Adjustment Expense Ratio (Line 8.3/Line 1.8) 2 Small Group Employer 3 Large Group Employer 4 6 Large Group Employer 5 Small Group Employer Individual Expatriate Plans 7 11 Government Business (excluded by statute) Other Health Business 9 8 Small Group 10 Student Health Plans Large Group 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 79413 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 9,570,214 0 (6,100) 760,446,873 0 (35,386) 2,548,438,691 0 (230,168) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,243,269,515 0 0 1,023,525,176 0 323,521 635,706,125 0 0 6,220,956,594 0 51,866 XXX XXX XXX 6,220,956,594 0 51,866 9,564,114 78,993 760,411,487 37,036,263 2,548,208,523 130,622,518 0 0 0 0 0 0 0 0 0 0 0 0 1,243,269,515 (127,238) 1,023,848,697 10,801,807 635,706,125 31,933,051 6,221,008,460 210,345,393 XXX 11,862,123 6,221,008,460 222,207,516 763,459 0 (6,153) 8,727,814 62 0 0 8,727,876 12,111,640 0 (967,760) 712,231,344 42,470 1,031,916 0 713,305,730 42,612,655 0 (1,734,668) 2,376,708,019 (182,713,511) 5,486,444 0 2,199,480,952 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 19,808,221 0 480,348 1,223,108,184 1,376 0 0 1,223,109,560 16,556,555 0 (437,100) 996,927,435 2,753,624 84,988 0 999,766,048 71,435 0 0 603,701,639 3,571,972 3,225,491 0 610,499,102 91,923,965 0 (2,665,334) 5,921,404,436 (176,344,006) 9,828,839 0 5,754,889,268 123,298 0 0 XXX XXX XXX XXX XXX 92,047,263 0 (2,665,334) 5,909,419,015 (176,344,006) 9,828,839 0 5,742,903,847 6,243,992 2,811,049 729,271 448,839,452 119,912,504 36,558,043 1,719,172,883 423,549,275 131,741,747 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 972,129,027 200,436,287 534,710 808,641,104 22,031,148 259,227 267,088,212 431,333,388 250,950,097 4,222,114,670 1,200,073,650 420,773,095 XXX XXX XXX 4,222,114,670 1,200,073,650 420,773,095 12 0 8 8,325,769 143 0 0 0 0 0 8,325,912 329,557 3,792,892 1,940,890 535,986,806 1,079,121 0 0 0 0 0 537,065,927 1,410,202 9,549,673 2,802,828 2,020,530,085 (279,594,333) 0 0 0 0 0 1,740,935,751 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 492,928 0 1,172,523,532 19,641 0 XXX XXX XXX 0 1,172,543,173 307 602 0 830,413,627 5,677,697 0 XXX XXX XXX 0 836,091,324 0 3,203,214 262,029 450,674,716 114,607 (2,410,770) 0 517,054 2,927,824 0 450,789,323 1,740,078 17,039,310 5,005,755 5,018,454,535 (272,703,125) (2,410,770) 0 517,054 2,927,824 0 4,745,751,411 XXX XXX 1,740,078 17,039,310 5,005,755 5,018,454,535 (272,703,125) (2,410,770) 0 517,054 2,927,824 0 4,745,751,411 76,562 0 0 0 0 6,083,575 0 0 0 0 20,387,510 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 18,884,197 11,222,463 9,236,025 6,813,462 2,347,974 1,888,168 805,743 740,386 4,231,459 564,852 5,310,332 786,842 1,514,093 1,433,333 1,917,051 52,630,342 12,815,047 11,490,504 12,478,255 4,829,877 5,592,844 2,188,570 2,933,203 2,327,469 3,010,503 58,223,187 15,003,618 14,423,707 14,805,723 7,840,380 76,562 0.963 6,083,575 0.764 20,387,510 0.860 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 48,504,120 XXX 8,230,608 XXX 10,961,651 0.765 94,244,025 XXX 16,052,590 XXX 110,296,615 XXX 64,931 123,007 187,937 0.022 8,355,378 10,872,848 19,228,226 0.027 30,864,290 40,878,118 71,742,408 0.030 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 6,193,700 15,317,133 21,510,834 0.018 3,848,312 14,997,800 18,846,111 0.019 7,686,989 24,339,076 32,026,065 0.053 57,013,600 106,527,982 163,541,582 XXX 14,774,018 17,389,986 32,164,004 XXX 71,787,618 123,917,968 195,705,586 XXX 0 XXX XXX XXX XXX XXX XXX XXX XXX SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 (Continued) Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 10. General and Administrative (G&A) Expenses: 10.1 Direct sales salaries and benefits 10.2 Agents and brokers fees and commissions 10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below) 10.4 Other general and administrative expenses 10.4a Community Benefit Expenditures (informational only) 10.5 Total general and administrative (Lines 10.1 +10.2 + 10.3 + 10.4) 3 Large Group Employer 2 Small Group Employer 18,549 315,284 (2,321) 484,372 0 815,884 4 5 Small Group Employer Individual 2,402,641 39,551,848 542,357 39,914,211 0 82,411,056 11,753,136 11,890,179 2,689,344 76,928,342 0 103,261,001 0 0 0 0 0 0 Expatriate Plans 6 Large Group Employer 0 0 0 0 0 0 7 8 Small Group 0 0 0 0 0 0 Student Health Plans Large Group 0 0 0 0 0 0 10 11 Government Business (excluded by statute) Other Health Business 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 9 0 0 0 0 0 0 0 0 0 0 0 0 58,373 0 1,235,416 36,725,695 0 38,019,484 0 3,341,994 37,324,986 1,770,555 78,851,851 0 121,289,387 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 1,296,605 11,306,455 1,071,205 35,471,754 0 49,146,019 18,871,298 100,388,752 7,306,556 268,376,225 0 394,942,832 7,074,230 0 1,283,187 38,476,665 0 46,834,082 25,945,528 100,388,752 8,589,743 306,852,890 0 441,776,913 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) 68,516,945 263,154,282 (57,468,051) 15,308,618 67,576,044 356,409,419 XXX 249,373,323 12. Income from fees of uninsured plans XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 154,750,829 154,750,829 13. Net investment and other gain/(loss) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 90,972,946 XXX 14. Federal income taxes (excluding taxes on Line 1.5 above) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 4,750,242 XXX 4,750,242 15. Net gain or (loss) (Lines 11 + 12 + 13 - 14) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 442,632,122 XXX 490,346,856 16. ICD-10 Implementation Expenses (informational only; already included in general expenses and line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16. 16a ICD-10 Implementation Expenses (informational only; already included in line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (678,419) 0 0 0 0 0 90,972,946 OTHER INDICATORS: 216-2.TX 1. Number of certificates/policies 2. Number of Covered Lives 3. Number of Groups 4. Member Months 729 58,366 412,213 0 0 0 0 0 0 69,012 1,113,356 258,304 1,911,980 101,679 2,013,659 1,144 99,936 754,463 0 0 0 0 0 0 69,012 1,899,472 258,304 3,082,331 101,679 3,184,010 10,169 4,963 0 0 0 0 0 1 13,850 48 29,031 3 29,034 13,582 1,348,265 8,943,821 0 0 0 0 0 825,945 22,558,590 3,115,337 36,805,540 1,190,229 37,995,769 XXX Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ XXX 0 ] If yes, show the amount of premiums and claims included. Premiums $ 0 Claims $ 0 AFFORDABLE CARE ACT (ACA) RECEIPTS, PAYMENTS, RECEIVABLES and PAYABLES Current Year Prior Year Comprehensive Health Coverage Comprehensive Health Coverage 1 2 3 4 Small Group Small Group Employer Plans Employer Plans Individual Plans Individual Plans ACA Receivables and Payables 1. Permanent ACA Risk Adjustment Program 1.0 Premium adjustments receivable/(payable) 2. Transitional ACA Reinsurance Program 2.0 Total amounts recoverable for claims (paid & unpaid) 0 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 0 0 436,823 (5,678,071) XXX 906,773 0 0 0 (15,377,624) XXX 0 0 0 0 ACA Receipts and Payments 4. Permanent ACA Risk Adjustment Program 4.0 Premium adjustments receipts/(payments) 5. Transitional ACA Reinsurance Program 5.0 Amounts received for claims 0 6. Temporary ACA Risk Corridors Program 6.1 Retrospective premium received 6.2 Rate credits or policy experience refunds paid 0 0 858,691 (3,785,242) XXX 410,750 0 0 0 0 0 (5,434,562) XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF 185 Asylum Street Hartford, CT 061033408 Texas DURING THE YEAR Comprehensive Health Coverage 1 2 3 Individual Small Group Employer Small Group Employer Individual Expatriate Plans: 7 8 6 Large Group Employer Small Group 10 11 Government Business (excluded by statute) Other Health Business 9 Student Health Plans Large Group 79413 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.TX Health Premiums Earned: 9,570,214 761,380,105 1.1 Direct premiums written 0 215,630 1.2 Unearned premium prior year 0 116,946 1.3 Unearned premium current year 0 98,684 1.4 Change in unearned premium (Lines 1.2 - 1.3) 316,193 0 1.5 Paid rate credits 0 0 1.6 Reserve for rate credits current year 0 0 1.7 Reserve for rate credits prior year 0 0 1.8 Change in reserve for rate credits (Lines 1.6 - 1.7) 0 1,031,916 1.9 Premium balances written off 0 0 1.10 Group conversion charge 9,570,214 760,446,873 1.11 Total direct premiums earned (Lines 1.1 + 1.4 - 1.9 + 1.10) 0 0 1.12 Assumed premiums earned from non-affiliates 62 42,470 1.13 Net Assumed less Ceded premiums earned from affiliates 0 0 1.14 Ceded premiums earned to non-affiliates 0 1,031,916 1.15 Other Adjustments due to MLR calculation - Premiums 9,254,084 761,521,258 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 8,603,634 543,989,679 2.1 Paid claims during the year 357,338 68,949,673 2.2 Direct claim liability current year 513,697 85,104,229 2.3 Direct claim liability prior year 31,065 4,477,518 2.4 Direct claim reserves current year 50,639 3,400,609 2.5 Direct claim reserves prior year 1,593,829 0 2.6 Direct contract reserves current year 1,994,565 0 2.7 Direct contract reserves prior year 316,193 0 2.8 Paid rate credits 0 0 2.9 Reserve for rate credits current year 0 0 2.10 Reserve for rate credits prior year 0 3,792,892 2.11 Incurred medical incentive pools and bonuses (Lines 2.11a + 2.11b - 2.11c) 0 3,993,485 2.11a Paid medical incentive pools and bonuses current year 0 2,630,052 2.11b Accrued medical incentive pools and bonuses current year 0 2,830,645 2.11c Accrued medical incentive pools and bonuses prior year 17,388 (3,281,882) 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 24,049 15,980,449 2.12a Healthcare receivables current year 6,661 19,262,331 2.12b Healthcare receivables prior year 0 0 2.13 Group conversion charge 0 0 2.14 Multi-option coverage blended rate adjustment 2.15 Total incurred claims (Lines 2.1 + 2.2 - 2.3 + 2.4 - 2.5 + 2.6 - 2.7 + 2.8 + 2.9 8,325,769 535,986,806 2.10 + 2.11 - 2.12 + 2.13 + 2.14) 0 0 2.16 Assumed incurred claims from non-affiliates 143 1,079,120 2.17 Net assumed less ceded incurred claims from affiliates 0 (1) 2.18 Ceded incurred claims to non-affiliates 0 0 2.19 Other adjustments due to MLR calculation - Claims 8,009,719 537,065,927 2.20 Net Incurred Claims (Lines 2.15 - 2.8 - 2.9 + 2.10 + 2.16 + 2.17 - 2.18 + 2.19) 3. Fraud and Abuse Recoveries that Reduced PAID Claims in Line 2.1 above 8 2,260,443 (informational only) 223,711,168 for stand-alone dental and $ (a) Column 13, Line 1.1 includes direct written premium of $ Large Group Employer 4 Business Subject to MLR Mini-Med Plans 5 (LOCATION) NAIC Company Code 2018 2,554,014,799 29,719 119,382 (89,663) (6,388,893) 32,341,610 25,977,128 6,364,482 5,486,444 0 2,548,438,692 0 98,903 182,812,413 5,486,444 2,371,236,035 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,243,269,515 0 0 0 0 2,124,789 2,124,789 0 0 0 1,243,269,515 0 1,376 0 0 1,243,270,891 2,005,587,016 326,351,882 321,641,977 6,818,357 7,037,480 0 0 (6,388,893) 32,341,610 25,977,128 9,549,673 6,268,523 9,748,117 6,466,967 (927,025) 80,222,001 81,149,026 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,173,832,880 100,441,204 106,783,991 213,585 142,232 0 0 0 2,124,789 2,124,789 492,928 307,548 302,665 117,285 (4,469,159) 1,277,676 5,746,835 0 0 2,020,530,085 0 (940,757) 278,653,576 0 1,740,960,162 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,802,828 0 0 45,452,234 for stand-alone vision policies. 0 0 0 0 1,022,051,379 (254,598) (1,813,383) 1,558,785 (6,373,181) 3,859,356 4,486,426 (627,070) 84,988 0 1,023,525,176 6,138,149 0 3,384,525 84,988 1,033,364,040 638,931,616 0 0 0 16,048,213 3,360,706 13,371,128 (10,010,423) 3,225,491 0 635,706,125 0 3,571,972 0 3,225,491 636,465,798 6,229,217,628 (9,250) (1,577,055) 1,567,805 3,602,332 41,686,461 45,959,471 (4,273,011) 9,828,839 0 6,220,956,594 6,138,149 3,714,782 186,196,938 9,828,839 6,055,112,105 828,750,639 79,697,133 75,626,748 51,809,980 50,630,715 6,824,595 3,343,437 (6,373,181) 3,859,356 4,486,426 602 602 220 220 68,169 106,535 38,366 0 0 449,842,339 34,111,960 38,297,838 380,149 32,399 0 0 16,048,213 3,360,706 13,371,128 3,203,214 3,226,801 1,128,488 1,152,076 4,570,499 90,049,789 85,479,290 0 0 5,010,606,187 609,909,189 627,968,480 63,730,653 61,294,076 8,418,424 5,338,002 3,602,332 41,686,461 45,959,471 17,039,310 13,796,960 13,809,542 10,567,192 (4,022,010) 187,660,498 191,682,508 0 0 1,172,523,533 0 19,641 0 0 1,172,543,173 830,413,627 5,872,712 0 195,015 0 843,091,576 450,674,716 0 114,607 0 0 444,751,533 5,018,454,536 5,872,712 272,753 278,848,590 0 4,746,422,090 0 0 262,029 5,325,308 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF Texas DURING THE YEAR All Expenses 1 Improve Health Outcomes 1. Individual Comprehensive Coverage Expenses: 221,500 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 12,382 for affiliated services) 1.3 EDP Equipment and Software (incl $ 1,189 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 129 for affiliated services) 1.5 Accreditation and Certification (incl $ 368,679 for affiliated services) 1.6 Other Expenses (incl $ 1.7 Subtotal before Reimbursements and Taxes (Lines 1.1 to 1.6) 1.8 Reimbursements by uninsured plans and fiscal intermediaries 1.9 Taxes, Licenses and Fees (in total, for tying purposes) 1.10 Total (1.7 to 1.9) 1.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 2. 216-4.TX Small Group Comprehensive Coverage Expenses: 31,512,298 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 2,242,316 for affiliated services) 2.3 EDP Equipment and Software (incl $ 215,236 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 23,370 for affiliated services) 2.5 Accreditation and Certification (incl $ 23,408,790 for affiliated services) 2.6 Other Expenses (incl $ 2.7 Subtotal before Reimbursements and Taxes (Lines 2.1 to 2.6) 2.8 Reimbursements by uninsured plans and fiscal intermediaries 2.9 Taxes, Licenses and Fees (in total, for tying purposes) 2.10 Total (2.7 to 2.9) 2.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 3. Large Group Comprehensive Coverage Expenses: 40,568,748 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 2,637,223 for affiliated services) 3.3 EDP Equipment and Software (incl $ 253,142 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 27,486 for affiliated services) 3.5 Accreditation and Certification (incl $ 141,659,247 for affiliated services) 3.6 Other Expenses (incl $ 3.7 Subtotal before Reimbursements and Taxes (Lines 3.1 to 3.6) 3.8 Reimbursements by uninsured plans and fiscal intermediaries 3.9 Taxes, Licenses and Fees (in total, for tying purposes) 3.10 Total (3.7 to 3.9) 3.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 185 Asylum Street Hartford, CT 061033408 0 0 0 0 0 76,562 76,562 0 XXX Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX Total (1 to 5) 0 0 0 0 0 76,562 76,562 0 XXX 0 0 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 0 0 0 0 0 0 0 XXX (LOCATION) NAIC Company Code 2018 XXX 17,521 4,877 1,463 140 15 39,186 63,202 0 XXX 46,866 3,229 2,303 221 24 68,523 121,166 0 XXX 76,562 0 0 0 0 0 0 0 0 0 76,562 0 63,202 14,980 121,166 0 0 0 0 0 0 6,083,575 6,083,575 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6,083,575 6,083,575 0 3,929,452 1,648,889 328,128 31,496 3,420 2,190,113 8,131,499 0 6,037,987 691,965 504,200 48,397 5,255 3,346,797 10,634,602 0 XXX 6,083,575 0 0 0 0 0 0 20,387,510 20,387,510 0 XXX 20,387,510 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 6,083,575 0 XXX 8,131,499 1,940,890 XXX 10,634,602 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 20,387,510 20,387,510 0 5,927,363 3,004,554 494,962 47,511 5,159 20,485,899 29,965,449 0 8,692,602 996,190 725,873 69,675 7,565 29,599,141 40,091,047 0 20,387,510 0 XXX 29,965,449 8,323,664 XXX 40,091,047 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 79413 9 10 General Administrative Expenses Total Expenses (6 to 9) 157,113 13,386 8,616 738 90 636,951 816,893 0 759,867 1,576,760 0 221,500 21,491 12,382 1,100 129 821,222 1,077,823 0 759,867 1,837,690 14,980 21,544,859 2,571,093 1,409,988 135,342 14,695 56,022,826 81,698,803 0 12,318,258 94,017,061 0 31,512,298 4,911,948 2,242,316 215,236 23,370 67,643,311 106,548,479 0 12,318,258 118,866,737 1,940,890 25,948,782 3,204,171 1,416,388 135,957 14,762 69,074,622 99,794,681 0 46,030,219 145,824,901 0 40,568,748 7,204,915 2,637,223 253,142 27,486 139,547,172 190,238,686 0 46,030,219 236,268,905 8,323,664 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 4. 5. 216-5.TX 6. Individual Mini-Med Plans Expenses: 0 for affiliated services) 4.1 Salaries (including $ 4.2 Outsourced Services 0 for affiliated services) 4.3 EDP Equipment and Software (incl $ 0 for affiliated services) 4.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 4.5 Accreditation and Certification (incl $ 0 for affiliated services) 4.6 Other Expenses (incl $ 4.7 Subtotal before Reimbursements and Taxes (Lines 4.1 to 4.6) 4.8 Reimbursements by uninsured plans and fiscal intermediaries 4.9 Taxes, Licenses and Fees (in total, for tying purposes) 4.10 Total (4.7 to 4.9) 4.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Mini-Med Plans Expenses: 0 for affiliated services) 5.1 Salaries (including $ 5.2 Outsourced Services 0 for affiliated services) 5.3 EDP Equipment and Software (incl $ 0 for affiliated services) 5.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 5.5 Accreditation and Certification (incl $ 0 for affiliated services) 5.6 Other Expenses (incl $ 5.7 Subtotal before Reimbursements and Taxes (Lines 5.1 to 5.6) 5.8 Reimbursements by uninsured plans and fiscal intermediaries 5.9 Taxes, Licenses and Fees (in total, for tying purposes) 5.10 Total (5.7 to 5.9) 5.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Mini-Med Plans Expenses: 0 for affiliated services) 6.1 Salaries (including $ 6.2 Outsourced Services 0 for affiliated services) 6.3 EDP Equipment and Software (incl $ 0 for affiliated services) 6.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 6.5 Accreditation and Certification (incl $ 0 for affiliated services) 6.6 Other Expenses (incl $ 6.7 Subtotal before Reimbursements and Taxes (Lines 6.1 to 6.6) 6.8 Reimbursements by uninsured plans and fiscal intermediaries 6.9 Taxes, Licenses and Fees (in total, for tying purposes) 6.10 Total (6.7 to 6.9) 6.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 7. 8. 216-6.TX 9. Small Group Expatriate Plans Expenses: 0 for affiliated services) 7.1 Salaries (including $ 7.2 Outsourced Services 0 for affiliated services) 7.3 EDP Equipment and Software (incl $ 0 for affiliated services) 7.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 7.5 Accreditation and Certification (incl $ 0 for affiliated services) 7.6 Other Expenses (incl $ 7.7 Subtotal before Reimbursements and Taxes (Lines 7.1 to 7.6) 7.8 Reimbursements by uninsured plans and fiscal intermediaries 7.9 Taxes, Licenses and Fees (in total, for tying purposes) 7.10 Total (7.7 to 7.9) 7.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Expatriate Plans Expenses: 0 for affiliated services) 8.1 Salaries (including $ 8.2 Outsourced Services 0 for affiliated services) 8.3 EDP Equipment and Software (incl $ 0 for affiliated services) 8.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 8.5 Accreditation and Certification (incl $ 0 for affiliated services) 8.6 Other Expenses (incl $ 8.7 Subtotal before Reimbursements and Taxes (Lines 8.1 to 8.6) 8.8 Reimbursements by uninsured plans and fiscal intermediaries 8.9 Taxes, Licenses and Fees (in total, for tying purposes) 8.10 Total (8.7 to 8.9) 8.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Student Health Plans Expenses: 0 for affiliated services) 9.1 Salaries (including $ 9.2 Outsourced Services 0 for affiliated services) 9.3 EDP Equipment and Software (incl $ 0 for affiliated services) 9.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 9.5 Accreditation and Certification (incl $ 0 for affiliated services) 9.6 Other Expenses (incl $ 9.7 Subtotal before Reimbursements and Taxes (Lines 9.1 to 9.6) 9.8 Reimbursements by uninsured plans and fiscal intermediaries 9.9 Taxes, Licenses and Fees (in total, for tying purposes) 9.10 Total (9.7 to 9.9) 9.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 *79413201821645100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes - See Cautionary Statement at http://www.naic.org/documents/committees_e_app_blanks_related_shce_cautionary_statement.pdf) UnitedHealthcare Insurance Company 2. 185 Asylum Street Hartford, CT 061033408 (LOCATION) BUSINESS IN THE STATE OF Utah DURING THE YEAR 2018 NAIC Company Code Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 1. 216-1.UT 2. 3. 4. 5. 6. 7. 8. 9. Premium: 1.1 Health premiums earned (From Part 2, Line 1.11) 1.2 Federal high risk pools 1.3 State high risk pools 1.4 Premiums earned including state and federal high risk programs (Lines 1.1 + 1.2 + 1.3) 1.5 Federal taxes and federal assessments 1.6 State insurance, premium and other taxes (Similar local taxes of 44,421 ) $ 1.6a Community Benefit Expenditures (informational only) 1.7 Regulatory authority licenses and fees 1.8 Adjusted Premiums Earned (Lines 1.4 - 1.5 - 1.6 - 1.7) 1.9 Net Assumed less Ceded reinsurance premiums earned 1.10 Other Adjustments due to MLR calculations - Premiums 1.11 Risk Revenue 1.12 Net adjusted premiums earned after reinsurance (Lines 1.8 + 1.9 + 1.10 + 1.11) Claims: 2.1 Incurred claims excluding prescription drugs 2.2 Prescription drugs 2.3 Pharmaceutical rebates 2.4 State stop loss, market stabilization and claim/census based assessments (informational only) Incurred medical incentive pools and bonuses Deductible Fraud and Abuse Detection/Recovery Expenses (for MLR use only) 5.0 Total Incurred Claims (Lines 2.1 + 2.2 - 2.3 + 3) (From Part 2, Line 2.15) 5.1 Net Assumed less Ceded reinsurance claims incurred 5.2 Other Adjustments due to MLR calculations - Claims 5.3 Rebates paid 5.4 Estimated rebates unpaid prior year 5.5 Estimated rebates unpaid current year 5.6 Fee for service and co-pay revenue 5.7 Net incurred claims after reinsurance (Lines 5.0 + 5.1 + 5.2 + 5.3 - 5.4 + 5.5 - 5.6) Improving Health Care Quality Expenses Incurred: 6.1 Improve health outcomes 6.2 Activities to prevent hospital readmissions 6.3 Improve patient safety and reduce medical errors 6.4 Wellness and health promotion activities 6.5 Health Information Technology expenses related to health improvement 6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5) Preliminary Medical Loss Ratio: MLR ((Lines 4 + 5.0 + 6.6 - Footnote 2.0)/Line 1.8 Claims Adjustment Expenses: 8.1 Cost containment expenses not included in quality of care expenses in Line 6.6 8.2 All other claims adjustment expenses 8.3 Total claims adjustment expenses (Lines 8.1 + 8.2) Claims Adjustment Expense Ratio (Line 8.3/Line 1.8) 2 Small Group Employer 3 Large Group Employer 4 5 Small Group Employer Individual Expatriate Plans 6 Large Group Employer 7 11 Government Business (excluded by statute) Other Health Business 9 8 Small Group 10 Student Health Plans Large Group 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 79413 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 204,621 0 (14) 41,973,225 0 (2,904) 225,409,596 0 (25,955) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 94,237,707 0 39,726 17,082,109 0 0 378,907,259 0 10,853 XXX XXX XXX 204,608 12,350 41,970,322 1,973,293 225,383,640 7,993,082 0 0 0 0 0 0 0 0 0 0 0 0 0 0 94,277,433 632,884 17,082,109 897,287 378,918,112 11,508,895 XXX 786 0 (4) 191,476 18 0 0 191,494 143,193 0 (592) 39,854,428 2,285 6,211 0 39,862,924 1,359,696 0 15,794 216,015,068 (35,104,008) 51,227 0 180,962,287 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,261,729 0 (14,746) 92,397,567 (155,045) 1,219 0 92,243,740 1,885 0 0 16,182,937 756,341 181,085 0 17,120,363 2,767,289 0 452 364,641,476 (34,500,409) 239,742 0 330,380,809 XXX XXX XXX XXX XXX 2,767,289 0 452 364,641,476 (34,500,409) 239,742 0 330,380,809 128,309 19,586 6,140 26,979,012 5,693,259 1,772,016 163,003,937 33,926,861 10,915,071 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 74,064,641 339,567 15,213 1,977,680 23,727,188 13,026,978 266,153,581 63,706,460 25,735,418 XXX XXX XXX 266,153,581 63,706,460 25,735,418 1 0 0 141,755 0 0 0 0 0 0 141,755 66,527 14,985 3,024 30,915,240 0 0 0 0 0 0 30,915,241 126,332 50,367 19,485 186,066,095 (29,173,152) (21,632) 21,632 0 0 0 156,892,943 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 94 0 0 74,388,996 (117,008) 0 XXX XXX XXX 0 74,271,987 0 0 0 12,677,890 0 0 0 0 0 0 12,677,890 192,954 65,352 22,509 304,189,975 (29,290,160) (21,632) 21,632 0 0 0 274,899,815 XXX XXX 192,954 65,352 22,509 304,189,975 (29,290,160) (21,632) 21,632 0 0 0 274,899,815 1,637 0 0 0 0 335,786 0 0 0 0 1,803,277 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,637 0.749 335,786 0.784 1,803,277 0.870 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 2,691 4,079 6,769 0.035 555,461 770,544 1,326,005 0.033 2,962,924 3,761,871 6,724,795 0.031 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 XXX XXX XXX 0 0 0 0 0 0 0 300,663 193,970 148,475 657,673 68,301 0 1,369,082 XXX 177,069 0.794 3,686,850 XXX 139,744 1,401,462 1,541,206 0.017 600,747 1,666,029 2,266,776 0.140 4,261,566 7,603,985 11,865,551 XXX XXX 0 0 0 0.000 31,493 6,748 81,578 (13,041) 70,290 378,907,259 0 10,853 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 2,472,855 200,718 230,054 644,632 138,590 0 0 0 0 0 2,472,855 200,718 230,054 644,632 138,590 0 3,686,850 XXX 0 0 0 4,261,566 7,603,985 11,865,551 XXX XXX XXX 378,918,112 11,508,895 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 (Continued) Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 10. General and Administrative (G&A) Expenses: 10.1 Direct sales salaries and benefits 10.2 Agents and brokers fees and commissions 10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below) 10.4 Other general and administrative expenses 10.4a Community Benefit Expenditures (informational only) 10.5 Total general and administrative (Lines 10.1 +10.2 + 10.3 + 10.4) 3 Large Group Employer 2 Small Group Employer 967 5,968 (10,911) 12,948 0 8,971 195,931 1,392,383 33,513 2,518,989 0 4,140,815 4 5 Small Group Employer Individual 1,307,337 515,440 278,811 6,357,422 0 8,459,010 0 0 0 0 0 0 Expatriate Plans 6 Large Group Employer 0 0 0 0 0 0 7 8 Small Group 0 0 0 0 0 0 Student Health Plans Large Group 0 0 0 0 0 0 10 11 Government Business (excluded by statute) Other Health Business 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 180,982 4,111,782 188,359 8,838,068 0 13,319,191 37,732 406,470 31,230 1,007,804 0 1,483,236 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 1,722,948 6,432,043 521,002 18,735,231 0 27,411,224 0 0 0 0 0 0 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) 12. Income from fees of uninsured plans XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 13. Net investment and other gain/(loss) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 14. Federal income taxes (excluding taxes on Line 1.5 above) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 15. Net gain or (loss) (Lines 11 + 12 + 13 - 14) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 16. ICD-10 Implementation Expenses (informational only; already included in general expenses and line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16. 16a ICD-10 Implementation Expenses (informational only; already included in line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 32,361 3,145,078 7,082,263 0 0 0 0 0 0 0 1,742,274 515,393 12,517,369 XXX 1,722,948 6,432,043 521,002 18,735,231 0 27,411,224 XXX 12,517,369 0 0 5,338,497 XXX XXX 304,891 XXX 304,891 XXX 17,550,976 XXX 17,550,976 5,338,497 OTHER INDICATORS: 216-2.UT 1. Number of certificates/policies 23 3,274 21,954 0 0 0 0 0 0 0 77,773 16,694 119,718 0 119,718 2. Number of Covered Lives 54 8,602 52,405 0 0 0 0 0 0 0 131,719 16,694 209,474 0 209,474 3. Number of Groups 449 267 0 0 0 0 0 0 546 0 1,262 0 1,262 4. Member Months 110,777 627,366 0 0 0 0 0 0 1,533,527 200,459 2,472,670 0 2,472,670 XXX 541 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ XXX 0 ] If yes, show the amount of premiums and claims included. Premiums $ 0 Claims $ 0 AFFORDABLE CARE ACT (ACA) RECEIPTS, PAYMENTS, RECEIVABLES and PAYABLES Current Year Prior Year Comprehensive Health Coverage Comprehensive Health Coverage 1 2 3 4 Small Group Small Group Employer Plans Employer Plans Individual Plans Individual Plans ACA Receivables and Payables 1. Permanent ACA Risk Adjustment Program 1.0 Premium adjustments receivable/(payable) 2. Transitional ACA Reinsurance Program 2.0 Total amounts recoverable for claims (paid & unpaid) 0 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 0 0 (16,476) (706,108) XXX (29,409) 0 0 0 (2,183,624) XXX 0 0 0 0 ACA Receipts and Payments 4. Permanent ACA Risk Adjustment Program 4.0 Premium adjustments receipts/(payments) 5. Transitional ACA Reinsurance Program 5.0 Amounts received for claims 0 6. Temporary ACA Risk Corridors Program 6.1 Retrospective premium received 6.2 Rate credits or policy experience refunds paid 0 0 (23,334) (1,033,699) XXX 0 0 0 0 0 0 (1,085,842) XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF 185 Asylum Street Hartford, CT 061033408 Utah DURING THE YEAR Comprehensive Health Coverage 1 2 3 Individual Small Group Employer Large Group Employer Small Group Employer Individual Expatriate Plans: 7 8 6 Large Group Employer Small Group 10 11 Government Business (excluded by statute) Other Health Business 9 Student Health Plans Large Group 79413 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.UT Health Premiums Earned: 204,621 41,978,328 1.1 Direct premiums written 0 2,246 1.2 Unearned premium prior year 0 1,138 1.3 Unearned premium current year 0 1,109 1.4 Change in unearned premium (Lines 1.2 - 1.3) 39 0 1.5 Paid rate credits 0 0 1.6 Reserve for rate credits current year 0 0 1.7 Reserve for rate credits prior year 0 0 1.8 Change in reserve for rate credits (Lines 1.6 - 1.7) 0 6,211 1.9 Premium balances written off 0 0 1.10 Group conversion charge 204,621 41,973,225 1.11 Total direct premiums earned (Lines 1.1 + 1.4 - 1.9 + 1.10) 0 0 1.12 Assumed premiums earned from non-affiliates 18 2,285 1.13 Net Assumed less Ceded premiums earned from affiliates 0 0 1.14 Ceded premiums earned to non-affiliates 0 6,211 1.15 Other Adjustments due to MLR calculation - Premiums 204,601 41,981,721 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 141,716 32,168,114 2.1 Paid claims during the year 5 5,594,572 2.2 Direct claim liability current year 5 7,430,830 2.3 Direct claim liability prior year 0 366,192 2.4 Direct claim reserves current year 0 350,779 2.5 Direct claim reserves prior year 0 0 2.6 Direct contract reserves current year 0 0 2.7 Direct contract reserves prior year 39 0 2.8 Paid rate credits 0 0 2.9 Reserve for rate credits current year 0 0 2.10 Reserve for rate credits prior year 0 14,985 2.11 Incurred medical incentive pools and bonuses (Lines 2.11a + 2.11b - 2.11c) 0 8,070 2.11a Paid medical incentive pools and bonuses current year 0 26,644 2.11b Accrued medical incentive pools and bonuses current year 0 19,728 2.11c Accrued medical incentive pools and bonuses prior year 0 (552,986) 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 0 691,663 2.12a Healthcare receivables current year 0 1,244,649 2.12b Healthcare receivables prior year 0 0 2.13 Group conversion charge 0 0 2.14 Multi-option coverage blended rate adjustment 2.15 Total incurred claims (Lines 2.1 + 2.2 - 2.3 + 2.4 - 2.5 + 2.6 - 2.7 + 2.8 + 2.9 141,755 30,915,240 2.10 + 2.11 - 2.12 + 2.13 + 2.14) 0 0 2.16 Assumed incurred claims from non-affiliates 0 0 2.17 Net assumed less ceded incurred claims from affiliates 0 0 2.18 Ceded incurred claims to non-affiliates 0 0 2.19 Other adjustments due to MLR calculation - Claims 141,716 30,915,241 2.20 Net Incurred Claims (Lines 2.15 - 2.8 - 2.9 + 2.10 + 2.16 + 2.17 - 2.18 + 2.19) 3. Fraud and Abuse Recoveries that Reduced PAID Claims in Line 2.1 above 0 3,024 (informational only) 6,849,814 for stand-alone dental and $ (a) Column 13, Line 1.1 includes direct written premium of $ 4 Business Subject to MLR Mini-Med Plans 5 (LOCATION) NAIC Company Code 2018 225,470,794 (9,972) 0 (9,972) 21,593 0 91,958 (91,958) 51,227 0 225,409,595 0 9,623 35,113,631 51,227 190,427,180 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 94,246,854 5,098 13,026 (7,928) (2,781,076) 315,385 337,976 (22,590) 1,219 0 94,237,707 0 0 155,045 1,219 96,887,548 17,263,194 0 0 0 2,249,627 1,287,666 1,563,212 (275,546) 181,085 0 17,082,109 0 756,341 0 181,085 16,045,454 379,163,791 (2,627) 14,164 (16,791) (509,817) 1,603,051 1,993,146 (390,094) 239,742 0 378,907,258 0 768,267 35,268,676 239,742 345,546,503 181,802,541 25,441,660 21,662,117 327,707 435,272 0 0 21,593 0 91,958 50,367 30,093 171,751 151,478 (611,573) 4,568,460 5,180,033 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 76,450,511 10,052,232 10,081,762 4,310,252 3,595,595 90,217 28,685 (2,781,076) 315,385 337,976 0 0 0 0 4,508 4,508 0 0 0 10,597,790 240,637 1,285,943 0 0 0 0 2,249,627 1,287,666 1,563,212 0 0 0 0 (1,151,325) 3,801,719 4,953,044 0 0 301,160,673 41,329,106 40,460,657 5,004,151 4,381,646 90,217 28,685 (509,817) 1,603,051 1,993,146 65,352 38,163 198,396 171,206 (2,311,376) 9,066,350 11,377,726 0 0 186,066,095 0 0 29,173,152 0 156,963,308 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 74,388,996 0 0 117,008 0 77,075,654 12,677,890 0 0 0 0 10,703,808 304,189,976 0 0 29,290,160 0 275,799,727 19,485 0 0 2,032,886 for stand-alone vision policies. 0 0 0 0 0 0 0 22,509 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF Utah DURING THE YEAR All Expenses 1 Improve Health Outcomes 1. Individual Comprehensive Coverage Expenses: 6,371 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 454 for affiliated services) 1.3 EDP Equipment and Software (incl $ 44 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 5 for affiliated services) 1.5 Accreditation and Certification (incl $ 14,342 for affiliated services) 1.6 Other Expenses (incl $ 1.7 Subtotal before Reimbursements and Taxes (Lines 1.1 to 1.6) 1.8 Reimbursements by uninsured plans and fiscal intermediaries 1.9 Taxes, Licenses and Fees (in total, for tying purposes) 1.10 Total (1.7 to 1.9) 1.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 2. 216-4.UT 3. 0 0 0 0 0 1,637 1,637 0 XXX Small Group Comprehensive Coverage Expenses: 2,404,373 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 167,295 for affiliated services) 2.3 EDP Equipment and Software (incl $ 16,058 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 1,744 for affiliated services) 2.5 Accreditation and Certification (incl $ 1,382,831 for affiliated services) 2.6 Other Expenses (incl $ 2.7 Subtotal before Reimbursements and Taxes (Lines 2.1 to 2.6) 2.8 Reimbursements by uninsured plans and fiscal intermediaries 2.9 Taxes, Licenses and Fees (in total, for tying purposes) 2.10 Total (2.7 to 2.9) 2.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Comprehensive Coverage Expenses: 4,301,918 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 271,696 for affiliated services) 3.3 EDP Equipment and Software (incl $ 26,080 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 2,832 for affiliated services) 3.5 Accreditation and Certification (incl $ 13,584,181 for affiliated services) 3.6 Other Expenses (incl $ 3.7 Subtotal before Reimbursements and Taxes (Lines 3.1 to 3.6) 3.8 Reimbursements by uninsured plans and fiscal intermediaries 3.9 Taxes, Licenses and Fees (in total, for tying purposes) 3.10 Total (3.7 to 3.9) 3.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 185 Asylum Street Hartford, CT 061033408 Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX Total (1 to 5) 0 0 0 0 0 1,637 1,637 0 XXX 0 0 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 0 0 0 0 0 0 0 XXX (LOCATION) NAIC Company Code 2018 XXX 755 87 63 6 1 1,689 2,600 0 XXX 1,157 133 97 9 1 2,587 3,983 0 XXX 1,637 0 0 0 0 0 0 0 0 0 1,637 0 2,600 778 3,983 0 0 0 0 0 0 335,786 335,786 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 335,786 335,786 0 318,400 36,712 26,588 2,552 277 152,618 537,148 0 457,496 52,430 38,203 3,667 398 198,887 751,081 0 XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX XXX XXX 335,786 0 0 0 0 0 0 0 0 0 335,786 0 537,148 158,245 751,081 0 0 0 0 0 0 1,803,277 1,803,277 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,803,277 1,803,277 0 639,223 114,178 53,378 5,124 556 2,053,195 2,865,654 0 828,744 94,976 69,204 6,643 721 2,677,875 3,678,163 0 1,803,277 0 XXX 2,865,654 898,406 XXX 3,678,163 0 XXX 1,803,277 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 79413 9 10 General Administrative Expenses Total Expenses (6 to 9) 4,459 404 295 28 3 14,625 19,814 0 (9,875) 9,940 0 6,371 623 454 44 5 20,538 28,034 0 (9,875) 18,160 778 1,628,476 153,756 102,504 9,839 1,068 2,197,808 4,093,451 0 227,740 4,321,191 0 2,404,373 242,899 167,295 16,058 1,744 2,885,099 5,717,466 0 227,740 5,945,207 158,245 2,833,951 258,986 149,114 14,313 1,554 4,836,757 8,094,675 0 1,920,802 10,015,478 0 4,301,918 468,140 271,696 26,080 2,832 11,371,103 16,441,769 0 1,920,802 18,362,572 898,406 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 4. 5. 216-5.UT 6. Individual Mini-Med Plans Expenses: 0 for affiliated services) 4.1 Salaries (including $ 4.2 Outsourced Services 0 for affiliated services) 4.3 EDP Equipment and Software (incl $ 0 for affiliated services) 4.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 4.5 Accreditation and Certification (incl $ 0 for affiliated services) 4.6 Other Expenses (incl $ 4.7 Subtotal before Reimbursements and Taxes (Lines 4.1 to 4.6) 4.8 Reimbursements by uninsured plans and fiscal intermediaries 4.9 Taxes, Licenses and Fees (in total, for tying purposes) 4.10 Total (4.7 to 4.9) 4.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Mini-Med Plans Expenses: 0 for affiliated services) 5.1 Salaries (including $ 5.2 Outsourced Services 0 for affiliated services) 5.3 EDP Equipment and Software (incl $ 0 for affiliated services) 5.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 5.5 Accreditation and Certification (incl $ 0 for affiliated services) 5.6 Other Expenses (incl $ 5.7 Subtotal before Reimbursements and Taxes (Lines 5.1 to 5.6) 5.8 Reimbursements by uninsured plans and fiscal intermediaries 5.9 Taxes, Licenses and Fees (in total, for tying purposes) 5.10 Total (5.7 to 5.9) 5.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Mini-Med Plans Expenses: 0 for affiliated services) 6.1 Salaries (including $ 6.2 Outsourced Services 0 for affiliated services) 6.3 EDP Equipment and Software (incl $ 0 for affiliated services) 6.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 6.5 Accreditation and Certification (incl $ 0 for affiliated services) 6.6 Other Expenses (incl $ 6.7 Subtotal before Reimbursements and Taxes (Lines 6.1 to 6.6) 6.8 Reimbursements by uninsured plans and fiscal intermediaries 6.9 Taxes, Licenses and Fees (in total, for tying purposes) 6.10 Total (6.7 to 6.9) 6.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 7. 8. 216-6.UT 9. Small Group Expatriate Plans Expenses: 0 for affiliated services) 7.1 Salaries (including $ 7.2 Outsourced Services 0 for affiliated services) 7.3 EDP Equipment and Software (incl $ 0 for affiliated services) 7.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 7.5 Accreditation and Certification (incl $ 0 for affiliated services) 7.6 Other Expenses (incl $ 7.7 Subtotal before Reimbursements and Taxes (Lines 7.1 to 7.6) 7.8 Reimbursements by uninsured plans and fiscal intermediaries 7.9 Taxes, Licenses and Fees (in total, for tying purposes) 7.10 Total (7.7 to 7.9) 7.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Expatriate Plans Expenses: 0 for affiliated services) 8.1 Salaries (including $ 8.2 Outsourced Services 0 for affiliated services) 8.3 EDP Equipment and Software (incl $ 0 for affiliated services) 8.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 8.5 Accreditation and Certification (incl $ 0 for affiliated services) 8.6 Other Expenses (incl $ 8.7 Subtotal before Reimbursements and Taxes (Lines 8.1 to 8.6) 8.8 Reimbursements by uninsured plans and fiscal intermediaries 8.9 Taxes, Licenses and Fees (in total, for tying purposes) 8.10 Total (8.7 to 8.9) 8.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Student Health Plans Expenses: 0 for affiliated services) 9.1 Salaries (including $ 9.2 Outsourced Services 0 for affiliated services) 9.3 EDP Equipment and Software (incl $ 0 for affiliated services) 9.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 9.5 Accreditation and Certification (incl $ 0 for affiliated services) 9.6 Other Expenses (incl $ 9.7 Subtotal before Reimbursements and Taxes (Lines 9.1 to 9.6) 9.8 Reimbursements by uninsured plans and fiscal intermediaries 9.9 Taxes, Licenses and Fees (in total, for tying purposes) 9.10 Total (9.7 to 9.9) 9.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 *79413201821646100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes - See Cautionary Statement at http://www.naic.org/documents/committees_e_app_blanks_related_shce_cautionary_statement.pdf) UnitedHealthcare Insurance Company 2. 185 Asylum Street Hartford, CT 061033408 (LOCATION) BUSINESS IN THE STATE OF Vermont DURING THE YEAR 2018 NAIC Company Code Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 1. 216-1.VT 2. 3. 4. 5. 6. 7. 8. 9. Premium: 1.1 Health premiums earned (From Part 2, Line 1.11) 1.2 Federal high risk pools 1.3 State high risk pools 1.4 Premiums earned including state and federal high risk programs (Lines 1.1 + 1.2 + 1.3) 1.5 Federal taxes and federal assessments 1.6 State insurance, premium and other taxes (Similar local taxes of 11,563 ) $ 1.6a Community Benefit Expenditures (informational only) 1.7 Regulatory authority licenses and fees 1.8 Adjusted Premiums Earned (Lines 1.4 - 1.5 - 1.6 - 1.7) 1.9 Net Assumed less Ceded reinsurance premiums earned 1.10 Other Adjustments due to MLR calculations - Premiums 1.11 Risk Revenue 1.12 Net adjusted premiums earned after reinsurance (Lines 1.8 + 1.9 + 1.10 + 1.11) Claims: 2.1 Incurred claims excluding prescription drugs 2.2 Prescription drugs 2.3 Pharmaceutical rebates 2.4 State stop loss, market stabilization and claim/census based assessments (informational only) Incurred medical incentive pools and bonuses Deductible Fraud and Abuse Detection/Recovery Expenses (for MLR use only) 5.0 Total Incurred Claims (Lines 2.1 + 2.2 - 2.3 + 3) (From Part 2, Line 2.15) 5.1 Net Assumed less Ceded reinsurance claims incurred 5.2 Other Adjustments due to MLR calculations - Claims 5.3 Rebates paid 5.4 Estimated rebates unpaid prior year 5.5 Estimated rebates unpaid current year 5.6 Fee for service and co-pay revenue 5.7 Net incurred claims after reinsurance (Lines 5.0 + 5.1 + 5.2 + 5.3 - 5.4 + 5.5 - 5.6) Improving Health Care Quality Expenses Incurred: 6.1 Improve health outcomes 6.2 Activities to prevent hospital readmissions 6.3 Improve patient safety and reduce medical errors 6.4 Wellness and health promotion activities 6.5 Health Information Technology expenses related to health improvement 6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5) Preliminary Medical Loss Ratio: MLR ((Lines 4 + 5.0 + 6.6 - Footnote 2.0)/Line 1.8 Claims Adjustment Expenses: 8.1 Cost containment expenses not included in quality of care expenses in Line 6.6 8.2 All other claims adjustment expenses 8.3 Total claims adjustment expenses (Lines 8.1 + 8.2) Claims Adjustment Expense Ratio (Line 8.3/Line 1.8) 3 Large Group Employer 2 Small Group Employer 4 6 Large Group Employer 5 Small Group Employer Individual Expatriate Plans 7 11 Government Business (excluded by statute) Other Health Business 9 8 Small Group 10 Student Health Plans Large Group 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 79413 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 44,252,068 0 26,022 77,200,049 0 0 121,452,117 0 26,022 XXX XXX XXX 0 62 0 195 0 42 0 0 0 0 0 0 0 0 0 0 0 0 0 0 44,278,090 222,454 77,200,049 4,796,309 121,478,139 5,019,061 XXX 0 0 0 (62) 0 0 0 (62) (4) 0 1 (192) 0 0 0 (192) 0 0 0 (42) 0 0 0 (42) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 636,689 0 (11,026) 43,429,974 0 12 0 43,429,986 8,122 0 0 72,395,618 27,707 181,316 0 72,604,641 644,807 0 (11,025) 115,825,297 27,707 181,328 0 116,034,331 XXX XXX XXX XXX XXX 644,807 0 (11,025) 115,825,297 27,707 181,328 0 116,034,331 146 0 0 (33) 0 0 (189) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 35,610,815 58,363 16,743 45,285,959 20,370,375 11,388,689 80,896,698 20,428,738 11,405,432 XXX XXX XXX 80,896,698 20,428,738 11,405,432 0 0 0 146 0 0 0 0 0 0 146 0 0 0 (33) 0 0 0 0 0 0 (33) (1) 0 0 (189) 30 0 0 0 0 0 (159) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 580 54,267,644 0 0 0 0 0 0 54,267,644 353,700 0 580 89,920,004 30 0 0 0 0 0 89,920,034 XXX XXX 0 0 353,701 0 0 35,652,435 0 0 XXX XXX XXX 0 35,652,435 353,700 0 580 89,920,004 30 0 0 0 0 0 89,920,034 0 0 0 0 0 75,226 23 25 343,779 14,354 580,272 154,285 118,111 17,839 249,157 655,499 154,308 118,136 361,618 263,511 0 433,407 XXX 1,119,664 0.765 1,553,071 XXX 7,719 595,363 603,082 0.014 514,379 1,005,888 1,520,267 0.021 522,098 1,601,251 2,123,349 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (2.352) 0 0.170 0 4.526 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0 0 0.000 0 0 0 (0.001) 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 XXX XXX XXX XXX 0 0 0 0.000 121,452,117 0 26,022 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 655,499 154,308 118,136 361,618 263,511 0 1,553,071 XXX 0 0 0 522,098 1,601,251 2,123,349 XXX XXX XXX 121,478,139 5,019,061 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 (Continued) Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 2 Small Group Employer Individual 10. General and Administrative (G&A) Expenses: 10.1 Direct sales salaries and benefits 10.2 Agents and brokers fees and commissions 10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below) 10.4 Other general and administrative expenses 10.4a Community Benefit Expenditures (informational only) 10.5 Total general and administrative (Lines 10.1 +10.2 + 10.3 + 10.4) 0 0 (458) 0 0 (458) 3 Large Group Employer 0 0 (940) 0 0 (940) 4 5 Small Group Employer Individual 0 0 (51) 0 0 (51) 0 0 0 0 0 0 Expatriate Plans 6 Large Group Employer 0 0 0 0 0 0 7 8 Small Group 0 0 0 0 0 0 Student Health Plans Large Group 0 0 0 0 0 0 10 11 Government Business (excluded by statute) Other Health Business 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 48,754 1,526,189 71,687 4,199,306 0 5,845,936 172,100 275,095 90,989 2,430,022 0 2,968,205 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 220,854 1,801,283 161,228 6,629,328 0 8,812,693 0 0 0 0 0 0 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) 12,728,861 13,625,185 12. Income from fees of uninsured plans XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 13. Net investment and other gain/(loss) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 14. Federal income taxes (excluding taxes on Line 1.5 above) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 15. Net gain or (loss) (Lines 11 + 12 + 13 - 14) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 16. ICD-10 Implementation Expenses (informational only; already included in general expenses and line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16. 16a ICD-10 Implementation Expenses (informational only; already included in line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 250 780 167 0 0 0 0 0 0 0 895,127 XXX 220,854 1,801,283 161,228 6,629,328 0 8,812,693 13,625,185 0 0 1,579,339 XXX XXX 91,784 XXX 91,784 XXX 15,112,740 XXX 15,112,740 1,579,339 OTHER INDICATORS: 216-2.VT 1. Number of certificates/policies 0 0 0 0 0 0 0 0 0 0 18,160 21,176 39,336 0 39,336 2. Number of Covered Lives 0 0 0 0 0 0 0 0 0 0 18,045 21,176 39,221 0 39,221 3. Number of Groups 0 0 0 0 0 0 0 0 2 0 2 0 2 4. Member Months 0 0 0 0 0 0 0 0 221,219 259,301 480,520 0 480,520 XXX 0 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ XXX 0 ] If yes, show the amount of premiums and claims included. Premiums $ 0 Claims $ 0 AFFORDABLE CARE ACT (ACA) RECEIPTS, PAYMENTS, RECEIVABLES and PAYABLES Current Year Prior Year Comprehensive Health Coverage Comprehensive Health Coverage 1 2 3 4 Small Group Small Group Employer Plans Employer Plans Individual Plans Individual Plans ACA Receivables and Payables 1. Permanent ACA Risk Adjustment Program 1.0 Premium adjustments receivable/(payable) 0 2. Transitional ACA Reinsurance Program 2.0 Total amounts recoverable for claims (paid & unpaid) 0 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 0 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 XXX ACA Receipts and Payments 4. Permanent ACA Risk Adjustment Program 4.0 Premium adjustments receipts/(payments) 0 5. Transitional ACA Reinsurance Program 5.0 Amounts received for claims 0 6. Temporary ACA Risk Corridors Program 6.1 Retrospective premium received 6.2 Rate credits or policy experience refunds paid 0 0 XXX 0 0 0 0 0 XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF 185 Asylum Street Hartford, CT 061033408 Vermont DURING THE YEAR Comprehensive Health Coverage 1 2 3 Individual Small Group Employer Large Group Employer Small Group Employer Individual Expatriate Plans: 7 8 6 Large Group Employer Small Group 10 11 Government Business (excluded by statute) Other Health Business 9 Student Health Plans Large Group 79413 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.VT Health Premiums Earned: 0 1.1 Direct premiums written 0 1.2 Unearned premium prior year 0 1.3 Unearned premium current year 0 1.4 Change in unearned premium (Lines 1.2 - 1.3) 146 1.5 Paid rate credits 0 1.6 Reserve for rate credits current year 0 1.7 Reserve for rate credits prior year 0 1.8 Change in reserve for rate credits (Lines 1.6 - 1.7) 0 1.9 Premium balances written off 0 1.10 Group conversion charge 0 1.11 Total direct premiums earned (Lines 1.1 + 1.4 - 1.9 + 1.10) 0 1.12 Assumed premiums earned from non-affiliates 0 1.13 Net Assumed less Ceded premiums earned from affiliates 0 1.14 Ceded premiums earned to non-affiliates 0 1.15 Other Adjustments due to MLR calculation - Premiums (146) 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 0 2.1 Paid claims during the year 0 2.2 Direct claim liability current year 0 2.3 Direct claim liability prior year 0 2.4 Direct claim reserves current year 0 2.5 Direct claim reserves prior year 0 2.6 Direct contract reserves current year 0 2.7 Direct contract reserves prior year 146 2.8 Paid rate credits 0 2.9 Reserve for rate credits current year 0 2.10 Reserve for rate credits prior year 0 2.11 Incurred medical incentive pools and bonuses (Lines 2.11a + 2.11b - 2.11c) 0 2.11a Paid medical incentive pools and bonuses current year 0 2.11b Accrued medical incentive pools and bonuses current year 0 2.11c Accrued medical incentive pools and bonuses prior year 0 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 0 2.12a Healthcare receivables current year 0 2.12b Healthcare receivables prior year 0 2.13 Group conversion charge 0 2.14 Multi-option coverage blended rate adjustment 2.15 Total incurred claims (Lines 2.1 + 2.2 - 2.3 + 2.4 - 2.5 + 2.6 - 2.7 + 2.8 + 2.9 146 2.10 + 2.11 - 2.12 + 2.13 + 2.14) 0 2.16 Assumed incurred claims from non-affiliates 0 2.17 Net assumed less ceded incurred claims from affiliates 0 2.18 Ceded incurred claims to non-affiliates 0 2.19 Other adjustments due to MLR calculation - Claims 0 2.20 Net Incurred Claims (Lines 2.15 - 2.8 - 2.9 + 2.10 + 2.16 + 2.17 - 2.18 + 2.19) 3. Fraud and Abuse Recoveries that Reduced PAID Claims in Line 2.1 above 0 (informational only) 0 for stand-alone dental and $ (a) Column 13, Line 1.1 includes direct written premium of $ 4 Business Subject to MLR Mini-Med Plans 5 (LOCATION) NAIC Company Code 2018 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (146) 0 0 0 0 0 0 0 0 0 0 146 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 44,252,080 0 0 0 469,324 0 0 0 12 0 44,252,068 0 0 0 12 43,782,756 77,381,365 0 0 0 0 (411,132) 15,622 (426,754) 181,316 0 77,200,049 0 27,707 0 181,316 77,835,826 121,633,445 0 0 0 469,324 (411,132) 15,622 (426,754) 181,328 0 121,452,117 0 27,707 0 181,328 121,618,582 (38) 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (43) 0 0 0 0 0 0 (146) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 35,192,118 4,345,185 4,302,386 1,195,582 1,242,167 8 39 469,324 0 0 0 0 0 0 5,190 5,190 0 0 0 54,759,939 2,540,347 2,803,654 3,018 2,393 0 0 0 (411,132) 15,622 0 0 0 0 (197,143) 5,998,560 6,195,703 0 0 89,951,976 6,885,537 7,106,041 1,198,600 1,244,560 8 39 469,324 (411,132) 15,622 0 0 0 0 (191,953) 6,003,750 6,195,703 0 0 (33) 0 0 0 0 (33) (189) 0 0 (30) 0 (13) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 35,652,435 0 0 0 0 35,183,111 54,267,644 0 0 0 0 54,694,398 89,920,004 0 0 (30) 0 89,877,464 42 0 0 554 for stand-alone vision policies. 0 0 0 0 0 0 580 38 659 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF Vermont DURING THE YEAR Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities All Expenses 1 2 Activities to Prevent Hospital Readmissions Improve Health Outcomes 1. 2. 216-4.VT 3. Individual Comprehensive Coverage Expenses: 0 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 0 for affiliated services) 1.3 EDP Equipment and Software (incl $ 0 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 1.5 Accreditation and Certification (incl $ 0 for affiliated services) 1.6 Other Expenses (incl $ 1.7 Subtotal before Reimbursements and Taxes (Lines 1.1 to 1.6) 1.8 Reimbursements by uninsured plans and fiscal intermediaries 1.9 Taxes, Licenses and Fees (in total, for tying purposes) 1.10 Total (1.7 to 1.9) 1.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Comprehensive Coverage Expenses: 0 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 0 for affiliated services) 2.3 EDP Equipment and Software (incl $ 0 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 2.5 Accreditation and Certification (incl $ 0 for affiliated services) 2.6 Other Expenses (incl $ 2.7 Subtotal before Reimbursements and Taxes (Lines 2.1 to 2.6) 2.8 Reimbursements by uninsured plans and fiscal intermediaries 2.9 Taxes, Licenses and Fees (in total, for tying purposes) 2.10 Total (2.7 to 2.9) 2.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Comprehensive Coverage Expenses: 0 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 0 for affiliated services) 3.3 EDP Equipment and Software (incl $ 0 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 3.5 Accreditation and Certification (incl $ 0 for affiliated services) 3.6 Other Expenses (incl $ 3.7 Subtotal before Reimbursements and Taxes (Lines 3.1 to 3.6) 3.8 Reimbursements by uninsured plans and fiscal intermediaries 3.9 Taxes, Licenses and Fees (in total, for tying purposes) 3.10 Total (3.7 to 3.9) 3.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 185 Asylum Street Hartford, CT 061033408 0 0 0 0 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX Total (1 to 5) 0 0 0 0 0 0 0 0 XXX 0 0 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 0 0 0 0 0 0 0 XXX (LOCATION) NAIC Company Code 2018 XXX 0 0 0 0 0 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 79413 9 10 General Administrative Expenses Total Expenses (6 to 9) 0 0 0 0 0 0 0 0 (458) (458) 0 0 0 0 0 0 0 0 0 (458) (458) 0 0 0 0 0 0 0 0 0 (943) (943) 0 0 0 0 0 0 0 0 0 (943) (942) 0 0 0 0 0 0 0 0 0 (51) (51) 0 0 0 0 0 0 0 0 0 (51) (51) 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 4. 5. 216-5.VT 6. Individual Mini-Med Plans Expenses: 0 for affiliated services) 4.1 Salaries (including $ 4.2 Outsourced Services 0 for affiliated services) 4.3 EDP Equipment and Software (incl $ 0 for affiliated services) 4.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 4.5 Accreditation and Certification (incl $ 0 for affiliated services) 4.6 Other Expenses (incl $ 4.7 Subtotal before Reimbursements and Taxes (Lines 4.1 to 4.6) 4.8 Reimbursements by uninsured plans and fiscal intermediaries 4.9 Taxes, Licenses and Fees (in total, for tying purposes) 4.10 Total (4.7 to 4.9) 4.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Mini-Med Plans Expenses: 0 for affiliated services) 5.1 Salaries (including $ 5.2 Outsourced Services 0 for affiliated services) 5.3 EDP Equipment and Software (incl $ 0 for affiliated services) 5.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 5.5 Accreditation and Certification (incl $ 0 for affiliated services) 5.6 Other Expenses (incl $ 5.7 Subtotal before Reimbursements and Taxes (Lines 5.1 to 5.6) 5.8 Reimbursements by uninsured plans and fiscal intermediaries 5.9 Taxes, Licenses and Fees (in total, for tying purposes) 5.10 Total (5.7 to 5.9) 5.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Mini-Med Plans Expenses: 0 for affiliated services) 6.1 Salaries (including $ 6.2 Outsourced Services 0 for affiliated services) 6.3 EDP Equipment and Software (incl $ 0 for affiliated services) 6.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 6.5 Accreditation and Certification (incl $ 0 for affiliated services) 6.6 Other Expenses (incl $ 6.7 Subtotal before Reimbursements and Taxes (Lines 6.1 to 6.6) 6.8 Reimbursements by uninsured plans and fiscal intermediaries 6.9 Taxes, Licenses and Fees (in total, for tying purposes) 6.10 Total (6.7 to 6.9) 6.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 7. 8. 216-6.VT 9. Small Group Expatriate Plans Expenses: 0 for affiliated services) 7.1 Salaries (including $ 7.2 Outsourced Services 0 for affiliated services) 7.3 EDP Equipment and Software (incl $ 0 for affiliated services) 7.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 7.5 Accreditation and Certification (incl $ 0 for affiliated services) 7.6 Other Expenses (incl $ 7.7 Subtotal before Reimbursements and Taxes (Lines 7.1 to 7.6) 7.8 Reimbursements by uninsured plans and fiscal intermediaries 7.9 Taxes, Licenses and Fees (in total, for tying purposes) 7.10 Total (7.7 to 7.9) 7.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Expatriate Plans Expenses: 0 for affiliated services) 8.1 Salaries (including $ 8.2 Outsourced Services 0 for affiliated services) 8.3 EDP Equipment and Software (incl $ 0 for affiliated services) 8.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 8.5 Accreditation and Certification (incl $ 0 for affiliated services) 8.6 Other Expenses (incl $ 8.7 Subtotal before Reimbursements and Taxes (Lines 8.1 to 8.6) 8.8 Reimbursements by uninsured plans and fiscal intermediaries 8.9 Taxes, Licenses and Fees (in total, for tying purposes) 8.10 Total (8.7 to 8.9) 8.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Student Health Plans Expenses: 0 for affiliated services) 9.1 Salaries (including $ 9.2 Outsourced Services 0 for affiliated services) 9.3 EDP Equipment and Software (incl $ 0 for affiliated services) 9.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 9.5 Accreditation and Certification (incl $ 0 for affiliated services) 9.6 Other Expenses (incl $ 9.7 Subtotal before Reimbursements and Taxes (Lines 9.1 to 9.6) 9.8 Reimbursements by uninsured plans and fiscal intermediaries 9.9 Taxes, Licenses and Fees (in total, for tying purposes) 9.10 Total (9.7 to 9.9) 9.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 *79413201821647100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes - See Cautionary Statement at http://www.naic.org/documents/committees_e_app_blanks_related_shce_cautionary_statement.pdf) UnitedHealthcare Insurance Company 2. 185 Asylum Street Hartford, CT 061033408 (LOCATION) BUSINESS IN THE STATE OF Virginia DURING THE YEAR 2018 NAIC Company Code Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 1. 216-1.VA 2. 3. 4. 5. 6. 7. 8. 9. Premium: 1.1 Health premiums earned (From Part 2, Line 1.11) 1.2 Federal high risk pools 1.3 State high risk pools 1.4 Premiums earned including state and federal high risk programs (Lines 1.1 + 1.2 + 1.3) 1.5 Federal taxes and federal assessments 1.6 State insurance, premium and other taxes (Similar local taxes of 219,656 ) $ 1.6a Community Benefit Expenditures (informational only) 1.7 Regulatory authority licenses and fees 1.8 Adjusted Premiums Earned (Lines 1.4 - 1.5 - 1.6 - 1.7) 1.9 Net Assumed less Ceded reinsurance premiums earned 1.10 Other Adjustments due to MLR calculations - Premiums 1.11 Risk Revenue 1.12 Net adjusted premiums earned after reinsurance (Lines 1.8 + 1.9 + 1.10 + 1.11) Claims: 2.1 Incurred claims excluding prescription drugs 2.2 Prescription drugs 2.3 Pharmaceutical rebates 2.4 State stop loss, market stabilization and claim/census based assessments (informational only) Incurred medical incentive pools and bonuses Deductible Fraud and Abuse Detection/Recovery Expenses (for MLR use only) 5.0 Total Incurred Claims (Lines 2.1 + 2.2 - 2.3 + 3) (From Part 2, Line 2.15) 5.1 Net Assumed less Ceded reinsurance claims incurred 5.2 Other Adjustments due to MLR calculations - Claims 5.3 Rebates paid 5.4 Estimated rebates unpaid prior year 5.5 Estimated rebates unpaid current year 5.6 Fee for service and co-pay revenue 5.7 Net incurred claims after reinsurance (Lines 5.0 + 5.1 + 5.2 + 5.3 - 5.4 + 5.5 - 5.6) Improving Health Care Quality Expenses Incurred: 6.1 Improve health outcomes 6.2 Activities to prevent hospital readmissions 6.3 Improve patient safety and reduce medical errors 6.4 Wellness and health promotion activities 6.5 Health Information Technology expenses related to health improvement 6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5) Preliminary Medical Loss Ratio: MLR ((Lines 4 + 5.0 + 6.6 - Footnote 2.0)/Line 1.8 Claims Adjustment Expenses: 8.1 Cost containment expenses not included in quality of care expenses in Line 6.6 8.2 All other claims adjustment expenses 8.3 Total claims adjustment expenses (Lines 8.1 + 8.2) Claims Adjustment Expense Ratio (Line 8.3/Line 1.8) 2 Small Group Employer 3 Large Group Employer 4 5 Small Group Employer Individual Expatriate Plans 6 Large Group Employer 7 11 Government Business (excluded by statute) Other Health Business 9 8 Small Group 10 Student Health Plans Large Group 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 79413 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 2,362,267 0 (882) 352,101,001 0 (8,938) 650,093,437 0 (65,479) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 445,171,066 0 0 343,444,504 0 149,001 166,026,723 0 0 1,959,198,997 0 73,702 XXX XXX XXX 2,361,384 (4,942) 352,092,063 12,306,664 650,027,958 23,509,824 0 0 0 0 0 0 0 0 0 0 0 0 445,171,066 (4,163,497) 343,593,505 2,816,055 166,026,723 7,069,752 1,959,272,699 41,533,856 XXX 15,669 0 775 2,349,883 299 0 0 2,350,182 5,017,060 0 59,425 334,708,914 68,720 48,761 0 334,826,394 1,992,343 0 127,819 624,397,971 (54,602,731) 2,342 0 569,797,583 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 9,960,053 0 0 439,374,509 164,410 0 0 439,538,919 17,718,192 0 (40,611) 323,099,869 (1,154,582) 1,176 0 321,946,463 18,923 0 0 158,938,048 460,663 1,092,604 0 160,491,314 34,722,241 0 147,408 1,882,869,195 (55,063,221) 1,144,883 0 1,828,950,856 XXX XXX XXX XXX XXX 34,722,241 0 147,408 1,882,869,197 (55,063,221) 1,144,883 0 1,828,950,858 1,974,959 255,890 76,387 224,967,467 55,544,430 17,507,288 447,975,269 117,731,539 34,217,272 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 378,487,232 38,366,215 240,682 254,774,996 5,822,012 154,867 46,974,990 177,584,887 98,063,806 1,355,154,913 395,304,972 150,260,302 XXX XXX XXX 1,355,154,913 395,304,972 150,260,302 1,051 0 0 2,154,462 0 0 0 0 0 0 2,154,462 210,165 220,365 4,885 263,224,974 0 (246,219) 246,219 (1) (1) 0 263,224,974 676,491 936,067 39,405 532,425,604 (43,384,842) 0 0 0 0 0 489,040,762 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 20,040 6,993 416,632,804 0 0 XXX XXX XXX 0 416,632,804 85 0 0 260,442,141 (1,160,405) 0 XXX XXX XXX 0 259,281,736 0 76,989 436 126,573,060 0 0 0 0 0 0 126,573,060 887,792 1,253,462 51,719 1,601,453,045 (44,545,247) (246,219) 246,219 (1) (1) 0 1,556,907,798 XXX XXX 887,792 1,253,462 51,719 1,601,453,045 (44,545,247) (246,219) 246,219 (1) (1) 0 1,556,907,798 18,898 0 0 0 0 2,816,808 0 0 0 0 5,200,747 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7,620,126 5,307,823 4,389,718 3,219,404 368,211 651,461 190,546 159,714 2,221,248 157,168 18,898 0.925 2,816,808 0.795 5,200,747 0.861 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 20,905,282 XXX 3,380,137 XXX 1,336,367 0.805 33,658,239 XXX 31,760 54,408 86,168 0.037 4,356,373 6,333,252 10,689,625 0.032 7,285,967 8,708,233 15,994,200 0.026 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 887,676 4,591,990 5,479,666 0.012 620,364 5,167,987 5,788,351 0.018 1,728,705 8,684,539 10,413,244 0.066 14,910,844 33,540,410 48,451,254 XXX 457,991 132,745 438,317 (90,750) 398,064 1,959,198,997 0 73,702 (2) 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 16,766,033 5,631,114 4,987,749 5,349,902 923,442 0 0 0 0 0 16,766,033 5,631,114 4,987,749 5,349,902 923,442 0 33,658,239 XXX 0 0 0 14,910,844 33,540,410 48,451,254 XXX XXX XXX 1,959,272,699 41,533,854 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 (Continued) Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 2 Small Group Employer Individual 10. General and Administrative (G&A) Expenses: 10.1 Direct sales salaries and benefits 10.2 Agents and brokers fees and commissions 10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below) 10.4 Other general and administrative expenses 10.4a Community Benefit Expenditures (informational only) 10.5 Total general and administrative (Lines 10.1 +10.2 + 10.3 + 10.4) 10,920 79,450 (1,954) 141,334 0 229,750 3 Large Group Employer 1,462,777 11,866,317 461,233 18,162,347 0 31,952,675 4 5 Small Group Employer Individual 2,030,080 5,638,336 591,846 13,803,155 0 22,063,416 0 0 0 0 0 0 Expatriate Plans 6 Large Group Employer 0 0 0 0 0 0 7 8 Small Group 0 0 0 0 0 0 Student Health Plans Large Group 0 0 0 0 0 0 10 11 Government Business (excluded by statute) Other Health Business 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 9 0 0 0 0 0 0 0 0 0 0 0 0 18,186 0 453,916 13,820,138 0 14,292,241 0 (17,771,074) 759,509 14,155,479 643,218 30,947,266 0 46,505,471 337,331 1,815,944 300,455 9,105,076 0 11,558,806 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 4,618,803 33,555,526 2,448,713 85,979,316 0 126,602,358 0 10 0 0 0 10 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) 26,142,312 37,498,458 10,609,838 63,331,207 12. Income from fees of uninsured plans XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 13. Net investment and other gain/(loss) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 28,209,183 XXX 14. Federal income taxes (excluding taxes on Line 1.5 above) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 1,587,703 XXX 1,587,703 15. Net gain or (loss) (Lines 11 + 12 + 13 - 14) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 89,952,687 XXX 89,952,679 16. ICD-10 Implementation Expenses (informational only; already included in general expenses and line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16. 16a ICD-10 Implementation Expenses (informational only; already included in line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (139,095) 0 0 0 0 0 6,990,768 XXX 4,618,803 33,555,536 2,448,713 85,979,316 0 126,602,368 63,331,199 0 0 28,209,183 OTHER INDICATORS: 216-2.VA 1. Number of certificates/policies 291 39,805 64,097 0 0 0 0 0 0 24,505 300,687 113,721 543,106 0 543,106 2. Number of Covered Lives 593 75,638 121,341 0 0 0 0 0 0 24,505 450,258 113,721 786,056 0 786,056 3. Number of Groups 6,631 907 0 0 0 0 0 1 6,149 13 13,701 0 13,701 4. Member Months 6,491 844,224 1,472,070 0 0 0 0 0 285,556 5,480,546 1,379,871 9,468,758 0 9,468,758 XXX Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ XXX 0 ] If yes, show the amount of premiums and claims included. Premiums $ 0 Claims $ 0 AFFORDABLE CARE ACT (ACA) RECEIPTS, PAYMENTS, RECEIVABLES and PAYABLES Current Year Prior Year Comprehensive Health Coverage Comprehensive Health Coverage 1 2 3 4 Small Group Small Group Employer Plans Employer Plans Individual Plans Individual Plans ACA Receivables and Payables 1. Permanent ACA Risk Adjustment Program 1.0 Premium adjustments receivable/(payable) 2. Transitional ACA Reinsurance Program 2.0 Total amounts recoverable for claims (paid & unpaid) 0 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 0 0 (537,084) (19,149,785) XXX (271,473) 0 0 0 (19,182,719) XXX 0 0 0 0 ACA Receipts and Payments 4. Permanent ACA Risk Adjustment Program 4.0 Premium adjustments receipts/(payments) 5. Transitional ACA Reinsurance Program 5.0 Amounts received for claims 0 6. Temporary ACA Risk Corridors Program 6.1 Retrospective premium received 6.2 Rate credits or policy experience refunds paid 0 0 (284,332) (14,745,690) XXX 9,473 0 0 0 0 0 (11,836,143) XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF 185 Asylum Street Hartford, CT 061033408 Virginia DURING THE YEAR Comprehensive Health Coverage 1 2 3 Individual Small Group Employer Small Group Employer Individual Expatriate Plans: 7 8 6 Large Group Employer Small Group 10 11 Government Business (excluded by statute) Other Health Business 9 Student Health Plans Large Group 79413 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.VA Health Premiums Earned: 2,362,267 352,141,068 1.1 Direct premiums written 0 40,320 1.2 Unearned premium prior year 0 31,626 1.3 Unearned premium current year 0 8,694 1.4 Change in unearned premium (Lines 1.2 - 1.3) 145,104 246,219 1.5 Paid rate credits 0 (1) 1.6 Reserve for rate credits current year 0 (1) 1.7 Reserve for rate credits prior year 0 0 1.8 Change in reserve for rate credits (Lines 1.6 - 1.7) 0 48,761 1.9 Premium balances written off 0 0 1.10 Group conversion charge 2,362,267 352,101,001 1.11 Total direct premiums earned (Lines 1.1 + 1.4 - 1.9 + 1.10) 0 0 1.12 Assumed premiums earned from non-affiliates 299 68,720 1.13 Net Assumed less Ceded premiums earned from affiliates 0 0 1.14 Ceded premiums earned to non-affiliates 0 48,761 1.15 Other Adjustments due to MLR calculation - Premiums 2,217,462 351,972,262 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 2,095,433 256,665,485 2.1 Paid claims during the year 18,242 28,105,132 2.2 Direct claim liability current year 32,051 19,913,756 2.3 Direct claim liability prior year 922 0 2.4 Direct claim reserves current year 5,200 0 2.5 Direct claim reserves prior year 159,318 0 2.6 Direct contract reserves current year 226,440 0 2.7 Direct contract reserves prior year 145,104 246,219 2.8 Paid rate credits 0 (1) 2.9 Reserve for rate credits current year 0 (1) 2.10 Reserve for rate credits prior year 0 220,365 2.11 Incurred medical incentive pools and bonuses (Lines 2.11a + 2.11b - 2.11c) 0 69,895 2.11a Paid medical incentive pools and bonuses current year 0 511,802 2.11b Accrued medical incentive pools and bonuses current year 0 361,331 2.11c Accrued medical incentive pools and bonuses prior year 866 2,098,471 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 866 7,338,671 2.12a Healthcare receivables current year 0 5,240,200 2.12b Healthcare receivables prior year 0 0 2.13 Group conversion charge 0 0 2.14 Multi-option coverage blended rate adjustment 2.15 Total incurred claims (Lines 2.1 + 2.2 - 2.3 + 2.4 - 2.5 + 2.6 - 2.7 + 2.8 + 2.9 2,154,462 263,224,974 2.10 + 2.11 - 2.12 + 2.13 + 2.14) 0 0 2.16 Assumed incurred claims from non-affiliates 0 0 2.17 Net assumed less ceded incurred claims from affiliates 0 0 2.18 Ceded incurred claims to non-affiliates 0 0 2.19 Other adjustments due to MLR calculation - Claims 2,009,358 262,978,755 2.20 Net Incurred Claims (Lines 2.15 - 2.8 - 2.9 + 2.10 + 2.16 + 2.17 - 2.18 + 2.19) 3. Fraud and Abuse Recoveries that Reduced PAID Claims in Line 2.1 above 0 4,885 (informational only) 28,289,549 for stand-alone dental and $ (a) Column 13, Line 1.1 includes direct written premium of $ Large Group Employer 4 Business Subject to MLR Mini-Med Plans 5 (LOCATION) NAIC Company Code 2018 650,091,131 (4,203) (8,852) 4,649 (989,098) (958,163) (1,170,939) 212,776 2,342 0 650,093,437 1,588,575 97,450 56,288,756 2,342 596,269,371 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 445,171,066 0 0 0 0 0 0 0 0 0 445,171,066 0 164,410 0 0 445,335,475 343,705,289 51,814 311,423 (259,609) 252,868 939,954 1,777,551 (837,597) 1,176 0 343,444,504 0 0 1,154,582 1,176 342,875,827 167,119,327 0 0 0 6,887,530 2,365,699 7,240,034 (4,874,335) 1,092,604 0 166,026,723 0 460,663 0 1,092,604 165,566,794 1,960,590,147 87,930 334,198 (246,267) 6,542,623 2,347,489 7,846,645 (5,499,156) 1,144,883 0 1,959,198,997 1,588,575 791,541 57,443,338 1,144,883 1,904,237,191 527,006,030 54,361,196 48,615,862 573,276 339,239 0 0 (989,098) (958,163) (1,170,939) 936,067 352,673 1,634,222 1,050,828 719,543 13,224,374 12,504,831 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 390,556,670 44,363,840 17,314,813 81,585 289,940 0 0 0 0 0 20,040 0 20,040 0 784,579 806,719 22,140 0 0 259,317,357 23,224,741 22,222,489 17,692,490 17,027,687 114,691 26,501 252,868 939,954 1,777,551 0 0 0 0 45,731 45,754 23 0 0 130,714,677 8,186,432 14,167,100 8,528 9,972 0 0 6,887,530 2,365,699 7,240,034 76,989 76,946 1,011 968 249,690 35,134,887 34,885,198 0 0 1,566,355,651 158,259,583 122,266,072 18,356,802 17,672,037 274,009 252,941 6,542,623 2,347,489 7,846,645 1,253,462 499,514 2,167,075 1,413,128 3,898,879 56,551,272 52,652,392 0 0 532,425,604 1,149,813 0 44,534,655 0 489,817,084 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 416,632,804 0 0 0 0 416,632,804 260,442,141 0 0 1,160,405 0 259,866,466 126,573,060 0 0 0 0 124,559,864 1,601,453,045 1,149,813 0 45,695,060 0 1,555,864,330 39,405 0 0 11,467,034 for stand-alone vision policies. 0 0 0 0 6,993 0 436 51,719 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF Virginia DURING THE YEAR All Expenses 1 Improve Health Outcomes 1. Individual Comprehensive Coverage Expenses: 73,495 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 4,710 for affiliated services) 1.3 EDP Equipment and Software (incl $ 452 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 49 for affiliated services) 1.5 Accreditation and Certification (incl $ 151,088 for affiliated services) 1.6 Other Expenses (incl $ 1.7 Subtotal before Reimbursements and Taxes (Lines 1.1 to 1.6) 1.8 Reimbursements by uninsured plans and fiscal intermediaries 1.9 Taxes, Licenses and Fees (in total, for tying purposes) 1.10 Total (1.7 to 1.9) 1.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 2. 216-4.VA Small Group Comprehensive Coverage Expenses: 9,122,981 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 644,055 for affiliated services) 2.3 EDP Equipment and Software (incl $ 61,822 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 6,713 for affiliated services) 2.5 Accreditation and Certification (incl $ 20,931,986 for affiliated services) 2.6 Other Expenses (incl $ 2.7 Subtotal before Reimbursements and Taxes (Lines 2.1 to 2.6) 2.8 Reimbursements by uninsured plans and fiscal intermediaries 2.9 Taxes, Licenses and Fees (in total, for tying purposes) 2.10 Total (2.7 to 2.9) 2.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 3. Large Group Comprehensive Coverage Expenses: 11,098,288 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 763,334 for affiliated services) 3.3 EDP Equipment and Software (incl $ 73,271 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 7,956 for affiliated services) 3.5 Accreditation and Certification (incl $ 26,320,225 for affiliated services) 3.6 Other Expenses (incl $ 3.7 Subtotal before Reimbursements and Taxes (Lines 3.1 to 3.6) 3.8 Reimbursements by uninsured plans and fiscal intermediaries 3.9 Taxes, Licenses and Fees (in total, for tying purposes) 3.10 Total (3.7 to 3.9) 3.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 185 Asylum Street Hartford, CT 061033408 0 0 0 0 0 18,898 18,898 0 XXX Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX Total (1 to 5) 0 0 0 0 0 18,898 18,898 0 XXX 0 0 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 0 0 0 0 0 0 0 XXX (LOCATION) NAIC Company Code 2018 XXX 8,928 1,022 746 72 8 19,967 30,742 0 XXX 16,871 1,679 1,218 117 13 33,427 53,325 0 XXX 18,898 0 0 0 0 0 0 0 0 0 18,898 0 30,742 8,786 53,325 0 0 0 0 0 0 2,816,808 2,816,808 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,816,808 2,816,808 0 1,154,071 301,249 96,370 9,250 1,004 2,658,014 4,219,959 0 1,797,000 205,940 150,058 14,404 1,564 4,019,109 6,188,075 0 XXX 2,816,808 0 0 0 0 0 0 5,200,747 5,200,747 0 XXX 5,200,747 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 2,816,808 0 XXX 4,219,959 1,178,289 XXX 6,188,075 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5,200,747 5,200,747 0 1,800,514 962,846 150,351 14,432 1,567 4,140,070 7,069,780 0 2,477,050 283,875 206,845 19,855 2,156 5,540,087 8,529,868 0 5,200,747 0 XXX 7,069,780 2,004,533 XXX 8,529,868 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 79413 9 10 General Administrative Expenses Total Expenses (6 to 9) 47,696 3,754 2,746 253 29 176,454 230,932 0 17,363 248,295 0 73,495 6,455 4,710 442 49 248,746 333,896 0 17,363 351,259 8,786 6,171,910 624,547 397,627 38,168 4,144 24,151,590 31,387,986 0 5,922,765 37,310,752 0 9,122,981 1,131,736 644,055 61,822 6,713 33,645,521 44,612,827 0 5,922,765 50,535,593 1,178,289 6,820,723 754,974 406,137 38,984 4,233 13,287,805 21,312,857 0 3,265,273 24,578,130 0 11,098,288 2,001,695 763,334 73,271 7,956 28,168,709 42,113,253 0 3,265,273 45,378,526 2,004,533 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 4. 5. 216-5.VA 6. Individual Mini-Med Plans Expenses: 0 for affiliated services) 4.1 Salaries (including $ 4.2 Outsourced Services 0 for affiliated services) 4.3 EDP Equipment and Software (incl $ 0 for affiliated services) 4.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 4.5 Accreditation and Certification (incl $ 0 for affiliated services) 4.6 Other Expenses (incl $ 4.7 Subtotal before Reimbursements and Taxes (Lines 4.1 to 4.6) 4.8 Reimbursements by uninsured plans and fiscal intermediaries 4.9 Taxes, Licenses and Fees (in total, for tying purposes) 4.10 Total (4.7 to 4.9) 4.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Mini-Med Plans Expenses: 0 for affiliated services) 5.1 Salaries (including $ 5.2 Outsourced Services 0 for affiliated services) 5.3 EDP Equipment and Software (incl $ 0 for affiliated services) 5.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 5.5 Accreditation and Certification (incl $ 0 for affiliated services) 5.6 Other Expenses (incl $ 5.7 Subtotal before Reimbursements and Taxes (Lines 5.1 to 5.6) 5.8 Reimbursements by uninsured plans and fiscal intermediaries 5.9 Taxes, Licenses and Fees (in total, for tying purposes) 5.10 Total (5.7 to 5.9) 5.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Mini-Med Plans Expenses: 0 for affiliated services) 6.1 Salaries (including $ 6.2 Outsourced Services 0 for affiliated services) 6.3 EDP Equipment and Software (incl $ 0 for affiliated services) 6.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 6.5 Accreditation and Certification (incl $ 0 for affiliated services) 6.6 Other Expenses (incl $ 6.7 Subtotal before Reimbursements and Taxes (Lines 6.1 to 6.6) 6.8 Reimbursements by uninsured plans and fiscal intermediaries 6.9 Taxes, Licenses and Fees (in total, for tying purposes) 6.10 Total (6.7 to 6.9) 6.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 7. 8. 216-6.VA 9. Small Group Expatriate Plans Expenses: 0 for affiliated services) 7.1 Salaries (including $ 7.2 Outsourced Services 0 for affiliated services) 7.3 EDP Equipment and Software (incl $ 0 for affiliated services) 7.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 7.5 Accreditation and Certification (incl $ 0 for affiliated services) 7.6 Other Expenses (incl $ 7.7 Subtotal before Reimbursements and Taxes (Lines 7.1 to 7.6) 7.8 Reimbursements by uninsured plans and fiscal intermediaries 7.9 Taxes, Licenses and Fees (in total, for tying purposes) 7.10 Total (7.7 to 7.9) 7.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Expatriate Plans Expenses: 0 for affiliated services) 8.1 Salaries (including $ 8.2 Outsourced Services 0 for affiliated services) 8.3 EDP Equipment and Software (incl $ 0 for affiliated services) 8.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 8.5 Accreditation and Certification (incl $ 0 for affiliated services) 8.6 Other Expenses (incl $ 8.7 Subtotal before Reimbursements and Taxes (Lines 8.1 to 8.6) 8.8 Reimbursements by uninsured plans and fiscal intermediaries 8.9 Taxes, Licenses and Fees (in total, for tying purposes) 8.10 Total (8.7 to 8.9) 8.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Student Health Plans Expenses: 0 for affiliated services) 9.1 Salaries (including $ 9.2 Outsourced Services 0 for affiliated services) 9.3 EDP Equipment and Software (incl $ 0 for affiliated services) 9.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 9.5 Accreditation and Certification (incl $ 0 for affiliated services) 9.6 Other Expenses (incl $ 9.7 Subtotal before Reimbursements and Taxes (Lines 9.1 to 9.6) 9.8 Reimbursements by uninsured plans and fiscal intermediaries 9.9 Taxes, Licenses and Fees (in total, for tying purposes) 9.10 Total (9.7 to 9.9) 9.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 *79413201821648100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes - See Cautionary Statement at http://www.naic.org/documents/committees_e_app_blanks_related_shce_cautionary_statement.pdf) UnitedHealthcare Insurance Company 2. 185 Asylum Street Hartford, CT 061033408 (LOCATION) BUSINESS IN THE STATE OF Washington DURING THE YEAR 2018 NAIC Company Code Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 1. 216-1.WA 2. 3. 4. 5. 6. 7. 8. 9. Premium: 1.1 Health premiums earned (From Part 2, Line 1.11) 1.2 Federal high risk pools 1.3 State high risk pools 1.4 Premiums earned including state and federal high risk programs (Lines 1.1 + 1.2 + 1.3) 1.5 Federal taxes and federal assessments 1.6 State insurance, premium and other taxes (Similar local taxes of 124,196 ) $ 1.6a Community Benefit Expenditures (informational only) 1.7 Regulatory authority licenses and fees 1.8 Adjusted Premiums Earned (Lines 1.4 - 1.5 - 1.6 - 1.7) 1.9 Net Assumed less Ceded reinsurance premiums earned 1.10 Other Adjustments due to MLR calculations - Premiums 1.11 Risk Revenue 1.12 Net adjusted premiums earned after reinsurance (Lines 1.8 + 1.9 + 1.10 + 1.11) Claims: 2.1 Incurred claims excluding prescription drugs 2.2 Prescription drugs 2.3 Pharmaceutical rebates 2.4 State stop loss, market stabilization and claim/census based assessments (informational only) Incurred medical incentive pools and bonuses Deductible Fraud and Abuse Detection/Recovery Expenses (for MLR use only) 5.0 Total Incurred Claims (Lines 2.1 + 2.2 - 2.3 + 3) (From Part 2, Line 2.15) 5.1 Net Assumed less Ceded reinsurance claims incurred 5.2 Other Adjustments due to MLR calculations - Claims 5.3 Rebates paid 5.4 Estimated rebates unpaid prior year 5.5 Estimated rebates unpaid current year 5.6 Fee for service and co-pay revenue 5.7 Net incurred claims after reinsurance (Lines 5.0 + 5.1 + 5.2 + 5.3 - 5.4 + 5.5 - 5.6) Improving Health Care Quality Expenses Incurred: 6.1 Improve health outcomes 6.2 Activities to prevent hospital readmissions 6.3 Improve patient safety and reduce medical errors 6.4 Wellness and health promotion activities 6.5 Health Information Technology expenses related to health improvement 6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5) Preliminary Medical Loss Ratio: MLR ((Lines 4 + 5.0 + 6.6 - Footnote 2.0)/Line 1.8 Claims Adjustment Expenses: 8.1 Cost containment expenses not included in quality of care expenses in Line 6.6 8.2 All other claims adjustment expenses 8.3 Total claims adjustment expenses (Lines 8.1 + 8.2) Claims Adjustment Expense Ratio (Line 8.3/Line 1.8) 2 Small Group Employer 3 Large Group Employer 4 5 Small Group Employer Individual Expatriate Plans 6 Large Group Employer 7 11 Government Business (excluded by statute) Other Health Business 9 8 Small Group 10 Student Health Plans Large Group 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 79413 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 343,448,521 0 196,109 748,344,420 0 0 1,309,489,606 0 453,471 XXX XXX XXX 1,309,489,606 0 453,471 0 (123) 343,644,630 4,101,033 748,344,420 31,010,812 1,309,943,077 39,831,385 XXX 15,125 1,309,943,077 39,846,510 0 0 0 0 0 0 0 0 0 0 0 123 0 0 0 123 (2,865,585) 0 (77,528) 342,486,711 (155,833) 1,340 0 342,332,218 87,804 0 0 717,245,805 0 789,754 0 718,035,559 5,600,873 0 (49,052) 1,264,559,871 (8,627,613) 814,749 0 1,256,747,007 61 0 0 XXX XXX XXX XXX XXX 5,600,934 0 (49,052) 1,264,544,685 (8,627,613) 814,749 0 1,256,731,820 0 0 0 0 0 0 0 46 0 271,044,755 1,005,841 70,672 490,821,397 204,194,039 115,935,337 916,972,344 242,806,790 126,920,865 XXX XXX XXX 916,972,344 242,806,790 126,920,865 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 46 0 0 0 4,140,666 34,468 583,220,765 0 (11,032,581) 0 0 11,032,581 0 583,220,765 109,148 4,612,236 50,113 1,037,470,505 (8,158,559) (11,032,581) 0 0 11,032,581 0 1,029,311,946 XXX XXX 0 46 37 0 0 271,979,924 (110,829) 0 XXX XXX XXX 0 271,869,095 109,148 4,612,236 50,113 1,037,470,505 (8,158,559) (11,032,581) 0 0 11,032,581 0 1,029,311,946 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 2 858,841 393,665 298,523 2,536,140 183,854 3,114,609 1,153,269 1,489,641 1,714,503 2,172,623 5,715,023 1,546,933 1,788,165 4,250,643 2,356,479 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 3 4,271,023 XXX 9,644,644 0.827 15,657,243 XXX 16,943 XXX 15,674,187 XXX 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 3 47 49 0.400 210,260 4,828,821 5,039,081 0.015 8,536,397 17,425,748 25,962,145 0.036 11,261,691 25,576,837 36,838,528 XXX 15,894 206,530 222,424 XXX 11,277,585 25,783,367 37,060,952 XXX 888,562 0 404 92,742,937 0 50,506 124,065,165 0 206,451 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 888,966 34,015 92,793,443 3,075,206 124,271,617 1,610,442 0 0 0 0 0 0 0 0 0 0 0 0 79,219 0 14 775,718 0 0 0 775,718 5,104,323 0 1,819 84,612,095 0 23,655 0 84,635,750 3,195,113 0 26,643 119,439,418 (8,471,780) 0 0 110,967,639 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 548,470 106,641 33,838 58,127,434 15,064,577 4,777,343 96,430,288 22,435,646 6,103,676 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 621,274 0 0 0 0 0 0 621,274 46,652 137,241 1,713 68,551,909 0 0 0 0 0 0 68,551,909 62,458 334,329 13,932 113,096,587 (8,047,730) 0 0 0 0 0 105,048,857 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7,108 0 0 0 0 741,943 0 0 0 0 992,521 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7,108 0.810 741,943 0.819 992,521 0.955 0 0.000 7,543 12,190 19,733 0.025 1,017,321 1,514,839 2,532,160 0.030 1,490,167 1,795,193 3,285,360 0.028 0 0 0 0.000 0 0 0 XXX XXX XXX XXX 0 XXX XXX XXX XXX XXX XXX XXX XXX 3,207 (21) 10,083 (2,539) 6,213 5,718,230 1,546,912 1,798,249 4,248,104 2,362,692 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 (Continued) Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 2 Small Group Employer Individual 10. General and Administrative (G&A) Expenses: 10.1 Direct sales salaries and benefits 10.2 Agents and brokers fees and commissions 10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below) 10.4 Other general and administrative expenses 10.4a Community Benefit Expenditures (informational only) 10.5 Total general and administrative (Lines 10.1 +10.2 + 10.3 + 10.4) 2,696 29,770 (842) 32,864 0 64,488 3 Large Group Employer 350,803 3,777,551 82,840 4,300,053 0 8,511,247 4 5 Small Group Employer Individual 258,748 1,820,181 40,813 1,137,698 0 3,257,439 0 0 0 0 0 0 Expatriate Plans 6 Large Group Employer 0 0 0 0 0 0 7 8 Small Group 0 0 0 0 0 0 Student Health Plans Large Group 0 0 0 0 0 0 10 11 Government Business (excluded by statute) Other Health Business 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 521 0 521 485,139 12,171,409 601,753 32,392,263 0 45,650,564 2,131,631 14,966,562 957,995 29,880,016 0 47,936,204 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 3,229,017 32,765,473 1,682,559 67,743,413 0 105,420,462 6,507 0 1,384 37,713 0 45,605 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) 15,502,455 51,271,801 69,518,827 12. Income from fees of uninsured plans XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 13. Net investment and other gain/(loss) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 18,011,439 XXX 18,011,439 14. Federal income taxes (excluding taxes on Line 1.5 above) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX (1,242,698) XXX (1,242,698) 15. Net gain or (loss) (Lines 11 + 12 + 13 - 14) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 88,772,964 XXX 88,833,752 16. ICD-10 Implementation Expenses (informational only; already included in general expenses and line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16. 16a ICD-10 Implementation Expenses (informational only; already included in line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 63,116 4,298,492 (1,616,539) 0 0 0 0 0 0 (496) XXX 3,235,524 32,765,473 1,683,943 67,781,127 0 105,466,067 69,218,668 360,947 360,947 OTHER INDICATORS: 216-2.WA 1. Number of certificates/policies 2. Number of Covered Lives 3. Number of Groups 4. Member Months 83 11,266 17,322 0 0 0 0 0 0 0 227,405 138,955 395,031 2,882 397,913 125 17,671 28,686 0 0 0 0 0 0 0 298,454 138,955 483,891 2,882 486,773 2,332 9 0 0 0 0 0 0 1,374 2 3,717 1 3,718 1,509 196,313 328,452 0 0 0 0 0 0 3,571,447 1,638,199 5,735,920 34,572 5,770,492 XXX Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ XXX 0 ] If yes, show the amount of premiums and claims included. Premiums $ 0 Claims $ 0 AFFORDABLE CARE ACT (ACA) RECEIPTS, PAYMENTS, RECEIVABLES and PAYABLES Current Year Prior Year Comprehensive Health Coverage Comprehensive Health Coverage 1 2 3 4 Small Group Small Group Employer Plans Employer Plans Individual Plans Individual Plans ACA Receivables and Payables 1. Permanent ACA Risk Adjustment Program 1.0 Premium adjustments receivable/(payable) 2. Transitional ACA Reinsurance Program 2.0 Total amounts recoverable for claims (paid & unpaid) 0 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 0 0 (95,722) 544,589 XXX 168,623 0 0 0 (2,515,233) XXX 0 0 0 0 ACA Receipts and Payments 4. Permanent ACA Risk Adjustment Program 4.0 Premium adjustments receipts/(payments) 5. Transitional ACA Reinsurance Program 5.0 Amounts received for claims 0 6. Temporary ACA Risk Corridors Program 6.1 Retrospective premium received 6.2 Rate credits or policy experience refunds paid 0 0 414,232 (1,853,130) XXX (63,835) 0 0 0 0 0 (547,781) XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF 185 Asylum Street Hartford, CT 061033408 Washington DURING THE YEAR Comprehensive Health Coverage 1 2 3 Individual Small Group Employer Large Group Employer Small Group Employer Individual Expatriate Plans: 7 8 6 Large Group Employer Small Group 10 11 Government Business (excluded by statute) Other Health Business 9 Student Health Plans Large Group 79413 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.WA Health Premiums Earned: 888,562 92,766,592 1.1 Direct premiums written 0 0 1.2 Unearned premium prior year 0 0 1.3 Unearned premium current year 0 0 1.4 Change in unearned premium (Lines 1.2 - 1.3) 76 0 1.5 Paid rate credits 0 0 1.6 Reserve for rate credits current year 0 0 1.7 Reserve for rate credits prior year 0 0 1.8 Change in reserve for rate credits (Lines 1.6 - 1.7) 0 23,655 1.9 Premium balances written off 0 0 1.10 Group conversion charge 888,562 92,742,937 1.11 Total direct premiums earned (Lines 1.1 + 1.4 - 1.9 + 1.10) 0 0 1.12 Assumed premiums earned from non-affiliates 0 0 1.13 Net Assumed less Ceded premiums earned from affiliates 0 0 1.14 Ceded premiums earned to non-affiliates 0 23,655 1.15 Other Adjustments due to MLR calculation - Premiums 888,486 92,766,592 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 621,169 66,942,073 2.1 Paid claims during the year 0 8,134,032 2.2 Direct claim liability current year (28) 6,534,438 2.3 Direct claim liability prior year 0 193,594 2.4 Direct claim reserves current year 0 170,636 2.5 Direct claim reserves prior year 0 0 2.6 Direct contract reserves current year 0 0 2.7 Direct contract reserves prior year 76 0 2.8 Paid rate credits 0 0 2.9 Reserve for rate credits current year 0 0 2.10 Reserve for rate credits prior year 0 137,241 2.11 Incurred medical incentive pools and bonuses (Lines 2.11a + 2.11b - 2.11c) 0 5,442 2.11a Paid medical incentive pools and bonuses current year 0 165,751 2.11b Accrued medical incentive pools and bonuses current year 0 33,951 2.11c Accrued medical incentive pools and bonuses prior year 0 149,957 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 0 1,923,861 2.12a Healthcare receivables current year 0 1,773,904 2.12b Healthcare receivables prior year 0 0 2.13 Group conversion charge 0 0 2.14 Multi-option coverage blended rate adjustment 2.15 Total incurred claims (Lines 2.1 + 2.2 - 2.3 + 2.4 - 2.5 + 2.6 - 2.7 + 2.8 + 2.9 621,274 68,551,909 2.10 + 2.11 - 2.12 + 2.13 + 2.14) 0 0 2.16 Assumed incurred claims from non-affiliates 0 0 2.17 Net assumed less ceded incurred claims from affiliates 0 0 2.18 Ceded incurred claims to non-affiliates 0 0 2.19 Other adjustments due to MLR calculation - Claims 621,197 68,551,909 2.20 Net Incurred Claims (Lines 2.15 - 2.8 - 2.9 + 2.10 + 2.16 + 2.17 - 2.18 + 2.19) 3. Fraud and Abuse Recoveries that Reduced PAID Claims in Line 2.1 above 0 1,713 (informational only) 9,487,372 for stand-alone dental and $ (a) Column 13, Line 1.1 includes direct written premium of $ 4 Business Subject to MLR Mini-Med Plans 5 (LOCATION) NAIC Company Code 2018 124,028,054 0 (37,111) 37,111 (76) 0 0 0 0 0 124,065,165 2,016 0 8,473,796 0 115,593,462 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 106,373,928 15,955,099 8,455,443 376,097 234,942 0 0 (76) 0 0 334,329 20,894 441,456 128,022 1,252,404 2,418,736 1,166,332 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 113,096,587 95 0 8,047,824 0 105,048,934 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 13,932 0 0 1,620,040 for stand-alone vision policies. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 343,449,861 0 0 0 6,362,486 414,450 427,994 (13,544) 1,340 0 343,448,521 0 0 155,833 1,340 336,945,086 749,134,174 0 0 0 8,860,476 13,596,258 7,050,961 6,545,297 789,754 0 748,344,420 0 0 0 789,754 733,728,401 1,310,267,244 0 (37,111) 37,111 15,222,962 14,010,708 7,478,954 6,531,753 814,749 0 1,309,489,606 2,016 0 8,629,629 814,749 1,279,922,026 268,241,745 25,980,790 29,203,190 10,412,176 9,772,534 46,492 53,240 6,362,486 414,450 427,994 0 0 0 0 21,258 20,721 (536) 0 0 575,612,199 48,315,772 56,776,259 919,615 41,493 0 1 8,860,476 13,596,258 7,050,961 4,140,666 2,427,992 4,268,498 2,555,824 4,355,507 49,829,958 45,474,450 0 0 1,017,779,849 98,385,693 100,957,991 11,901,482 10,219,606 46,492 53,240 15,222,962 14,010,708 7,478,954 4,612,236 2,454,328 4,875,705 2,717,797 5,779,126 54,193,276 48,414,150 0 0 46 0 0 0 0 46 271,979,924 0 0 110,829 0 265,520,154 583,220,765 0 0 0 0 567,814,992 1,037,470,505 95 0 8,158,653 0 1,007,557,231 0 0 34,468 50,113 (11,264) 0 (11,310) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF Washington DURING THE YEAR All Expenses 1 Improve Health Outcomes 1. Individual Comprehensive Coverage Expenses: 17,651 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 1,257 for affiliated services) 1.3 EDP Equipment and Software (incl $ 121 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 13 for affiliated services) 1.5 Accreditation and Certification (incl $ 40,010 for affiliated services) 1.6 Other Expenses (incl $ 1.7 Subtotal before Reimbursements and Taxes (Lines 1.1 to 1.6) 1.8 Reimbursements by uninsured plans and fiscal intermediaries 1.9 Taxes, Licenses and Fees (in total, for tying purposes) 1.10 Total (1.7 to 1.9) 1.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 2. 216-4.WA 3. 0 0 0 0 0 7,108 7,108 0 XXX Small Group Comprehensive Coverage Expenses: 2,190,501 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 154,677 for affiliated services) 2.3 EDP Equipment and Software (incl $ 14,847 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 1,612 for affiliated services) 2.5 Accreditation and Certification (incl $ 5,036,017 for affiliated services) 2.6 Other Expenses (incl $ 2.7 Subtotal before Reimbursements and Taxes (Lines 2.1 to 2.6) 2.8 Reimbursements by uninsured plans and fiscal intermediaries 2.9 Taxes, Licenses and Fees (in total, for tying purposes) 2.10 Total (2.7 to 2.9) 2.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX Total (1 to 5) 0 0 0 0 0 7,108 7,108 0 XXX 0 0 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 0 0 0 0 0 0 0 XXX (LOCATION) NAIC Company Code 2018 XXX 2,116 247 177 17 2 4,733 7,292 0 XXX 3,462 397 289 28 3 7,743 11,922 0 XXX 7,108 0 0 0 0 0 0 0 0 0 7,108 0 7,292 2,170 11,922 0 0 0 0 0 0 741,943 741,943 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 741,943 741,943 0 273,770 55,204 22,861 2,194 238 630,352 984,620 0 429,795 49,255 35,890 3,445 374 961,264 1,480,023 0 XXX Large Group Comprehensive Coverage Expenses: 1,547,238 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 108,372 for affiliated services) 3.3 EDP Equipment and Software (incl $ 10,402 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 1,130 for affiliated services) 3.5 Accreditation and Certification (incl $ 4,320,219 for affiliated services) 3.6 Other Expenses (incl $ 3.7 Subtotal before Reimbursements and Taxes (Lines 3.1 to 3.6) 3.8 Reimbursements by uninsured plans and fiscal intermediaries 3.9 Taxes, Licenses and Fees (in total, for tying purposes) 3.10 Total (3.7 to 3.9) 3.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 185 Asylum Street Hartford, CT 061033408 XXX XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 741,943 0 984,620 282,325 XXX 1,480,023 0 0 0 0 0 0 992,521 992,521 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 992,521 992,521 0 407,282 56,546 34,010 3,265 354 938,503 1,439,959 767 510,831 58,542 42,657 4,095 445 1,142,508 1,759,077 558 992,521 0 XXX 1,440,726 469,769 XXX 1,759,635 0 XXX XXX 0 0 0 XXX 992,521 0 XXX 0 0 0 741,943 0 XXX XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX XXX 0 0 79413 9 10 General Administrative Expenses Total Expenses (6 to 9) 12,073 1,086 791 76 8 51,105 65,139 0 79,101 144,239 0 17,651 1,729 1,257 121 13 70,690 91,461 0 79,101 170,562 2,170 1,486,936 138,154 95,926 9,208 1,000 6,672,376 8,403,599 0 5,281,306 13,684,905 0 2,190,501 242,613 154,677 14,847 1,612 9,005,936 11,610,186 0 5,281,306 16,891,491 282,325 629,125 42,673 31,705 3,043 330 2,477,298 3,184,175 3,326 3,376,693 6,564,194 0 1,547,238 157,761 108,372 10,402 1,130 5,550,829 7,375,732 4,651 3,376,693 10,757,077 469,769 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 4. 5. 216-5.WA 6. Individual Mini-Med Plans Expenses: 0 for affiliated services) 4.1 Salaries (including $ 4.2 Outsourced Services 0 for affiliated services) 4.3 EDP Equipment and Software (incl $ 0 for affiliated services) 4.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 4.5 Accreditation and Certification (incl $ 0 for affiliated services) 4.6 Other Expenses (incl $ 4.7 Subtotal before Reimbursements and Taxes (Lines 4.1 to 4.6) 4.8 Reimbursements by uninsured plans and fiscal intermediaries 4.9 Taxes, Licenses and Fees (in total, for tying purposes) 4.10 Total (4.7 to 4.9) 4.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Mini-Med Plans Expenses: 0 for affiliated services) 5.1 Salaries (including $ 5.2 Outsourced Services 0 for affiliated services) 5.3 EDP Equipment and Software (incl $ 0 for affiliated services) 5.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 5.5 Accreditation and Certification (incl $ 0 for affiliated services) 5.6 Other Expenses (incl $ 5.7 Subtotal before Reimbursements and Taxes (Lines 5.1 to 5.6) 5.8 Reimbursements by uninsured plans and fiscal intermediaries 5.9 Taxes, Licenses and Fees (in total, for tying purposes) 5.10 Total (5.7 to 5.9) 5.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Mini-Med Plans Expenses: 0 for affiliated services) 6.1 Salaries (including $ 6.2 Outsourced Services 0 for affiliated services) 6.3 EDP Equipment and Software (incl $ 0 for affiliated services) 6.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 6.5 Accreditation and Certification (incl $ 0 for affiliated services) 6.6 Other Expenses (incl $ 6.7 Subtotal before Reimbursements and Taxes (Lines 6.1 to 6.6) 6.8 Reimbursements by uninsured plans and fiscal intermediaries 6.9 Taxes, Licenses and Fees (in total, for tying purposes) 6.10 Total (6.7 to 6.9) 6.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 7. 8. 216-6.WA 9. Small Group Expatriate Plans Expenses: 0 for affiliated services) 7.1 Salaries (including $ 7.2 Outsourced Services 0 for affiliated services) 7.3 EDP Equipment and Software (incl $ 0 for affiliated services) 7.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 7.5 Accreditation and Certification (incl $ 0 for affiliated services) 7.6 Other Expenses (incl $ 7.7 Subtotal before Reimbursements and Taxes (Lines 7.1 to 7.6) 7.8 Reimbursements by uninsured plans and fiscal intermediaries 7.9 Taxes, Licenses and Fees (in total, for tying purposes) 7.10 Total (7.7 to 7.9) 7.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Expatriate Plans Expenses: 0 for affiliated services) 8.1 Salaries (including $ 8.2 Outsourced Services 0 for affiliated services) 8.3 EDP Equipment and Software (incl $ 0 for affiliated services) 8.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 8.5 Accreditation and Certification (incl $ 0 for affiliated services) 8.6 Other Expenses (incl $ 8.7 Subtotal before Reimbursements and Taxes (Lines 8.1 to 8.6) 8.8 Reimbursements by uninsured plans and fiscal intermediaries 8.9 Taxes, Licenses and Fees (in total, for tying purposes) 8.10 Total (8.7 to 8.9) 8.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Student Health Plans Expenses: 0 for affiliated services) 9.1 Salaries (including $ 9.2 Outsourced Services 0 for affiliated services) 9.3 EDP Equipment and Software (incl $ 0 for affiliated services) 9.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 9.5 Accreditation and Certification (incl $ 0 for affiliated services) 9.6 Other Expenses (incl $ 9.7 Subtotal before Reimbursements and Taxes (Lines 9.1 to 9.6) 9.8 Reimbursements by uninsured plans and fiscal intermediaries 9.9 Taxes, Licenses and Fees (in total, for tying purposes) 9.10 Total (9.7 to 9.9) 9.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 *79413201821649100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes - See Cautionary Statement at http://www.naic.org/documents/committees_e_app_blanks_related_shce_cautionary_statement.pdf) UnitedHealthcare Insurance Company 2. 185 Asylum Street Hartford, CT 061033408 (LOCATION) BUSINESS IN THE STATE OF West Virginia DURING THE YEAR 2018 NAIC Company Code Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 1. 216-1.WV 2. 3. 4. 5. 6. 7. 8. 9. Premium: 1.1 Health premiums earned (From Part 2, Line 1.11) 1.2 Federal high risk pools 1.3 State high risk pools 1.4 Premiums earned including state and federal high risk programs (Lines 1.1 + 1.2 + 1.3) 1.5 Federal taxes and federal assessments 1.6 State insurance, premium and other taxes (Similar local taxes of 16,768 ) $ 1.6a Community Benefit Expenditures (informational only) 1.7 Regulatory authority licenses and fees 1.8 Adjusted Premiums Earned (Lines 1.4 - 1.5 - 1.6 - 1.7) 1.9 Net Assumed less Ceded reinsurance premiums earned 1.10 Other Adjustments due to MLR calculations - Premiums 1.11 Risk Revenue 1.12 Net adjusted premiums earned after reinsurance (Lines 1.8 + 1.9 + 1.10 + 1.11) Claims: 2.1 Incurred claims excluding prescription drugs 2.2 Prescription drugs 2.3 Pharmaceutical rebates 2.4 State stop loss, market stabilization and claim/census based assessments (informational only) Incurred medical incentive pools and bonuses Deductible Fraud and Abuse Detection/Recovery Expenses (for MLR use only) 5.0 Total Incurred Claims (Lines 2.1 + 2.2 - 2.3 + 3) (From Part 2, Line 2.15) 5.1 Net Assumed less Ceded reinsurance claims incurred 5.2 Other Adjustments due to MLR calculations - Claims 5.3 Rebates paid 5.4 Estimated rebates unpaid prior year 5.5 Estimated rebates unpaid current year 5.6 Fee for service and co-pay revenue 5.7 Net incurred claims after reinsurance (Lines 5.0 + 5.1 + 5.2 + 5.3 - 5.4 + 5.5 - 5.6) Improving Health Care Quality Expenses Incurred: 6.1 Improve health outcomes 6.2 Activities to prevent hospital readmissions 6.3 Improve patient safety and reduce medical errors 6.4 Wellness and health promotion activities 6.5 Health Information Technology expenses related to health improvement 6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5) Preliminary Medical Loss Ratio: MLR ((Lines 4 + 5.0 + 6.6 - Footnote 2.0)/Line 1.8 Claims Adjustment Expenses: 8.1 Cost containment expenses not included in quality of care expenses in Line 6.6 8.2 All other claims adjustment expenses 8.3 Total claims adjustment expenses (Lines 8.1 + 8.2) Claims Adjustment Expense Ratio (Line 8.3/Line 1.8) 2 Small Group Employer 3 Large Group Employer 4 5 Small Group Employer Individual Expatriate Plans 6 Large Group Employer 7 11 Government Business (excluded by statute) Other Health Business 9 8 Small Group 10 Student Health Plans Large Group 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 79413 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 220,241 0 (166) 29,337,201 0 (1,257) 5,605,346 0 (5,196) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 92,573,227 0 53,627 33,159,167 0 0 160,895,182 0 47,008 XXX XXX XXX 220,075 (76,151) 29,335,944 (99,978) 5,600,150 371,672 0 0 0 0 0 0 0 0 0 0 0 0 0 0 92,626,854 634,452 33,159,167 1,676,537 160,942,190 2,506,533 XXX 14,027 0 71 282,128 0 0 0 282,128 903,013 0 481 28,532,427 588 5,178 0 28,538,193 205,238 0 366 5,022,874 (189,615) 50 0 4,833,308 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,290,603 0 (22,689) 90,724,487 (12,154) 896 0 90,713,229 4,834 0 0 31,477,797 0 398,657 0 31,876,454 2,417,715 0 (21,770) 156,039,713 (201,181) 404,781 0 156,243,312 XXX XXX XXX XXX XXX 2,417,715 0 (21,770) 156,039,713 (201,181) 404,781 0 156,243,312 545,509 47,533 15,435 23,284,545 5,186,009 1,644,142 3,074,064 913,420 300,046 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 72,273,702 126,015 36,882 (864,794) 63,708,544 37,961,379 98,313,026 69,981,521 39,957,885 XXX XXX XXX 98,313,026 69,981,521 39,957,885 1 0 3 577,607 0 0 0 0 0 0 577,607 1,176 992 2,157 26,827,404 462 0 0 0 0 0 26,827,866 6,112 0 1,710 3,687,437 (243,480) (413,289) 418,301 5,012 0 0 3,443,957 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 24,882,370 0 0 0 0 0 0 24,882,370 7,290 992 3,870 128,337,654 (240,484) (413,289) 418,301 5,012 0 0 128,097,170 XXX XXX 0 0 0 0 0 72,362,835 2,534 0 XXX XXX XXX 0 72,365,369 7,290 992 3,870 128,337,654 (240,484) (413,289) 418,301 5,012 0 0 128,097,170 1,762 0 0 0 0 234,698 0 0 0 0 44,843 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 355,450 259,853 193,428 711,818 74,898 1,762 2.054 234,698 0.949 44,843 0.743 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 1,595,448 XXX 44,469 0.792 1,921,220 XXX 3,639 7,251 10,890 0.039 308,163 476,509 784,672 0.028 57,257 82,383 139,640 0.028 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 27,235 1,353,853 1,381,088 0.015 (165,928) 400,224 234,297 0.007 230,365 2,320,220 2,550,586 XXX XXX XXX XXX XXX 0 0 0 0.000 18,171 13,386 10,313 (30,372) 32,971 160,895,182 0 47,008 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 654,924 273,240 203,741 681,446 107,869 0 0 0 0 0 654,924 273,240 203,741 681,446 107,869 0 1,921,220 XXX 0 0 0 230,365 2,320,220 2,550,586 XXX XXX XXX 160,942,190 2,506,533 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 (Continued) Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 2 Small Group Employer Individual 10. General and Administrative (G&A) Expenses: 10.1 Direct sales salaries and benefits 10.2 Agents and brokers fees and commissions 10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below) 10.4 Other general and administrative expenses 10.4a Community Benefit Expenditures (informational only) 10.5 Total general and administrative (Lines 10.1 +10.2 + 10.3 + 10.4) 1,185 7,799 (2,176) 17,986 0 24,793 3 Large Group Employer 101,698 727,560 25,551 1,187,538 0 2,042,347 4 5 Small Group Employer Individual 19,908 166,585 (4,636) 187,028 0 368,886 0 0 0 0 0 0 Expatriate Plans 6 Large Group Employer 0 0 0 0 0 0 7 8 Small Group 0 0 0 0 0 0 Student Health Plans Large Group 0 0 0 0 0 0 10 11 Government Business (excluded by statute) Other Health Business 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 119,728 3,276,081 168,368 9,302,713 0 12,866,889 70,658 26,773 82,752 2,535,520 0 2,715,703 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 313,176 4,204,798 269,859 13,230,786 0 18,018,618 0 0 0 0 0 0 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) 12. Income from fees of uninsured plans XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 13. Net investment and other gain/(loss) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 14. Federal income taxes (excluding taxes on Line 1.5 above) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 15. Net gain or (loss) (Lines 11 + 12 + 13 - 14) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 16. ICD-10 Implementation Expenses (informational only; already included in general expenses and line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16. 16a ICD-10 Implementation Expenses (informational only; already included in line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (332,924) (1,351,388) 835,983 0 0 0 0 0 0 0 2,504,435 3,999,614 5,655,719 XXX 313,176 4,204,798 269,859 13,230,786 0 18,018,618 XXX 5,655,719 0 0 1,893,495 XXX XXX 26,974 XXX 26,974 XXX 7,522,240 XXX 7,522,240 1,893,495 OTHER INDICATORS: 216-2.WV 1. Number of certificates/policies 33 3,200 712 0 0 0 0 0 0 0 46,358 30,402 80,705 0 80,705 2. Number of Covered Lives 72 5,529 1,072 0 0 0 0 0 0 0 48,322 30,402 85,397 0 85,397 3. Number of Groups 534 39 0 0 0 0 0 0 320 2 895 0 895 4. Member Months 56,911 19,417 0 0 0 0 0 0 594,714 375,370 1,047,193 0 1,047,193 XXX 781 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ XXX 0 ] If yes, show the amount of premiums and claims included. Premiums $ 0 Claims $ 0 AFFORDABLE CARE ACT (ACA) RECEIPTS, PAYMENTS, RECEIVABLES and PAYABLES Current Year Prior Year Comprehensive Health Coverage Comprehensive Health Coverage 1 2 3 4 Small Group Small Group Employer Plans Employer Plans Individual Plans Individual Plans ACA Receivables and Payables 1. Permanent ACA Risk Adjustment Program 1.0 Premium adjustments receivable/(payable) 2. Transitional ACA Reinsurance Program 2.0 Total amounts recoverable for claims (paid & unpaid) 0 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 0 0 (196,071) (727,965) XXX 113,456 0 0 0 (428,574) XXX 0 0 0 0 ACA Receipts and Payments 4. Permanent ACA Risk Adjustment Program 4.0 Premium adjustments receipts/(payments) 5. Transitional ACA Reinsurance Program 5.0 Amounts received for claims 0 6. Temporary ACA Risk Corridors Program 6.1 Retrospective premium received 6.2 Rate credits or policy experience refunds paid 0 0 141,236 (192,019) XXX 0 0 0 0 0 0 (532,150) XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF 185 Asylum Street Hartford, CT 061033408 West Virginia DURING THE YEAR Comprehensive Health Coverage 1 2 3 Individual Small Group Employer Large Group Employer Small Group Employer Individual Expatriate Plans: 7 8 6 Large Group Employer Small Group 10 11 Government Business (excluded by statute) Other Health Business 9 Student Health Plans Large Group 79413 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.WV Health Premiums Earned: 220,241 29,344,869 1.1 Direct premiums written 0 0 1.2 Unearned premium prior year 0 2,490 1.3 Unearned premium current year 0 (2,490) 1.4 Change in unearned premium (Lines 1.2 - 1.3) (73,074) 0 1.5 Paid rate credits 0 0 1.6 Reserve for rate credits current year 0 0 1.7 Reserve for rate credits prior year 0 0 1.8 Change in reserve for rate credits (Lines 1.6 - 1.7) 0 5,178 1.9 Premium balances written off 0 0 1.10 Group conversion charge 220,241 29,337,201 1.11 Total direct premiums earned (Lines 1.1 + 1.4 - 1.9 + 1.10) 0 0 1.12 Assumed premiums earned from non-affiliates 0 588 1.13 Net Assumed less Ceded premiums earned from affiliates 0 0 1.14 Ceded premiums earned to non-affiliates 0 5,178 1.15 Other Adjustments due to MLR calculation - Premiums 293,314 29,342,967 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 648,360 24,846,107 2.1 Paid claims during the year 4,964 3,378,107 2.2 Direct claim liability current year 55 1,012,487 2.3 Direct claim liability prior year 0 79,943 2.4 Direct claim reserves current year 0 25,034 2.5 Direct claim reserves prior year 37,366 0 2.6 Direct contract reserves current year 39,943 0 2.7 Direct contract reserves prior year (73,074) 0 2.8 Paid rate credits 0 0 2.9 Reserve for rate credits current year 0 0 2.10 Reserve for rate credits prior year 0 992 2.11 Incurred medical incentive pools and bonuses (Lines 2.11a + 2.11b - 2.11c) 0 632 2.11a Paid medical incentive pools and bonuses current year 0 470 2.11b Accrued medical incentive pools and bonuses current year 0 110 2.11c Accrued medical incentive pools and bonuses prior year 11 440,224 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 16 765,379 2.12a Healthcare receivables current year 5 325,155 2.12b Healthcare receivables prior year 0 0 2.13 Group conversion charge 0 0 2.14 Multi-option coverage blended rate adjustment 2.15 Total incurred claims (Lines 2.1 + 2.2 - 2.3 + 2.4 - 2.5 + 2.6 - 2.7 + 2.8 + 2.9 577,607 26,827,404 2.10 + 2.11 - 2.12 + 2.13 + 2.14) 0 0 2.16 Assumed incurred claims from non-affiliates 0 462 2.17 Net assumed less ceded incurred claims from affiliates 0 0 2.18 Ceded incurred claims to non-affiliates 0 0 2.19 Other adjustments due to MLR calculation - Claims 650,681 26,827,866 2.20 Net Incurred Claims (Lines 2.15 - 2.8 - 2.9 + 2.10 + 2.16 + 2.17 - 2.18 + 2.19) 3. Fraud and Abuse Recoveries that Reduced PAID Claims in Line 2.1 above 3 2,157 (informational only) 519,229 for stand-alone dental and $ (a) Column 13, Line 1.1 includes direct written premium of $ 4 Business Subject to MLR Mini-Med Plans 5 (LOCATION) NAIC Company Code 2018 5,606,602 0 1,207 (1,207) 417,638 0 5,012 (5,012) 50 0 5,605,346 0 535 190,150 50 5,003,155 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 92,574,130 0 7 (7) (1,492,264) 0 0 0 896 0 92,573,227 0 0 12,154 896 94,054,234 33,557,824 0 0 0 0 (160,191) 705,029 (865,220) 398,657 0 33,159,167 0 0 0 398,657 34,423,044 161,303,667 0 3,704 (3,704) (1,147,700) (160,191) 710,041 (870,232) 404,781 0 160,895,182 0 1,123 202,304 404,781 163,116,714 3,765,608 556,248 958,307 15,502 5,560 0 0 417,638 0 5,012 0 0 0 0 98,679 154,518 55,839 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 74,448,114 8,296,723 8,944,721 2,623,646 2,548,594 13,350 22,022 (1,492,264) 0 0 0 0 0 0 11,396 11,396 0 0 0 38,001,251 3,194,712 2,650,701 0 0 0 0 0 (160,191) 705,029 0 0 0 0 12,797,671 22,004,246 9,206,575 0 0 141,709,439 15,430,754 13,566,272 2,719,091 2,579,187 50,716 61,965 (1,147,700) (160,191) 710,041 992 632 470 110 13,347,981 22,935,556 9,587,574 0 0 3,687,437 0 235 243,715 0 3,031,331 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 72,362,835 0 0 (2,534) 0 73,857,634 24,882,370 0 0 0 0 25,747,590 128,337,654 0 697 241,181 0 130,115,102 1,710 0 0 259,422 for stand-alone vision policies. 0 0 0 0 0 0 3,870 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF West Virginia DURING THE YEAR Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities All Expenses 1 Improve Health Outcomes 1. Individual Comprehensive Coverage Expenses: 9,681 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 543 for affiliated services) 1.3 EDP Equipment and Software (incl $ 52 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 6 for affiliated services) 1.5 Accreditation and Certification (incl $ 16,935 for affiliated services) 1.6 Other Expenses (incl $ 1.7 Subtotal before Reimbursements and Taxes (Lines 1.1 to 1.6) 1.8 Reimbursements by uninsured plans and fiscal intermediaries 1.9 Taxes, Licenses and Fees (in total, for tying purposes) 1.10 Total (1.7 to 1.9) 1.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 2. 216-4.WV 3. 0 0 0 0 0 1,762 1,762 0 XXX Small Group Comprehensive Coverage Expenses: 639,187 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 45,188 for affiliated services) 2.3 EDP Equipment and Software (incl $ 4,338 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 471 for affiliated services) 2.5 Accreditation and Certification (incl $ 1,465,766 for affiliated services) 2.6 Other Expenses (incl $ 2.7 Subtotal before Reimbursements and Taxes (Lines 2.1 to 2.6) 2.8 Reimbursements by uninsured plans and fiscal intermediaries 2.9 Taxes, Licenses and Fees (in total, for tying purposes) 2.10 Total (2.7 to 2.9) 2.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 2 Activities to Prevent Hospital Readmissions 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX Total (1 to 5) 0 0 0 0 0 1,762 1,762 0 XXX 0 0 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 0 0 0 0 0 0 0 XXX (LOCATION) NAIC Company Code 2018 XXX 1,025 117 86 8 1 2,292 3,528 0 XXX 2,502 208 150 14 2 4,258 7,134 0 XXX 1,762 0 0 0 0 0 0 0 0 0 1,762 0 3,528 953 7,134 0 0 0 0 0 0 234,698 234,698 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 234,698 234,698 0 80,489 25,552 6,721 645 70 185,206 298,683 0 135,446 15,522 11,310 1,086 118 302,934 466,416 0 XXX Large Group Comprehensive Coverage Expenses: 112,895 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 7,825 for affiliated services) 3.3 EDP Equipment and Software (incl $ 751 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 82 for affiliated services) 3.5 Accreditation and Certification (incl $ 258,378 for affiliated services) 3.6 Other Expenses (incl $ 3.7 Subtotal before Reimbursements and Taxes (Lines 3.1 to 3.6) 3.8 Reimbursements by uninsured plans and fiscal intermediaries 3.9 Taxes, Licenses and Fees (in total, for tying purposes) 3.10 Total (3.7 to 3.9) 3.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 185 Asylum Street Hartford, CT 061033408 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX XXX XXX 234,698 0 0 0 0 0 0 0 0 0 234,698 0 298,683 81,848 466,416 0 0 0 0 0 0 44,843 44,843 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 44,843 44,843 0 14,347 6,904 1,198 115 12 32,973 55,550 0 23,429 2,685 1,956 188 20 52,400 80,679 0 XXX XXX XXX 0 0 0 XXX 44,843 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 44,843 0 XXX 55,550 15,088 80,679 0 79413 9 10 General Administrative Expenses Total Expenses (6 to 9) 6,155 417 308 26 3 19,976 26,885 0 12,234 39,119 0 9,681 742 543 49 6 28,288 39,309 0 12,234 51,543 953 423,252 42,718 27,157 2,607 283 1,513,588 2,009,604 0 955,810 2,965,414 0 639,187 83,792 45,188 4,338 471 2,236,425 3,009,401 0 955,810 3,965,210 81,848 75,119 9,274 4,670 448 49 282,563 372,123 0 205,778 577,901 0 112,895 18,863 7,825 751 82 412,780 553,195 0 205,778 758,972 15,088 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 4. 5. 216-5.WV 6. Individual Mini-Med Plans Expenses: 0 for affiliated services) 4.1 Salaries (including $ 4.2 Outsourced Services 0 for affiliated services) 4.3 EDP Equipment and Software (incl $ 0 for affiliated services) 4.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 4.5 Accreditation and Certification (incl $ 0 for affiliated services) 4.6 Other Expenses (incl $ 4.7 Subtotal before Reimbursements and Taxes (Lines 4.1 to 4.6) 4.8 Reimbursements by uninsured plans and fiscal intermediaries 4.9 Taxes, Licenses and Fees (in total, for tying purposes) 4.10 Total (4.7 to 4.9) 4.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Mini-Med Plans Expenses: 0 for affiliated services) 5.1 Salaries (including $ 5.2 Outsourced Services 0 for affiliated services) 5.3 EDP Equipment and Software (incl $ 0 for affiliated services) 5.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 5.5 Accreditation and Certification (incl $ 0 for affiliated services) 5.6 Other Expenses (incl $ 5.7 Subtotal before Reimbursements and Taxes (Lines 5.1 to 5.6) 5.8 Reimbursements by uninsured plans and fiscal intermediaries 5.9 Taxes, Licenses and Fees (in total, for tying purposes) 5.10 Total (5.7 to 5.9) 5.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Mini-Med Plans Expenses: 0 for affiliated services) 6.1 Salaries (including $ 6.2 Outsourced Services 0 for affiliated services) 6.3 EDP Equipment and Software (incl $ 0 for affiliated services) 6.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 6.5 Accreditation and Certification (incl $ 0 for affiliated services) 6.6 Other Expenses (incl $ 6.7 Subtotal before Reimbursements and Taxes (Lines 6.1 to 6.6) 6.8 Reimbursements by uninsured plans and fiscal intermediaries 6.9 Taxes, Licenses and Fees (in total, for tying purposes) 6.10 Total (6.7 to 6.9) 6.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 7. 8. 216-6.WV 9. Small Group Expatriate Plans Expenses: 0 for affiliated services) 7.1 Salaries (including $ 7.2 Outsourced Services 0 for affiliated services) 7.3 EDP Equipment and Software (incl $ 0 for affiliated services) 7.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 7.5 Accreditation and Certification (incl $ 0 for affiliated services) 7.6 Other Expenses (incl $ 7.7 Subtotal before Reimbursements and Taxes (Lines 7.1 to 7.6) 7.8 Reimbursements by uninsured plans and fiscal intermediaries 7.9 Taxes, Licenses and Fees (in total, for tying purposes) 7.10 Total (7.7 to 7.9) 7.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Expatriate Plans Expenses: 0 for affiliated services) 8.1 Salaries (including $ 8.2 Outsourced Services 0 for affiliated services) 8.3 EDP Equipment and Software (incl $ 0 for affiliated services) 8.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 8.5 Accreditation and Certification (incl $ 0 for affiliated services) 8.6 Other Expenses (incl $ 8.7 Subtotal before Reimbursements and Taxes (Lines 8.1 to 8.6) 8.8 Reimbursements by uninsured plans and fiscal intermediaries 8.9 Taxes, Licenses and Fees (in total, for tying purposes) 8.10 Total (8.7 to 8.9) 8.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Student Health Plans Expenses: 0 for affiliated services) 9.1 Salaries (including $ 9.2 Outsourced Services 0 for affiliated services) 9.3 EDP Equipment and Software (incl $ 0 for affiliated services) 9.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 9.5 Accreditation and Certification (incl $ 0 for affiliated services) 9.6 Other Expenses (incl $ 9.7 Subtotal before Reimbursements and Taxes (Lines 9.1 to 9.6) 9.8 Reimbursements by uninsured plans and fiscal intermediaries 9.9 Taxes, Licenses and Fees (in total, for tying purposes) 9.10 Total (9.7 to 9.9) 9.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 *79413201821650100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes - See Cautionary Statement at http://www.naic.org/documents/committees_e_app_blanks_related_shce_cautionary_statement.pdf) UnitedHealthcare Insurance Company 2. 185 Asylum Street Hartford, CT 061033408 (LOCATION) BUSINESS IN THE STATE OF Wisconsin DURING THE YEAR 2018 NAIC Company Code Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 1. 216-1.WI 2. 3. 4. 5. 6. 7. 8. 9. Premium: 1.1 Health premiums earned (From Part 2, Line 1.11) 1.2 Federal high risk pools 1.3 State high risk pools 1.4 Premiums earned including state and federal high risk programs (Lines 1.1 + 1.2 + 1.3) 1.5 Federal taxes and federal assessments 1.6 State insurance, premium and other taxes (Similar local taxes of 131,188 ) $ 1.6a Community Benefit Expenditures (informational only) 1.7 Regulatory authority licenses and fees 1.8 Adjusted Premiums Earned (Lines 1.4 - 1.5 - 1.6 - 1.7) 1.9 Net Assumed less Ceded reinsurance premiums earned 1.10 Other Adjustments due to MLR calculations - Premiums 1.11 Risk Revenue 1.12 Net adjusted premiums earned after reinsurance (Lines 1.8 + 1.9 + 1.10 + 1.11) Claims: 2.1 Incurred claims excluding prescription drugs 2.2 Prescription drugs 2.3 Pharmaceutical rebates 2.4 State stop loss, market stabilization and claim/census based assessments (informational only) Incurred medical incentive pools and bonuses Deductible Fraud and Abuse Detection/Recovery Expenses (for MLR use only) 5.0 Total Incurred Claims (Lines 2.1 + 2.2 - 2.3 + 3) (From Part 2, Line 2.15) 5.1 Net Assumed less Ceded reinsurance claims incurred 5.2 Other Adjustments due to MLR calculations - Claims 5.3 Rebates paid 5.4 Estimated rebates unpaid prior year 5.5 Estimated rebates unpaid current year 5.6 Fee for service and co-pay revenue 5.7 Net incurred claims after reinsurance (Lines 5.0 + 5.1 + 5.2 + 5.3 - 5.4 + 5.5 - 5.6) Improving Health Care Quality Expenses Incurred: 6.1 Improve health outcomes 6.2 Activities to prevent hospital readmissions 6.3 Improve patient safety and reduce medical errors 6.4 Wellness and health promotion activities 6.5 Health Information Technology expenses related to health improvement 6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5) Preliminary Medical Loss Ratio: MLR ((Lines 4 + 5.0 + 6.6 - Footnote 2.0)/Line 1.8 Claims Adjustment Expenses: 8.1 Cost containment expenses not included in quality of care expenses in Line 6.6 8.2 All other claims adjustment expenses 8.3 Total claims adjustment expenses (Lines 8.1 + 8.2) Claims Adjustment Expense Ratio (Line 8.3/Line 1.8) 2 Small Group Employer 3 Large Group Employer 4 5 Small Group Employer Individual Expatriate Plans 6 Large Group Employer 7 11 Government Business (excluded by statute) Other Health Business 9 8 Small Group 10 Student Health Plans Large Group 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 79413 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 2,466,764 0 (56) 353,368,090 0 (7,162) 572,095,444 0 (20,582) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6,243 0 0 237,912,379 0 73,724 57,999,796 0 0 1,223,848,714 0 45,925 XXX XXX XXX 1,223,848,714 0 45,925 2,466,708 43,352 353,360,928 20,367,459 572,074,862 19,410,429 0 0 0 0 0 0 0 0 0 0 0 0 6,243 120,956 237,986,102 5,040,029 57,999,796 2,718,605 1,223,894,639 47,700,830 XXX 16,114 1,223,894,639 47,716,944 41,750 0 39 2,381,567 243 0 0 2,381,810 4,982,714 0 5,086 328,005,670 84,350 54,987 0 328,145,007 8,010,671 0 26,639 544,627,123 (59,656,515) 674,816 0 485,645,424 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (114,713) 600,832 0 0 486,119 4,575,491 0 (30,304) 228,400,886 (1,409,231) 1,621 0 226,993,276 7,202 0 0 55,273,989 1,995,058 353,436 0 57,622,484 17,617,828 0 1,460 1,158,574,521 (58,385,262) 1,084,860 0 1,101,274,119 79 0 0 XXX XXX XXX XXX XXX 17,617,907 0 1,460 1,158,558,329 (58,385,262) 1,084,860 0 1,101,257,927 1,810,686 418,547 156,697 214,019,168 44,449,382 16,463,258 418,294,414 84,807,140 29,641,757 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 163,027,399 18,644,807 9,052 1,940,459 87,534,085 47,675,456 799,092,127 235,853,961 93,946,219 XXX XXX XXX 799,092,127 235,853,961 93,946,219 0 0 0 2,072,536 0 0 0 0 0 0 2,072,536 40,019 13,717 76,020 242,019,009 0 0 0 0 0 0 242,019,009 154,394 (959,303) 203,948 472,500,494 (47,669,729) 0 0 0 0 0 424,830,765 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (1,648) 37 41,797,440 0 0 0 0 0 0 41,797,440 194,533 (947,235) 280,004 940,052,634 (48,971,957) 0 0 0 0 0 891,080,677 XXX XXX 0 0 120 0 0 181,663,154 (1,302,228) 0 XXX XXX XXX 0 180,360,926 194,533 (947,235) 280,004 940,052,634 (48,971,957) 0 0 0 0 0 891,080,677 19,734 0 0 0 0 2,826,945 0 0 0 0 4,576,764 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 579,554 158,550 129,351 1,223,394 95,986 19,734 0.879 2,826,945 0.747 4,576,764 0.876 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 24,935 39,218 64,154 0.027 3,402,293 4,922,975 8,325,269 0.025 5,988,002 8,363,660 14,351,662 0.026 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 XXX XXX XXX XXX 0 XXX XXX XXX XXX XXX XXX XXX XXX 95,923 27,977 203,088 (36,259) 210,182 8,098,919 186,527 332,439 1,187,135 306,168 4,537 (31) 14,721 (3,404) 8,829 8,103,456 186,496 347,160 1,183,731 314,997 2,186,835 XXX 500,911 0.765 10,111,188 XXX 24,652 XXX 10,135,840 XXX 458,173 3,098,288 3,556,460 0.016 1,155,673 4,182,229 5,337,902 0.097 11,029,076 20,606,371 31,635,447 XXX 23,644 292,719 316,363 XXX 11,052,721 20,899,090 31,951,810 XXX SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 (Continued) Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 2 Small Group Employer Individual 10. General and Administrative (G&A) Expenses: 10.1 Direct sales salaries and benefits 10.2 Agents and brokers fees and commissions 10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below) 10.4 Other general and administrative expenses 10.4a Community Benefit Expenditures (informational only) 10.5 Total general and administrative (Lines 10.1 +10.2 + 10.3 + 10.4) 8,947 63,169 101 124,139 0 196,356 3 Large Group Employer 1,177,845 9,553,383 210,193 14,681,407 0 25,622,828 4 5 Small Group Employer Individual 2,469,909 2,714,577 664,443 17,573,568 0 23,422,497 0 0 0 0 0 0 Expatriate Plans 6 Large Group Employer 0 0 0 0 0 0 7 8 Small Group 0 0 0 0 0 0 Student Health Plans Large Group 0 0 0 0 0 0 10 11 Government Business (excluded by statute) Other Health Business 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 629,644 9,302,748 412,030 17,829,809 0 28,174,231 141,032 962,796 117,207 3,481,801 0 4,702,836 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 4,427,377 22,596,673 1,403,974 53,690,723 0 82,118,748 8,593 0 1,365 37,195 0 47,152 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) 49,350,956 18,463,736 12. Income from fees of uninsured plans XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 13. Net investment and other gain/(loss) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 17,842,215 XXX 14. Federal income taxes (excluding taxes on Line 1.5 above) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 1,035,796 XXX 1,035,796 15. Net gain or (loss) (Lines 11 + 12 + 13 - 14) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 103,134,478 XXX 103,199,240 16. ICD-10 Implementation Expenses (informational only; already included in general expenses and line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16. 16a ICD-10 Implementation Expenses (informational only; already included in line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 29,029 0 0 0 0 0 0 486,119 12,714,824 5,283,395 86,328,059 XXX 4,435,970 22,596,673 1,405,339 53,727,918 0 82,165,900 85,923,699 469,122 469,122 17,842,215 OTHER INDICATORS: 216-2.WI 1. Number of certificates/policies 213 29,370 55,010 0 0 0 0 0 0 0 244,955 61,420 390,968 3,819 394,787 2. Number of Covered Lives 422 55,638 106,299 0 0 0 0 0 0 5 425,945 61,420 649,729 3,819 653,548 3. Number of Groups 4,404 1,359 0 0 0 0 0 0 3,347 5 9,115 3 9,118 4. Member Months 662,140 1,360,958 0 0 0 0 0 50 5,322,475 749,313 8,099,943 45,665 8,145,608 XXX 5,007 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ XXX 0 ] If yes, show the amount of premiums and claims included. Premiums $ 0 Claims $ 0 AFFORDABLE CARE ACT (ACA) RECEIPTS, PAYMENTS, RECEIVABLES and PAYABLES Current Year Prior Year Comprehensive Health Coverage Comprehensive Health Coverage 1 2 3 4 Small Group Small Group Employer Plans Employer Plans Individual Plans Individual Plans ACA Receivables and Payables 1. Permanent ACA Risk Adjustment Program 1.0 Premium adjustments receivable/(payable) 2. Transitional ACA Reinsurance Program 2.0 Total amounts recoverable for claims (paid & unpaid) 0 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 0 0 0 0 162,783 13,017,835 (331,224) 11,635,771 XXX 154,841 0 8,341,916 XXX 0 0 0 0 ACA Receipts and Payments 4. Permanent ACA Risk Adjustment Program 4.0 Premium adjustments receipts/(payments) 5. Transitional ACA Reinsurance Program 5.0 Amounts received for claims 0 6. Temporary ACA Risk Corridors Program 6.1 Retrospective premium received 6.2 Rate credits or policy experience refunds paid 0 0 XXX (255,978) 0 0 0 0 0 12,292,552 XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF 185 Asylum Street Hartford, CT 061033408 Wisconsin DURING THE YEAR Comprehensive Health Coverage 1 2 3 Individual Small Group Employer Small Group Employer Individual Expatriate Plans: 7 8 6 Large Group Employer Small Group 10 11 Government Business (excluded by statute) Other Health Business 9 Student Health Plans Large Group 79413 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.WI Health Premiums Earned: 2,466,764 353,423,416 1.1 Direct premiums written 0 56,463 1.2 Unearned premium prior year 0 56,802 1.3 Unearned premium current year 0 (339) 1.4 Change in unearned premium (Lines 1.2 - 1.3) 469 0 1.5 Paid rate credits 0 0 1.6 Reserve for rate credits current year 0 0 1.7 Reserve for rate credits prior year 0 0 1.8 Change in reserve for rate credits (Lines 1.6 - 1.7) 0 54,987 1.9 Premium balances written off 0 0 1.10 Group conversion charge 2,466,764 353,368,090 1.11 Total direct premiums earned (Lines 1.1 + 1.4 - 1.9 + 1.10) 0 0 1.12 Assumed premiums earned from non-affiliates 243 84,350 1.13 Net Assumed less Ceded premiums earned from affiliates 0 0 1.14 Ceded premiums earned to non-affiliates 0 54,987 1.15 Other Adjustments due to MLR calculation - Premiums 2,466,538 353,507,427 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 2,087,475 246,728,904 2.1 Paid claims during the year 363 34,458,072 2.2 Direct claim liability current year 15,771 39,171,760 2.3 Direct claim liability prior year 0 1,676,441 2.4 Direct claim reserves current year 0 1,226,103 2.5 Direct claim reserves prior year 0 0 2.6 Direct contract reserves current year 0 0 2.7 Direct contract reserves prior year 469 0 2.8 Paid rate credits 0 0 2.9 Reserve for rate credits current year 0 0 2.10 Reserve for rate credits prior year 0 13,717 2.11 Incurred medical incentive pools and bonuses (Lines 2.11a + 2.11b - 2.11c) 0 14,199 2.11a Paid medical incentive pools and bonuses current year 0 244,310 2.11b Accrued medical incentive pools and bonuses current year 0 244,793 2.11c Accrued medical incentive pools and bonuses prior year 0 460,263 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 0 8,060,479 2.12a Healthcare receivables current year 0 7,600,216 2.12b Healthcare receivables prior year 0 0 2.13 Group conversion charge 0 0 2.14 Multi-option coverage blended rate adjustment 2.15 Total incurred claims (Lines 2.1 + 2.2 - 2.3 + 2.4 - 2.5 + 2.6 - 2.7 + 2.8 + 2.9 2,072,536 242,019,009 2.10 + 2.11 - 2.12 + 2.13 + 2.14) 0 0 2.16 Assumed incurred claims from non-affiliates 0 0 2.17 Net assumed less ceded incurred claims from affiliates 0 0 2.18 Ceded incurred claims to non-affiliates 0 0 2.19 Other adjustments due to MLR calculation - Claims 2,072,067 242,019,009 2.20 Net Incurred Claims (Lines 2.15 - 2.8 - 2.9 + 2.10 + 2.16 + 2.17 - 2.18 + 2.19) 3. Fraud and Abuse Recoveries that Reduced PAID Claims in Line 2.1 above 0 76,020 (informational only) 18,386,236 for stand-alone dental and $ (a) Column 13, Line 1.1 includes direct written premium of $ Large Group Employer 4 Business Subject to MLR Mini-Med Plans 5 (LOCATION) NAIC Company Code 2018 572,774,748 25,725 30,214 (4,489) 141,302 (126,164) 97,330 (223,494) 674,816 0 572,095,444 0 209,089 59,865,604 674,816 513,195,937 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6,243 0 0 0 0 0 0 0 0 0 6,243 0 600,832 0 0 607,075 237,921,936 5,093 13,029 (7,936) 1,349,238 1,345,416 1,523,703 (178,287) 1,621 0 237,912,379 0 0 1,409,231 1,621 235,333,819 58,353,232 0 0 0 3,435,910 2,393,496 3,842,647 (1,449,150) 353,436 0 57,999,796 0 1,995,058 0 353,436 58,361,531 1,224,946,338 87,281 100,045 (12,763) 4,926,919 3,612,748 5,463,680 (1,850,932) 1,084,860 0 1,223,848,715 0 2,889,573 61,274,835 1,084,860 1,163,472,326 473,993,678 50,563,359 51,981,816 241,964 715,108 0 0 141,302 (126,164) 97,330 (959,303) 45,058 447,100 1,451,462 (1,439,913) 10,504,303 11,944,216 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (808,401) 621,467 (186,935) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 179,467,876 19,525,545 19,686,378 17,697,233 16,513,871 112,749 103,247 1,349,238 1,345,416 1,523,703 0 0 0 0 7,703 10,067 2,363 0 0 42,995,366 894,571 2,954,630 0 0 0 0 3,435,910 2,393,496 3,842,647 (1,648) (1,648) 107,770 107,770 1,122,978 16,392,848 15,269,870 0 0 944,464,898 106,063,376 113,623,419 19,615,638 18,455,081 112,749 103,247 4,926,919 3,612,748 5,463,680 (947,235) 57,609 799,180 1,804,024 151,032 34,967,698 34,816,666 0 0 472,500,494 0 0 47,669,729 0 424,912,958 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 181,663,154 0 0 1,302,228 0 179,189,975 41,797,440 0 0 0 0 39,810,681 940,052,634 0 0 48,971,957 0 888,004,690 203,948 0 0 11,606,631 for stand-alone vision policies. 0 0 0 0 0 0 33,272 313,239 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF Wisconsin DURING THE YEAR Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities All Expenses 1 Improve Health Outcomes 1. Individual Comprehensive Coverage Expenses: 61,867 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 4,446 for affiliated services) 1.3 EDP Equipment and Software (incl $ 427 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 46 for affiliated services) 1.5 Accreditation and Certification (incl $ 139,859 for affiliated services) 1.6 Other Expenses (incl $ 1.7 Subtotal before Reimbursements and Taxes (Lines 1.1 to 1.6) 1.8 Reimbursements by uninsured plans and fiscal intermediaries 1.9 Taxes, Licenses and Fees (in total, for tying purposes) 1.10 Total (1.7 to 1.9) 1.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 2. 216-4.WI Small Group Comprehensive Coverage Expenses: 12,074,307 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 850,019 for affiliated services) 2.3 EDP Equipment and Software (incl $ 81,592 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 8,859 for affiliated services) 2.5 Accreditation and Certification (incl $ 11,890,183 for affiliated services) 2.6 Other Expenses (incl $ 2.7 Subtotal before Reimbursements and Taxes (Lines 2.1 to 2.6) 2.8 Reimbursements by uninsured plans and fiscal intermediaries 2.9 Taxes, Licenses and Fees (in total, for tying purposes) 2.10 Total (2.7 to 2.9) 2.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 3. Large Group Comprehensive Coverage Expenses: 7,630,850 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 501,803 for affiliated services) 3.3 EDP Equipment and Software (incl $ 48,167 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 5,230 for affiliated services) 3.5 Accreditation and Certification (incl $ 33,167,070 for affiliated services) 3.6 Other Expenses (incl $ 3.7 Subtotal before Reimbursements and Taxes (Lines 3.1 to 3.6) 3.8 Reimbursements by uninsured plans and fiscal intermediaries 3.9 Taxes, Licenses and Fees (in total, for tying purposes) 3.10 Total (3.7 to 3.9) 3.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 185 Asylum Street Hartford, CT 061033408 0 0 0 0 0 19,734 19,734 0 XXX 2 Activities to Prevent Hospital Readmissions 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX Total (1 to 5) 0 0 0 0 0 19,734 19,734 0 XXX 0 0 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 0 0 0 0 0 0 0 XXX (LOCATION) NAIC Company Code 2018 XXX 6,999 802 584 56 6 15,654 24,101 0 XXX 11,131 1,276 930 89 10 24,895 38,330 0 XXX 19,734 0 0 0 0 0 0 0 0 0 19,734 0 24,101 7,198 38,330 0 0 0 0 0 0 2,826,945 2,826,945 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,826,945 2,826,945 0 1,520,862 247,292 126,999 12,190 1,324 1,383,830 3,292,497 0 2,327,139 266,695 194,327 18,653 2,025 1,997,240 4,806,079 0 XXX 2,826,945 0 0 0 0 0 0 4,576,764 4,576,764 0 XXX 4,576,764 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 2,826,945 0 XXX 3,292,497 947,901 XXX 4,806,079 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4,576,764 4,576,764 0 1,026,462 187,350 85,714 8,228 893 4,482,358 5,791,005 0 1,444,199 165,508 120,597 11,576 1,257 6,437,607 8,180,744 0 4,576,764 0 XXX 5,791,005 1,779,980 XXX 8,180,744 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 79413 9 10 General Administrative Expenses Total Expenses (6 to 9) 43,737 4,024 2,932 281 31 144,618 195,623 0 44,245 239,868 0 61,867 6,102 4,446 427 46 204,901 277,789 0 44,245 322,033 7,198 8,226,307 771,148 528,693 50,748 5,510 15,746,926 25,329,332 0 5,507,988 30,837,320 0 12,074,307 1,285,135 850,019 81,592 8,859 21,954,941 36,254,853 0 5,507,988 41,762,841 947,901 5,160,190 432,238 295,491 28,364 3,080 16,672,948 22,592,311 0 9,247,410 31,839,721 0 7,630,850 785,096 501,803 48,167 5,230 32,169,676 41,140,823 0 9,247,410 50,388,233 1,779,980 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 4. 5. 216-5.WI 6. Individual Mini-Med Plans Expenses: 0 for affiliated services) 4.1 Salaries (including $ 4.2 Outsourced Services 0 for affiliated services) 4.3 EDP Equipment and Software (incl $ 0 for affiliated services) 4.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 4.5 Accreditation and Certification (incl $ 0 for affiliated services) 4.6 Other Expenses (incl $ 4.7 Subtotal before Reimbursements and Taxes (Lines 4.1 to 4.6) 4.8 Reimbursements by uninsured plans and fiscal intermediaries 4.9 Taxes, Licenses and Fees (in total, for tying purposes) 4.10 Total (4.7 to 4.9) 4.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Mini-Med Plans Expenses: 0 for affiliated services) 5.1 Salaries (including $ 5.2 Outsourced Services 0 for affiliated services) 5.3 EDP Equipment and Software (incl $ 0 for affiliated services) 5.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 5.5 Accreditation and Certification (incl $ 0 for affiliated services) 5.6 Other Expenses (incl $ 5.7 Subtotal before Reimbursements and Taxes (Lines 5.1 to 5.6) 5.8 Reimbursements by uninsured plans and fiscal intermediaries 5.9 Taxes, Licenses and Fees (in total, for tying purposes) 5.10 Total (5.7 to 5.9) 5.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Mini-Med Plans Expenses: 0 for affiliated services) 6.1 Salaries (including $ 6.2 Outsourced Services 0 for affiliated services) 6.3 EDP Equipment and Software (incl $ 0 for affiliated services) 6.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 6.5 Accreditation and Certification (incl $ 0 for affiliated services) 6.6 Other Expenses (incl $ 6.7 Subtotal before Reimbursements and Taxes (Lines 6.1 to 6.6) 6.8 Reimbursements by uninsured plans and fiscal intermediaries 6.9 Taxes, Licenses and Fees (in total, for tying purposes) 6.10 Total (6.7 to 6.9) 6.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 7. 8. 216-6.WI 9. Small Group Expatriate Plans Expenses: 0 for affiliated services) 7.1 Salaries (including $ 7.2 Outsourced Services 0 for affiliated services) 7.3 EDP Equipment and Software (incl $ 0 for affiliated services) 7.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 7.5 Accreditation and Certification (incl $ 0 for affiliated services) 7.6 Other Expenses (incl $ 7.7 Subtotal before Reimbursements and Taxes (Lines 7.1 to 7.6) 7.8 Reimbursements by uninsured plans and fiscal intermediaries 7.9 Taxes, Licenses and Fees (in total, for tying purposes) 7.10 Total (7.7 to 7.9) 7.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Expatriate Plans Expenses: 0 for affiliated services) 8.1 Salaries (including $ 8.2 Outsourced Services 0 for affiliated services) 8.3 EDP Equipment and Software (incl $ 0 for affiliated services) 8.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 8.5 Accreditation and Certification (incl $ 0 for affiliated services) 8.6 Other Expenses (incl $ 8.7 Subtotal before Reimbursements and Taxes (Lines 8.1 to 8.6) 8.8 Reimbursements by uninsured plans and fiscal intermediaries 8.9 Taxes, Licenses and Fees (in total, for tying purposes) 8.10 Total (8.7 to 8.9) 8.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Student Health Plans Expenses: 0 for affiliated services) 9.1 Salaries (including $ 9.2 Outsourced Services 0 for affiliated services) 9.3 EDP Equipment and Software (incl $ 0 for affiliated services) 9.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 9.5 Accreditation and Certification (incl $ 0 for affiliated services) 9.6 Other Expenses (incl $ 9.7 Subtotal before Reimbursements and Taxes (Lines 9.1 to 9.6) 9.8 Reimbursements by uninsured plans and fiscal intermediaries 9.9 Taxes, Licenses and Fees (in total, for tying purposes) 9.10 Total (9.7 to 9.9) 9.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 *79413201821651100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes - See Cautionary Statement at http://www.naic.org/documents/committees_e_app_blanks_related_shce_cautionary_statement.pdf) UnitedHealthcare Insurance Company 2. 185 Asylum Street Hartford, CT 061033408 (LOCATION) BUSINESS IN THE STATE OF Wyoming DURING THE YEAR 2018 NAIC Company Code Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 1. 216-1.WY 2. 3. 4. 5. 6. 7. 8. 9. Premium: 1.1 Health premiums earned (From Part 2, Line 1.11) 1.2 Federal high risk pools 1.3 State high risk pools 1.4 Premiums earned including state and federal high risk programs (Lines 1.1 + 1.2 + 1.3) 1.5 Federal taxes and federal assessments 1.6 State insurance, premium and other taxes (Similar local taxes of 8,863 ) $ 1.6a Community Benefit Expenditures (informational only) 1.7 Regulatory authority licenses and fees 1.8 Adjusted Premiums Earned (Lines 1.4 - 1.5 - 1.6 - 1.7) 1.9 Net Assumed less Ceded reinsurance premiums earned 1.10 Other Adjustments due to MLR calculations - Premiums 1.11 Risk Revenue 1.12 Net adjusted premiums earned after reinsurance (Lines 1.8 + 1.9 + 1.10 + 1.11) Claims: 2.1 Incurred claims excluding prescription drugs 2.2 Prescription drugs 2.3 Pharmaceutical rebates 2.4 State stop loss, market stabilization and claim/census based assessments (informational only) Incurred medical incentive pools and bonuses Deductible Fraud and Abuse Detection/Recovery Expenses (for MLR use only) 5.0 Total Incurred Claims (Lines 2.1 + 2.2 - 2.3 + 3) (From Part 2, Line 2.15) 5.1 Net Assumed less Ceded reinsurance claims incurred 5.2 Other Adjustments due to MLR calculations - Claims 5.3 Rebates paid 5.4 Estimated rebates unpaid prior year 5.5 Estimated rebates unpaid current year 5.6 Fee for service and co-pay revenue 5.7 Net incurred claims after reinsurance (Lines 5.0 + 5.1 + 5.2 + 5.3 - 5.4 + 5.5 - 5.6) Improving Health Care Quality Expenses Incurred: 6.1 Improve health outcomes 6.2 Activities to prevent hospital readmissions 6.3 Improve patient safety and reduce medical errors 6.4 Wellness and health promotion activities 6.5 Health Information Technology expenses related to health improvement 6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5) Preliminary Medical Loss Ratio: MLR ((Lines 4 + 5.0 + 6.6 - Footnote 2.0)/Line 1.8 Claims Adjustment Expenses: 8.1 Cost containment expenses not included in quality of care expenses in Line 6.6 8.2 All other claims adjustment expenses 8.3 Total claims adjustment expenses (Lines 8.1 + 8.2) Claims Adjustment Expense Ratio (Line 8.3/Line 1.8) 2 Small Group Employer 3 Large Group Employer 4 5 Small Group Employer Individual Expatriate Plans 6 Large Group Employer 7 11 Government Business (excluded by statute) Other Health Business 9 8 Small Group 10 Student Health Plans Large Group 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 79413 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 237,015 0 (272) 17,547,849 0 (13,431) 11,793,686 0 (1,117) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 35,641,353 0 4,201 25,595,573 0 0 90,815,477 0 (10,619) XXX XXX XXX 236,744 1,558 17,534,418 735,219 11,792,569 319,542 0 0 0 0 0 0 0 0 0 0 0 0 0 0 35,645,554 266,678 25,595,573 774,794 90,804,858 2,097,791 XXX (86) 0 54 235,217 0 0 0 235,217 200,472 0 170 16,598,558 0 5,130 0 16,603,689 124,016 0 10 11,349,000 (1,496,052) 0 0 9,852,948 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 557,141 0 (8,401) 34,830,137 (1,796) 0 0 34,828,340 2,878 0 0 24,817,901 0 107,133 0 24,925,034 884,420 0 (8,167) 87,830,813 (1,497,849) 112,263 0 86,445,228 XXX XXX XXX XXX XXX 884,420 0 (8,167) 87,830,813 (1,497,849) 112,263 0 86,445,228 145,797 131,830 41,141 12,673,081 1,566,288 550,257 9,469,654 1,710,228 569,106 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 28,004,609 34,387 10,634 17,357,840 9,029,605 4,973,333 67,650,981 12,472,339 6,144,471 XXX XXX XXX 67,650,981 12,472,339 6,144,471 0 0 0 236,486 0 0 0 0 0 0 236,486 1,055 491 47 13,689,603 0 0 0 0 0 0 13,689,603 14 1,598 65 10,612,374 (1,468,093) 0 0 0 0 0 9,144,282 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 28,028,362 (387) 0 XXX XXX XXX 0 28,027,975 0 0 1,347 21,414,112 0 0 0 0 0 0 21,414,112 1,069 2,090 1,459 73,980,938 (1,468,480) 0 0 0 0 0 72,512,459 XXX XXX 1,069 2,090 1,459 73,980,938 (1,468,480) 0 0 0 0 0 72,512,459 1,896 0 0 0 0 140,383 0 0 0 0 94,349 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,896 1.013 140,383 0.833 94,349 0.943 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 1,640 3,067 4,707 0.020 155,276 222,489 377,765 0.023 107,082 138,712 245,795 0.022 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 XXX XXX XXX 0 0 0 0 0 0 0 181,781 133,834 99,633 280,047 35,021 0 730,315 XXX 242,364 0.873 1,209,307 XXX 12,342 523,474 535,816 0.015 90,782 358,278 449,060 0.018 367,122 1,246,021 1,613,143 XXX XXX 0 0 0 0.000 113,274 36,264 26,429 (920) 67,318 90,815,477 0 (10,619) 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 531,683 170,098 126,062 279,126 102,338 0 0 0 0 0 531,683 170,098 126,062 279,126 102,338 0 1,209,307 XXX 0 0 0 367,122 1,246,021 1,613,143 XXX XXX XXX 90,804,858 2,097,791 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 (Continued) Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 2 Small Group Employer Individual 10. General and Administrative (G&A) Expenses: 10.1 Direct sales salaries and benefits 10.2 Agents and brokers fees and commissions 10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below) 10.4 Other general and administrative expenses 10.4a Community Benefit Expenditures (informational only) 10.5 Total general and administrative (Lines 10.1 +10.2 + 10.3 + 10.4) 529 4,617 348 22,847 0 28,341 3 Large Group Employer 52,700 431,873 18,670 589,969 0 1,093,212 4 5 Small Group Employer Individual 44,782 161,242 13,348 278,131 0 497,504 0 0 0 0 0 0 Expatriate Plans 6 Large Group Employer 0 0 0 0 0 0 7 8 Small Group 0 0 0 0 0 0 Student Health Plans Large Group 0 0 0 0 0 0 10 11 Government Business (excluded by statute) Other Health Business 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 46,477 1,327,104 65,279 3,531,641 0 4,970,501 55,244 258,331 38,218 1,173,751 0 1,525,544 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 199,732 2,183,167 135,864 5,596,339 0 8,115,102 0 0 0 0 0 0 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) 12. Income from fees of uninsured plans XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 13. Net investment and other gain/(loss) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 14. Federal income taxes (excluding taxes on Line 1.5 above) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 15. Net gain or (loss) (Lines 11 + 12 + 13 - 14) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 16. ICD-10 Implementation Expenses (informational only; already included in general expenses and line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16. 16a ICD-10 Implementation Expenses (informational only; already included in line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (36,213) 1,302,726 (128,981) 0 0 0 0 0 0 0 563,733 1,293,953 2,995,217 XXX 199,732 2,183,167 135,864 5,596,339 0 8,115,102 XXX 2,995,217 0 0 1,173,553 XXX XXX 68,204 XXX 68,204 XXX 4,100,566 XXX 4,100,566 1,173,553 OTHER INDICATORS: 216-2.WY 1. Number of certificates/policies 16 1,261 471 0 0 0 0 0 0 0 19,870 11,731 33,349 0 33,349 2. Number of Covered Lives 29 2,246 847 0 0 0 0 0 0 0 22,394 11,731 37,247 0 37,247 3. Number of Groups 262 17 0 0 0 0 0 0 91 0 370 0 370 4. Member Months 361 29,511 33,275 0 0 0 0 0 0 270,094 141,897 475,138 0 475,138 XXX Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ XXX 0 ] If yes, show the amount of premiums and claims included. Premiums $ 0 Claims $ 0 AFFORDABLE CARE ACT (ACA) RECEIPTS, PAYMENTS, RECEIVABLES and PAYABLES Current Year Prior Year Comprehensive Health Coverage Comprehensive Health Coverage 1 2 3 4 Small Group Small Group Employer Plans Employer Plans Individual Plans Individual Plans ACA Receivables and Payables 1. Permanent ACA Risk Adjustment Program 1.0 Premium adjustments receivable/(payable) 2. Transitional ACA Reinsurance Program 2.0 Total amounts recoverable for claims (paid & unpaid) 0 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 0 0 0 0 0 0 0 0 195,034 113,048 26,711 1,448,242 83,094 665,780 XXX 287,580 0 332,734 XXX ACA Receipts and Payments 4. Permanent ACA Risk Adjustment Program 4.0 Premium adjustments receipts/(payments) 5. Transitional ACA Reinsurance Program 5.0 Amounts received for claims 0 6. Temporary ACA Risk Corridors Program 6.1 Retrospective premium received 6.2 Rate credits or policy experience refunds paid 0 0 XXX 0 0 0 0 0 XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF 185 Asylum Street Hartford, CT 061033408 Wyoming DURING THE YEAR Comprehensive Health Coverage 1 2 3 Individual Small Group Employer Large Group Employer Small Group Employer Individual Expatriate Plans: 7 8 6 Large Group Employer Small Group 10 11 Government Business (excluded by statute) Other Health Business 9 Student Health Plans Large Group 79413 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.WY Health Premiums Earned: 237,015 17,552,980 1.1 Direct premiums written 0 0 1.2 Unearned premium prior year 0 0 1.3 Unearned premium current year 0 0 1.4 Change in unearned premium (Lines 1.2 - 1.3) (71,561) 0 1.5 Paid rate credits 0 0 1.6 Reserve for rate credits current year 0 0 1.7 Reserve for rate credits prior year 0 0 1.8 Change in reserve for rate credits (Lines 1.6 - 1.7) 0 5,130 1.9 Premium balances written off 0 0 1.10 Group conversion charge 237,015 17,547,849 1.11 Total direct premiums earned (Lines 1.1 + 1.4 - 1.9 + 1.10) 0 0 1.12 Assumed premiums earned from non-affiliates 0 0 1.13 Net Assumed less Ceded premiums earned from affiliates 0 0 1.14 Ceded premiums earned to non-affiliates 0 5,130 1.15 Other Adjustments due to MLR calculation - Premiums 308,577 17,552,980 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 313,731 13,596,586 2.1 Paid claims during the year 7,673 1,541,812 2.2 Direct claim liability current year 4,035 1,459,109 2.3 Direct claim liability prior year 0 33,791 2.4 Direct claim reserves current year 732 34,081 2.5 Direct claim reserves prior year 25,694 0 2.6 Direct contract reserves current year 33,818 0 2.7 Direct contract reserves prior year (71,561) 0 2.8 Paid rate credits 0 0 2.9 Reserve for rate credits current year 0 0 2.10 Reserve for rate credits prior year 0 491 2.11 Incurred medical incentive pools and bonuses (Lines 2.11a + 2.11b - 2.11c) 0 198 2.11a Paid medical incentive pools and bonuses current year 0 538 2.11b Accrued medical incentive pools and bonuses current year 0 245 2.11c Accrued medical incentive pools and bonuses prior year 466 (10,113) 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 466 257,677 2.12a Healthcare receivables current year 0 267,790 2.12b Healthcare receivables prior year 0 0 2.13 Group conversion charge 0 0 2.14 Multi-option coverage blended rate adjustment 2.15 Total incurred claims (Lines 2.1 + 2.2 - 2.3 + 2.4 - 2.5 + 2.6 - 2.7 + 2.8 + 2.9 236,486 13,689,603 2.10 + 2.11 - 2.12 + 2.13 + 2.14) 0 0 2.16 Assumed incurred claims from non-affiliates 0 0 2.17 Net assumed less ceded incurred claims from affiliates 0 0 2.18 Ceded incurred claims to non-affiliates 0 0 2.19 Other adjustments due to MLR calculation - Claims 308,048 13,689,603 2.20 Net Incurred Claims (Lines 2.15 - 2.8 - 2.9 + 2.10 + 2.16 + 2.17 - 2.18 + 2.19) 3. Fraud and Abuse Recoveries that Reduced PAID Claims in Line 2.1 above 0 47 (informational only) 287,867 for stand-alone dental and $ (a) Column 13, Line 1.1 includes direct written premium of $ 4 Business Subject to MLR Mini-Med Plans 5 (LOCATION) NAIC Company Code 2018 11,782,467 0 (11,219) 11,219 (523) 0 0 0 0 0 11,793,686 0 0 1,496,052 0 10,298,157 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 35,640,315 3,325 2,287 1,038 (1,656,757) 13,191 21,368 (8,177) 0 0 35,641,353 0 0 1,796 0 37,304,490 25,702,706 0 0 0 0 88,504 463,830 (375,326) 107,133 0 25,595,573 0 0 0 107,133 26,078,032 90,915,482 3,325 (8,932) 12,258 (1,728,841) 101,695 485,198 (383,503) 112,263 0 90,815,477 0 0 1,497,849 112,263 91,542,235 11,006,079 646,574 1,232,799 6,138 20,839 0 0 (523) 0 0 1,598 702 1,349 452 (206,146) 72,972 279,118 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 29,051,428 4,582,559 4,081,274 1,153,943 1,003,175 58,082 65,133 (1,656,757) 13,191 21,368 0 0 0 0 3,133 3,133 0 0 0 18,514,112 5,021,043 2,567,421 3,536 3,223 0 0 0 88,504 463,830 0 0 0 0 (821,391) 2,591,935 3,413,326 0 0 72,481,936 11,799,661 9,344,638 1,197,407 1,062,049 83,776 98,951 (1,728,841) 101,695 485,198 2,090 900 1,887 697 (1,034,051) 2,926,184 3,960,235 0 0 10,612,374 0 0 1,468,093 0 9,144,805 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 28,028,362 0 0 387 0 29,692,909 21,414,112 0 0 0 0 21,789,438 73,980,938 0 0 1,468,480 0 74,624,803 65 0 0 89,361 for stand-alone vision policies. 0 0 0 0 0 0 1,347 1,459 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF Wyoming DURING THE YEAR All Expenses 1 Improve Health Outcomes 1. Individual Comprehensive Coverage Expenses: 8,706 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 591 for affiliated services) 1.3 EDP Equipment and Software (incl $ 57 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 6 for affiliated services) 1.5 Accreditation and Certification (incl $ 16,860 for affiliated services) 1.6 Other Expenses (incl $ 1.7 Subtotal before Reimbursements and Taxes (Lines 1.1 to 1.6) 1.8 Reimbursements by uninsured plans and fiscal intermediaries 1.9 Taxes, Licenses and Fees (in total, for tying purposes) 1.10 Total (1.7 to 1.9) 1.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 2. 216-4.WY 3. 0 0 0 0 0 1,896 1,896 0 XXX Small Group Comprehensive Coverage Expenses: 326,964 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 23,061 for affiliated services) 2.3 EDP Equipment and Software (incl $ 2,214 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 240 for affiliated services) 2.5 Accreditation and Certification (incl $ 742,447 for affiliated services) 2.6 Other Expenses (incl $ 2.7 Subtotal before Reimbursements and Taxes (Lines 2.1 to 2.6) 2.8 Reimbursements by uninsured plans and fiscal intermediaries 2.9 Taxes, Licenses and Fees (in total, for tying purposes) 2.10 Total (2.7 to 2.9) 2.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX Total (1 to 5) 0 0 0 0 0 1,896 1,896 0 XXX 0 0 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 0 0 0 0 0 0 0 XXX (LOCATION) NAIC Company Code 2018 XXX 461 57 39 4 0 1,030 1,591 0 XXX 1,112 84 60 6 1 1,751 3,014 0 XXX 1,896 0 0 0 0 0 0 0 0 0 1,896 0 1,591 426 3,014 0 0 0 0 0 0 140,383 140,383 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 140,383 140,383 0 41,509 9,361 3,466 333 36 95,650 150,356 0 63,091 7,230 5,268 506 55 141,106 217,256 0 XXX Large Group Comprehensive Coverage Expenses: 219,420 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 14,718 for affiliated services) 3.3 EDP Equipment and Software (incl $ 1,413 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 153 for affiliated services) 3.5 Accreditation and Certification (incl $ 504,862 for affiliated services) 3.6 Other Expenses (incl $ 3.7 Subtotal before Reimbursements and Taxes (Lines 3.1 to 3.6) 3.8 Reimbursements by uninsured plans and fiscal intermediaries 3.9 Taxes, Licenses and Fees (in total, for tying purposes) 3.10 Total (3.7 to 3.9) 3.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 185 Asylum Street Hartford, CT 061033408 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX XXX XXX 140,383 0 0 0 0 0 0 0 0 0 140,383 0 150,356 42,513 217,256 0 0 0 0 0 0 94,349 94,349 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 94,349 94,349 0 28,732 6,177 2,399 230 25 66,083 103,646 0 39,385 4,514 3,289 316 34 88,087 135,624 0 XXX XXX XXX 0 0 0 XXX 94,349 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 94,349 0 XXX 103,646 31,390 135,624 0 79413 9 10 General Administrative Expenses Total Expenses (6 to 9) 7,132 672 492 45 5 19,608 27,955 0 456 28,411 0 8,706 813 591 55 6 24,286 34,456 0 456 34,912 426 222,364 21,006 14,326 1,375 149 811,595 1,070,816 0 233,191 1,304,007 0 326,964 37,598 23,061 2,214 240 1,188,735 1,578,811 0 233,191 1,812,001 42,513 151,303 13,695 9,030 867 94 306,131 481,120 0 146,935 628,054 0 219,420 24,386 14,718 1,413 153 554,649 814,739 0 146,935 961,674 31,390 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 4. 5. 216-5.WY 6. Individual Mini-Med Plans Expenses: 0 for affiliated services) 4.1 Salaries (including $ 4.2 Outsourced Services 0 for affiliated services) 4.3 EDP Equipment and Software (incl $ 0 for affiliated services) 4.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 4.5 Accreditation and Certification (incl $ 0 for affiliated services) 4.6 Other Expenses (incl $ 4.7 Subtotal before Reimbursements and Taxes (Lines 4.1 to 4.6) 4.8 Reimbursements by uninsured plans and fiscal intermediaries 4.9 Taxes, Licenses and Fees (in total, for tying purposes) 4.10 Total (4.7 to 4.9) 4.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Mini-Med Plans Expenses: 0 for affiliated services) 5.1 Salaries (including $ 5.2 Outsourced Services 0 for affiliated services) 5.3 EDP Equipment and Software (incl $ 0 for affiliated services) 5.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 5.5 Accreditation and Certification (incl $ 0 for affiliated services) 5.6 Other Expenses (incl $ 5.7 Subtotal before Reimbursements and Taxes (Lines 5.1 to 5.6) 5.8 Reimbursements by uninsured plans and fiscal intermediaries 5.9 Taxes, Licenses and Fees (in total, for tying purposes) 5.10 Total (5.7 to 5.9) 5.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Mini-Med Plans Expenses: 0 for affiliated services) 6.1 Salaries (including $ 6.2 Outsourced Services 0 for affiliated services) 6.3 EDP Equipment and Software (incl $ 0 for affiliated services) 6.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 6.5 Accreditation and Certification (incl $ 0 for affiliated services) 6.6 Other Expenses (incl $ 6.7 Subtotal before Reimbursements and Taxes (Lines 6.1 to 6.6) 6.8 Reimbursements by uninsured plans and fiscal intermediaries 6.9 Taxes, Licenses and Fees (in total, for tying purposes) 6.10 Total (6.7 to 6.9) 6.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 7. 8. 216-6.WY 9. Small Group Expatriate Plans Expenses: 0 for affiliated services) 7.1 Salaries (including $ 7.2 Outsourced Services 0 for affiliated services) 7.3 EDP Equipment and Software (incl $ 0 for affiliated services) 7.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 7.5 Accreditation and Certification (incl $ 0 for affiliated services) 7.6 Other Expenses (incl $ 7.7 Subtotal before Reimbursements and Taxes (Lines 7.1 to 7.6) 7.8 Reimbursements by uninsured plans and fiscal intermediaries 7.9 Taxes, Licenses and Fees (in total, for tying purposes) 7.10 Total (7.7 to 7.9) 7.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Expatriate Plans Expenses: 0 for affiliated services) 8.1 Salaries (including $ 8.2 Outsourced Services 0 for affiliated services) 8.3 EDP Equipment and Software (incl $ 0 for affiliated services) 8.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 8.5 Accreditation and Certification (incl $ 0 for affiliated services) 8.6 Other Expenses (incl $ 8.7 Subtotal before Reimbursements and Taxes (Lines 8.1 to 8.6) 8.8 Reimbursements by uninsured plans and fiscal intermediaries 8.9 Taxes, Licenses and Fees (in total, for tying purposes) 8.10 Total (8.7 to 8.9) 8.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Student Health Plans Expenses: 0 for affiliated services) 9.1 Salaries (including $ 9.2 Outsourced Services 0 for affiliated services) 9.3 EDP Equipment and Software (incl $ 0 for affiliated services) 9.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 9.5 Accreditation and Certification (incl $ 0 for affiliated services) 9.6 Other Expenses (incl $ 9.7 Subtotal before Reimbursements and Taxes (Lines 9.1 to 9.6) 9.8 Reimbursements by uninsured plans and fiscal intermediaries 9.9 Taxes, Licenses and Fees (in total, for tying purposes) 9.10 Total (9.7 to 9.9) 9.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 *79413201821652100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes - See Cautionary Statement at http://www.naic.org/documents/committees_e_app_blanks_related_shce_cautionary_statement.pdf) UnitedHealthcare Insurance Company 2. 185 Asylum Street Hartford, CT 061033408 (LOCATION) BUSINESS IN THE STATE OF American Samoa DURING THE YEAR 2018 NAIC Company Code Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 2 Small Group Employer Individual 1. 216-1.AS 2. 3. 4. 5. 6. 7. 8. 9. Premium: 1.1 Health premiums earned (From Part 2, Line 1.11) 1.2 Federal high risk pools 1.3 State high risk pools 1.4 Premiums earned including state and federal high risk programs (Lines 1.1 + 1.2 + 1.3) 1.5 Federal taxes and federal assessments 1.6 State insurance, premium and other taxes (Similar local taxes of 2 ) $ 1.6a Community Benefit Expenditures (informational only) 1.7 Regulatory authority licenses and fees 1.8 Adjusted Premiums Earned (Lines 1.4 - 1.5 - 1.6 - 1.7) 1.9 Net Assumed less Ceded reinsurance premiums earned 1.10 Other Adjustments due to MLR calculations - Premiums 1.11 Risk Revenue 1.12 Net adjusted premiums earned after reinsurance (Lines 1.8 + 1.9 + 1.10 + 1.11) Claims: 2.1 Incurred claims excluding prescription drugs 2.2 Prescription drugs 2.3 Pharmaceutical rebates 2.4 State stop loss, market stabilization and claim/census based assessments (informational only) Incurred medical incentive pools and bonuses Deductible Fraud and Abuse Detection/Recovery Expenses (for MLR use only) 5.0 Total Incurred Claims (Lines 2.1 + 2.2 - 2.3 + 3) (From Part 2, Line 2.15) 5.1 Net Assumed less Ceded reinsurance claims incurred 5.2 Other Adjustments due to MLR calculations - Claims 5.3 Rebates paid 5.4 Estimated rebates unpaid prior year 5.5 Estimated rebates unpaid current year 5.6 Fee for service and co-pay revenue 5.7 Net incurred claims after reinsurance (Lines 5.0 + 5.1 + 5.2 + 5.3 - 5.4 + 5.5 - 5.6) Improving Health Care Quality Expenses Incurred: 6.1 Improve health outcomes 6.2 Activities to prevent hospital readmissions 6.3 Improve patient safety and reduce medical errors 6.4 Wellness and health promotion activities 6.5 Health Information Technology expenses related to health improvement 6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5) Preliminary Medical Loss Ratio: MLR ((Lines 4 + 5.0 + 6.6 - Footnote 2.0)/Line 1.8 Claims Adjustment Expenses: 8.1 Cost containment expenses not included in quality of care expenses in Line 6.6 8.2 All other claims adjustment expenses 8.3 Total claims adjustment expenses (Lines 8.1 + 8.2) Claims Adjustment Expense Ratio (Line 8.3/Line 1.8) 3 Large Group Employer 4 5 Small Group Employer Individual Expatriate Plans 6 Large Group Employer 7 11 Government Business (excluded by statute) Other Health Business 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 9 8 Small Group 10 Student Health Plans Large Group 79413 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5,423 0 3 10,322 0 0 15,745 0 3 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5,426 54 10,322 667,943 15,748 667,997 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 86 0 (1) 5,286 0 0 0 5,286 1 0 0 (657,621) 0 388 0 (657,234) 87 0 (1) (652,335) 0 388 0 (651,947) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3,246 0 0 5,760 8,996 7,930 9,006 8,996 7,930 XXX XXX XXX 9,006 8,996 7,930 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3,246 0 0 0 0 0 6,825 0 0 0 0 0 0 6,825 0 0 0 10,072 0 0 0 0 0 0 10,072 XXX XXX 0 0 0 10,072 0 0 0 0 0 0 10,072 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 XXX XXX XXX XXX XXX XXX 0 0 0 3,246 0 0 0 0 0 20 0 0 91 4 (36,807) 6 (147,294) (24) (103,778) (36,787) 6 (147,294) 68 (103,774) 115 (287,897) 0.427 (287,782) XXX (231,082) (2,828,439) (3,059,521) 4.652 (231,077) (2,828,234) (3,059,311) XXX 0 XXX XXX 0 0 0 0.000 5 205 209 0.040 15,745 0 3 0 0 0 0 XXX XXX XXX XXX XXX 0 XXX XXX XXX XXX XXX XXX XXX XXX 87 0 (1) (652,335) 0 388 0 (651,947) 0 0 0 0 0 (36,787) 6 (147,294) 68 (103,774) 0 (287,782) XXX 0 0 0 (231,077) (2,828,234) (3,059,311) XXX XXX XXX 15,748 667,997 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 (Continued) Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 2 Small Group Employer Individual 10. General and Administrative (G&A) Expenses: 10.1 Direct sales salaries and benefits 10.2 Agents and brokers fees and commissions 10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below) 10.4 Other general and administrative expenses 10.4a Community Benefit Expenditures (informational only) 10.5 Total general and administrative (Lines 10.1 +10.2 + 10.3 + 10.4) 0 0 0 0 0 0 3 Large Group Employer 0 0 0 0 0 0 4 5 Small Group Employer Individual 0 0 0 0 0 0 0 0 0 0 0 0 Expatriate Plans 6 Large Group Employer 0 0 0 0 0 0 7 8 Small Group 0 0 0 0 0 0 Student Health Plans Large Group 0 0 0 0 0 0 10 11 Government Business (excluded by statute) Other Health Business 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 18 405 27 1,047 0 1,497 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 64 372 (2) 175 0 609 82 777 25 1,222 0 2,106 0 0 0 0 0 0 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) 12. Income from fees of uninsured plans XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 13. Net investment and other gain/(loss) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 0 XXX 14. Federal income taxes (excluding taxes on Line 1.5 above) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 0 XXX 0 15. Net gain or (loss) (Lines 11 + 12 + 13 - 14) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 2,682,968 XXX 2,682,968 16. ICD-10 Implementation Expenses (informational only; already included in general expenses and line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16. 16a ICD-10 Implementation Expenses (informational only; already included in line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 219 2,682,750 2,682,968 XXX 82 777 25 1,222 0 2,106 XXX 2,682,968 0 0 0 OTHER INDICATORS: 216-2.AS 1. Number of certificates/policies 0 0 0 0 0 0 0 0 0 0 6 27 33 0 33 2. Number of Covered Lives 0 0 0 0 0 0 0 0 0 0 6 27 33 0 33 3. Number of Groups 0 0 0 0 0 0 0 0 0 0 0 0 0 4. Member Months 0 0 0 0 0 0 0 0 82 339 421 0 421 XXX 0 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ XXX 0 ] If yes, show the amount of premiums and claims included. Premiums $ 0 Claims $ 0 AFFORDABLE CARE ACT (ACA) RECEIPTS, PAYMENTS, RECEIVABLES and PAYABLES Current Year Prior Year Comprehensive Health Coverage Comprehensive Health Coverage 1 2 3 4 Small Group Small Group Employer Plans Employer Plans Individual Plans Individual Plans ACA Receivables and Payables 1. Permanent ACA Risk Adjustment Program 1.0 Premium adjustments receivable/(payable) 0 2. Transitional ACA Reinsurance Program 2.0 Total amounts recoverable for claims (paid & unpaid) 0 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 0 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 XXX ACA Receipts and Payments 4. Permanent ACA Risk Adjustment Program 4.0 Premium adjustments receipts/(payments) 0 5. Transitional ACA Reinsurance Program 5.0 Amounts received for claims 0 6. Temporary ACA Risk Corridors Program 6.1 Retrospective premium received 6.2 Rate credits or policy experience refunds paid 0 0 XXX 0 0 0 0 0 XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF 185 Asylum Street Hartford, CT 061033408 American Samoa DURING THE YEAR Comprehensive Health Coverage 1 2 3 Individual Small Group Employer Large Group Employer Small Group Employer Individual Expatriate Plans: 7 8 6 Large Group Employer Small Group 10 11 Government Business (excluded by statute) Other Health Business 9 Student Health Plans Large Group 79413 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.AS Health Premiums Earned: 0 1.1 Direct premiums written 0 1.2 Unearned premium prior year 0 1.3 Unearned premium current year 0 1.4 Change in unearned premium (Lines 1.2 - 1.3) 0 1.5 Paid rate credits 0 1.6 Reserve for rate credits current year 0 1.7 Reserve for rate credits prior year 0 1.8 Change in reserve for rate credits (Lines 1.6 - 1.7) 0 1.9 Premium balances written off 0 1.10 Group conversion charge 0 1.11 Total direct premiums earned (Lines 1.1 + 1.4 - 1.9 + 1.10) 0 1.12 Assumed premiums earned from non-affiliates 0 1.13 Net Assumed less Ceded premiums earned from affiliates 0 1.14 Ceded premiums earned to non-affiliates 0 1.15 Other Adjustments due to MLR calculation - Premiums 0 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 0 2.1 Paid claims during the year 0 2.2 Direct claim liability current year 0 2.3 Direct claim liability prior year 0 2.4 Direct claim reserves current year 0 2.5 Direct claim reserves prior year 0 2.6 Direct contract reserves current year 0 2.7 Direct contract reserves prior year 0 2.8 Paid rate credits 0 2.9 Reserve for rate credits current year 0 2.10 Reserve for rate credits prior year 0 2.11 Incurred medical incentive pools and bonuses (Lines 2.11a + 2.11b - 2.11c) 0 2.11a Paid medical incentive pools and bonuses current year 0 2.11b Accrued medical incentive pools and bonuses current year 0 2.11c Accrued medical incentive pools and bonuses prior year 0 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 0 2.12a Healthcare receivables current year 0 2.12b Healthcare receivables prior year 0 2.13 Group conversion charge 0 2.14 Multi-option coverage blended rate adjustment 2.15 Total incurred claims (Lines 2.1 + 2.2 - 2.3 + 2.4 - 2.5 + 2.6 - 2.7 + 2.8 + 2.9 0 2.10 + 2.11 - 2.12 + 2.13 + 2.14) 0 2.16 Assumed incurred claims from non-affiliates 0 2.17 Net assumed less ceded incurred claims from affiliates 0 2.18 Ceded incurred claims to non-affiliates 0 2.19 Other adjustments due to MLR calculation - Claims 0 2.20 Net Incurred Claims (Lines 2.15 - 2.8 - 2.9 + 2.10 + 2.16 + 2.17 - 2.18 + 2.19) 3. Fraud and Abuse Recoveries that Reduced PAID Claims in Line 2.1 above 0 (informational only) 0 for stand-alone dental and $ (a) Column 13, Line 1.1 includes direct written premium of $ 4 Business Subject to MLR Mini-Med Plans 5 (LOCATION) NAIC Company Code 2018 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5,423 0 0 0 (21,462) 0 0 0 0 0 5,423 0 0 0 0 26,885 10,709 0 0 0 (8,879) 2,281 (12,358) 14,639 388 0 10,322 0 0 0 388 4,949 16,132 0 0 0 (30,341) 2,281 (12,358) 14,639 388 0 15,745 0 0 0 388 31,834 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 21,236 36 (3,652) 491 708 0 0 (21,462) 0 0 0 0 0 0 0 0 0 0 0 3,150 65 575 0 0 0 0 (8,879) 2,281 (12,358) 0 0 0 0 1,575 3,465 1,890 0 0 24,386 102 (3,077) 491 708 0 0 (30,341) 2,281 (12,358) 0 0 0 0 1,575 3,465 1,890 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3,246 0 0 0 0 24,708 6,825 0 0 0 0 1,065 10,072 0 0 0 0 25,773 0 0 0 0 0 for stand-alone vision policies. 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF American Samoa DURING THE YEAR All Expenses 1 2. 216-4.AS 3. Individual Comprehensive Coverage Expenses: 0 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 0 for affiliated services) 1.3 EDP Equipment and Software (incl $ 0 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 1.5 Accreditation and Certification (incl $ 0 for affiliated services) 1.6 Other Expenses (incl $ 1.7 Subtotal before Reimbursements and Taxes (Lines 1.1 to 1.6) 1.8 Reimbursements by uninsured plans and fiscal intermediaries 1.9 Taxes, Licenses and Fees (in total, for tying purposes) 1.10 Total (1.7 to 1.9) 1.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Comprehensive Coverage Expenses: 0 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 0 for affiliated services) 2.3 EDP Equipment and Software (incl $ 0 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 2.5 Accreditation and Certification (incl $ 0 for affiliated services) 2.6 Other Expenses (incl $ 2.7 Subtotal before Reimbursements and Taxes (Lines 2.1 to 2.6) 2.8 Reimbursements by uninsured plans and fiscal intermediaries 2.9 Taxes, Licenses and Fees (in total, for tying purposes) 2.10 Total (2.7 to 2.9) 2.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Comprehensive Coverage Expenses: 0 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 0 for affiliated services) 3.3 EDP Equipment and Software (incl $ 0 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 3.5 Accreditation and Certification (incl $ 0 for affiliated services) 3.6 Other Expenses (incl $ 3.7 Subtotal before Reimbursements and Taxes (Lines 3.1 to 3.6) 3.8 Reimbursements by uninsured plans and fiscal intermediaries 3.9 Taxes, Licenses and Fees (in total, for tying purposes) 3.10 Total (3.7 to 3.9) 3.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions Improve Health Outcomes 1. 185 Asylum Street Hartford, CT 061033408 0 0 0 0 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX Total (1 to 5) 0 0 0 0 0 0 0 0 XXX 0 0 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 0 0 0 0 0 0 0 XXX (LOCATION) NAIC Company Code 2018 XXX 0 0 0 0 0 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 79413 9 10 General Administrative Expenses Total Expenses (6 to 9) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 4. 5. 216-5.AS 6. Individual Mini-Med Plans Expenses: 0 for affiliated services) 4.1 Salaries (including $ 4.2 Outsourced Services 0 for affiliated services) 4.3 EDP Equipment and Software (incl $ 0 for affiliated services) 4.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 4.5 Accreditation and Certification (incl $ 0 for affiliated services) 4.6 Other Expenses (incl $ 4.7 Subtotal before Reimbursements and Taxes (Lines 4.1 to 4.6) 4.8 Reimbursements by uninsured plans and fiscal intermediaries 4.9 Taxes, Licenses and Fees (in total, for tying purposes) 4.10 Total (4.7 to 4.9) 4.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Mini-Med Plans Expenses: 0 for affiliated services) 5.1 Salaries (including $ 5.2 Outsourced Services 0 for affiliated services) 5.3 EDP Equipment and Software (incl $ 0 for affiliated services) 5.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 5.5 Accreditation and Certification (incl $ 0 for affiliated services) 5.6 Other Expenses (incl $ 5.7 Subtotal before Reimbursements and Taxes (Lines 5.1 to 5.6) 5.8 Reimbursements by uninsured plans and fiscal intermediaries 5.9 Taxes, Licenses and Fees (in total, for tying purposes) 5.10 Total (5.7 to 5.9) 5.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Mini-Med Plans Expenses: 0 for affiliated services) 6.1 Salaries (including $ 6.2 Outsourced Services 0 for affiliated services) 6.3 EDP Equipment and Software (incl $ 0 for affiliated services) 6.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 6.5 Accreditation and Certification (incl $ 0 for affiliated services) 6.6 Other Expenses (incl $ 6.7 Subtotal before Reimbursements and Taxes (Lines 6.1 to 6.6) 6.8 Reimbursements by uninsured plans and fiscal intermediaries 6.9 Taxes, Licenses and Fees (in total, for tying purposes) 6.10 Total (6.7 to 6.9) 6.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 7. 8. 216-6.AS 9. Small Group Expatriate Plans Expenses: 0 for affiliated services) 7.1 Salaries (including $ 7.2 Outsourced Services 0 for affiliated services) 7.3 EDP Equipment and Software (incl $ 0 for affiliated services) 7.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 7.5 Accreditation and Certification (incl $ 0 for affiliated services) 7.6 Other Expenses (incl $ 7.7 Subtotal before Reimbursements and Taxes (Lines 7.1 to 7.6) 7.8 Reimbursements by uninsured plans and fiscal intermediaries 7.9 Taxes, Licenses and Fees (in total, for tying purposes) 7.10 Total (7.7 to 7.9) 7.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Expatriate Plans Expenses: 0 for affiliated services) 8.1 Salaries (including $ 8.2 Outsourced Services 0 for affiliated services) 8.3 EDP Equipment and Software (incl $ 0 for affiliated services) 8.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 8.5 Accreditation and Certification (incl $ 0 for affiliated services) 8.6 Other Expenses (incl $ 8.7 Subtotal before Reimbursements and Taxes (Lines 8.1 to 8.6) 8.8 Reimbursements by uninsured plans and fiscal intermediaries 8.9 Taxes, Licenses and Fees (in total, for tying purposes) 8.10 Total (8.7 to 8.9) 8.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Student Health Plans Expenses: 0 for affiliated services) 9.1 Salaries (including $ 9.2 Outsourced Services 0 for affiliated services) 9.3 EDP Equipment and Software (incl $ 0 for affiliated services) 9.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 9.5 Accreditation and Certification (incl $ 0 for affiliated services) 9.6 Other Expenses (incl $ 9.7 Subtotal before Reimbursements and Taxes (Lines 9.1 to 9.6) 9.8 Reimbursements by uninsured plans and fiscal intermediaries 9.9 Taxes, Licenses and Fees (in total, for tying purposes) 9.10 Total (9.7 to 9.9) 9.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 *79413201821653100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes - See Cautionary Statement at http://www.naic.org/documents/committees_e_app_blanks_related_shce_cautionary_statement.pdf) UnitedHealthcare Insurance Company 2. 185 Asylum Street Hartford, CT 061033408 (LOCATION) BUSINESS IN THE STATE OF Guam DURING THE YEAR 2018 NAIC Company Code Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 2 Small Group Employer Individual 1. 216-1.GU 2. 3. 4. 5. 6. 7. 8. 9. Premium: 1.1 Health premiums earned (From Part 2, Line 1.11) 1.2 Federal high risk pools 1.3 State high risk pools 1.4 Premiums earned including state and federal high risk programs (Lines 1.1 + 1.2 + 1.3) 1.5 Federal taxes and federal assessments 1.6 State insurance, premium and other taxes (Similar local taxes of 293 ) $ 1.6a Community Benefit Expenditures (informational only) 1.7 Regulatory authority licenses and fees 1.8 Adjusted Premiums Earned (Lines 1.4 - 1.5 - 1.6 - 1.7) 1.9 Net Assumed less Ceded reinsurance premiums earned 1.10 Other Adjustments due to MLR calculations - Premiums 1.11 Risk Revenue 1.12 Net adjusted premiums earned after reinsurance (Lines 1.8 + 1.9 + 1.10 + 1.11) Claims: 2.1 Incurred claims excluding prescription drugs 2.2 Prescription drugs 2.3 Pharmaceutical rebates 2.4 State stop loss, market stabilization and claim/census based assessments (informational only) Incurred medical incentive pools and bonuses Deductible Fraud and Abuse Detection/Recovery Expenses (for MLR use only) 5.0 Total Incurred Claims (Lines 2.1 + 2.2 - 2.3 + 3) (From Part 2, Line 2.15) 5.1 Net Assumed less Ceded reinsurance claims incurred 5.2 Other Adjustments due to MLR calculations - Claims 5.3 Rebates paid 5.4 Estimated rebates unpaid prior year 5.5 Estimated rebates unpaid current year 5.6 Fee for service and co-pay revenue 5.7 Net incurred claims after reinsurance (Lines 5.0 + 5.1 + 5.2 + 5.3 - 5.4 + 5.5 - 5.6) Improving Health Care Quality Expenses Incurred: 6.1 Improve health outcomes 6.2 Activities to prevent hospital readmissions 6.3 Improve patient safety and reduce medical errors 6.4 Wellness and health promotion activities 6.5 Health Information Technology expenses related to health improvement 6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5) Preliminary Medical Loss Ratio: MLR ((Lines 4 + 5.0 + 6.6 - Footnote 2.0)/Line 1.8 Claims Adjustment Expenses: 8.1 Cost containment expenses not included in quality of care expenses in Line 6.6 8.2 All other claims adjustment expenses 8.3 Total claims adjustment expenses (Lines 8.1 + 8.2) Claims Adjustment Expense Ratio (Line 8.3/Line 1.8) 3 Large Group Employer 4 5 Small Group Employer Individual Expatriate Plans 6 Large Group Employer 7 11 Government Business (excluded by statute) Other Health Business 9 8 Small Group 10 Student Health Plans Large Group 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 79413 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 823,036 0 484 1,499,359 0 0 2,322,395 0 484 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 823,520 5,899 1,499,359 107,300 2,322,879 113,199 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 13,026 0 (205) 804,799 0 0 0 804,799 193 0 0 1,391,867 0 7,023 0 1,398,890 13,219 0 (205) 2,196,666 0 7,023 0 2,203,689 XXX XXX XXX XXX XXX 13,219 0 (205) 2,196,666 0 7,023 0 2,203,689 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 576,846 115 23 21,155 1,932,681 1,033,557 598,001 1,932,796 1,033,580 XXX XXX XXX 598,001 1,932,796 1,033,580 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 920,279 0 0 0 0 0 0 920,279 0 0 0 1,497,217 0 0 0 0 0 0 1,497,217 XXX XXX 0 0 0 0 0 576,938 0 0 XXX XXX XXX 0 576,938 0 0 0 1,497,217 0 0 0 0 0 0 1,497,217 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 9,701 10,026 7,450 9,952 2,126 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 39,255 XXX 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 XXX XXX XXX XXX 0 0 0 0.000 197 17,282 17,480 0.022 3,413 1,140 7,830 (2,327) 7,540 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 13,114 11,166 15,280 7,625 9,666 17,596 0.674 56,852 XXX (16,951) 167,771 150,819 0.108 (16,754) 185,053 168,299 XXX 2,322,395 0 484 0 0 0 0 0 13,114 11,166 15,280 7,625 9,666 0 56,852 XXX 0 0 0 (16,754) 185,053 168,299 XXX XXX XXX 2,322,879 113,199 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 (Continued) Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 2 Small Group Employer Individual 10. General and Administrative (G&A) Expenses: 10.1 Direct sales salaries and benefits 10.2 Agents and brokers fees and commissions 10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below) 10.4 Other general and administrative expenses 10.4a Community Benefit Expenditures (informational only) 10.5 Total general and administrative (Lines 10.1 +10.2 + 10.3 + 10.4) 0 0 0 0 0 0 3 Large Group Employer 0 0 0 0 0 0 4 5 Small Group Employer Individual 0 0 0 0 0 0 0 0 0 0 0 0 Expatriate Plans 6 Large Group Employer 0 0 0 0 0 0 7 8 Small Group 0 0 0 0 0 0 Student Health Plans Large Group 0 0 0 0 0 0 10 11 Government Business (excluded by statute) Other Health Business 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,419 44,143 2,115 99,711 0 147,387 6,331 30 2,500 63,818 0 72,678 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 7,750 44,173 4,615 163,529 0 220,066 0 0 0 0 0 0 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) 12. Income from fees of uninsured plans XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 13. Net investment and other gain/(loss) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 14. Federal income taxes (excluding taxes on Line 1.5 above) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 15. Net gain or (loss) (Lines 11 + 12 + 13 - 14) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 16. ICD-10 Implementation Expenses (informational only; already included in general expenses and line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16. 16a ICD-10 Implementation Expenses (informational only; already included in line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 23,739 237,517 261,256 XXX 7,750 44,173 4,615 163,529 0 220,066 XXX 261,256 0 0 (30) XXX XXX 0 XXX 0 XXX 261,226 XXX 261,226 (30) OTHER INDICATORS: 216-2.GU 1. Number of certificates/policies 0 0 0 0 0 0 0 0 0 0 541 2,726 3,267 0 3,267 2. Number of Covered Lives 0 0 0 0 0 0 0 0 0 0 537 2,726 3,263 0 3,263 3. Number of Groups 0 0 0 0 0 0 0 0 0 0 0 0 0 4. Member Months 0 0 0 0 0 0 0 0 6,432 33,577 40,009 0 40,009 XXX 0 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ XXX 0 ] If yes, show the amount of premiums and claims included. Premiums $ 0 Claims $ 0 AFFORDABLE CARE ACT (ACA) RECEIPTS, PAYMENTS, RECEIVABLES and PAYABLES Current Year Prior Year Comprehensive Health Coverage Comprehensive Health Coverage 1 2 3 4 Small Group Small Group Employer Plans Employer Plans Individual Plans Individual Plans ACA Receivables and Payables 1. Permanent ACA Risk Adjustment Program 1.0 Premium adjustments receivable/(payable) 0 2. Transitional ACA Reinsurance Program 2.0 Total amounts recoverable for claims (paid & unpaid) 0 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 0 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 XXX ACA Receipts and Payments 4. Permanent ACA Risk Adjustment Program 4.0 Premium adjustments receipts/(payments) 0 5. Transitional ACA Reinsurance Program 5.0 Amounts received for claims 0 6. Temporary ACA Risk Corridors Program 6.1 Retrospective premium received 6.2 Rate credits or policy experience refunds paid 0 0 XXX 0 0 0 0 0 XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF 185 Asylum Street Hartford, CT 061033408 Guam DURING THE YEAR Comprehensive Health Coverage 1 2 3 Individual Small Group Employer Large Group Employer Small Group Employer Individual Expatriate Plans: 7 8 6 Large Group Employer Small Group 10 11 Government Business (excluded by statute) Other Health Business 9 Student Health Plans Large Group 79413 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.GU Health Premiums Earned: 0 1.1 Direct premiums written 0 1.2 Unearned premium prior year 0 1.3 Unearned premium current year 0 1.4 Change in unearned premium (Lines 1.2 - 1.3) 0 1.5 Paid rate credits 0 1.6 Reserve for rate credits current year 0 1.7 Reserve for rate credits prior year 0 1.8 Change in reserve for rate credits (Lines 1.6 - 1.7) 0 1.9 Premium balances written off 0 1.10 Group conversion charge 0 1.11 Total direct premiums earned (Lines 1.1 + 1.4 - 1.9 + 1.10) 0 1.12 Assumed premiums earned from non-affiliates 0 1.13 Net Assumed less Ceded premiums earned from affiliates 0 1.14 Ceded premiums earned to non-affiliates 0 1.15 Other Adjustments due to MLR calculation - Premiums 0 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 0 2.1 Paid claims during the year 0 2.2 Direct claim liability current year 0 2.3 Direct claim liability prior year 0 2.4 Direct claim reserves current year 0 2.5 Direct claim reserves prior year 0 2.6 Direct contract reserves current year 0 2.7 Direct contract reserves prior year 0 2.8 Paid rate credits 0 2.9 Reserve for rate credits current year 0 2.10 Reserve for rate credits prior year 0 2.11 Incurred medical incentive pools and bonuses (Lines 2.11a + 2.11b - 2.11c) 0 2.11a Paid medical incentive pools and bonuses current year 0 2.11b Accrued medical incentive pools and bonuses current year 0 2.11c Accrued medical incentive pools and bonuses prior year 0 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 0 2.12a Healthcare receivables current year 0 2.12b Healthcare receivables prior year 0 2.13 Group conversion charge 0 2.14 Multi-option coverage blended rate adjustment 2.15 Total incurred claims (Lines 2.1 + 2.2 - 2.3 + 2.4 - 2.5 + 2.6 - 2.7 + 2.8 + 2.9 0 2.10 + 2.11 - 2.12 + 2.13 + 2.14) 0 2.16 Assumed incurred claims from non-affiliates 0 2.17 Net assumed less ceded incurred claims from affiliates 0 2.18 Ceded incurred claims to non-affiliates 0 2.19 Other adjustments due to MLR calculation - Claims 0 2.20 Net Incurred Claims (Lines 2.15 - 2.8 - 2.9 + 2.10 + 2.16 + 2.17 - 2.18 + 2.19) 3. Fraud and Abuse Recoveries that Reduced PAID Claims in Line 2.1 above 0 (informational only) 0 for stand-alone dental and $ (a) Column 13, Line 1.1 includes direct written premium of $ 4 Business Subject to MLR Mini-Med Plans 5 (LOCATION) NAIC Company Code 2018 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 823,036 0 0 0 (306,373) 0 0 0 0 0 823,036 0 0 0 0 1,129,409 1,506,382 0 0 0 101,969 (4,430) 76,461 (80,891) 7,023 0 1,499,359 0 0 0 7,023 1,485,304 2,329,418 0 0 0 (204,404) (4,430) 76,461 (80,891) 7,023 0 2,322,395 0 0 0 7,023 2,614,713 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 886,190 72,488 75,098 23,767 21,637 0 2,388 (306,373) 0 0 0 0 0 0 11 11 0 0 0 901,012 24,821 83,314 0 0 0 0 101,969 (4,430) 76,461 0 0 0 0 (56,682) 394,536 451,218 0 0 1,787,201 97,309 158,412 23,767 21,637 0 2,388 (204,404) (4,430) 76,461 0 0 0 0 (56,671) 394,547 451,218 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 576,938 0 0 0 0 883,311 920,279 0 0 0 0 899,201 1,497,217 0 0 0 0 1,782,512 0 0 0 0 0 for stand-alone vision policies. 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF Guam DURING THE YEAR All Expenses 1 2. 216-4.GU 3. Individual Comprehensive Coverage Expenses: 0 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 0 for affiliated services) 1.3 EDP Equipment and Software (incl $ 0 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 1.5 Accreditation and Certification (incl $ 0 for affiliated services) 1.6 Other Expenses (incl $ 1.7 Subtotal before Reimbursements and Taxes (Lines 1.1 to 1.6) 1.8 Reimbursements by uninsured plans and fiscal intermediaries 1.9 Taxes, Licenses and Fees (in total, for tying purposes) 1.10 Total (1.7 to 1.9) 1.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Comprehensive Coverage Expenses: 0 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 0 for affiliated services) 2.3 EDP Equipment and Software (incl $ 0 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 2.5 Accreditation and Certification (incl $ 0 for affiliated services) 2.6 Other Expenses (incl $ 2.7 Subtotal before Reimbursements and Taxes (Lines 2.1 to 2.6) 2.8 Reimbursements by uninsured plans and fiscal intermediaries 2.9 Taxes, Licenses and Fees (in total, for tying purposes) 2.10 Total (2.7 to 2.9) 2.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Comprehensive Coverage Expenses: 0 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 0 for affiliated services) 3.3 EDP Equipment and Software (incl $ 0 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 3.5 Accreditation and Certification (incl $ 0 for affiliated services) 3.6 Other Expenses (incl $ 3.7 Subtotal before Reimbursements and Taxes (Lines 3.1 to 3.6) 3.8 Reimbursements by uninsured plans and fiscal intermediaries 3.9 Taxes, Licenses and Fees (in total, for tying purposes) 3.10 Total (3.7 to 3.9) 3.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions Improve Health Outcomes 1. 185 Asylum Street Hartford, CT 061033408 0 0 0 0 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX Total (1 to 5) 0 0 0 0 0 0 0 0 XXX 0 0 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 0 0 0 0 0 0 0 XXX (LOCATION) NAIC Company Code 2018 XXX 0 0 0 0 0 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 79413 9 10 General Administrative Expenses Total Expenses (6 to 9) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 4. 5. 216-5.GU 6. Individual Mini-Med Plans Expenses: 0 for affiliated services) 4.1 Salaries (including $ 4.2 Outsourced Services 0 for affiliated services) 4.3 EDP Equipment and Software (incl $ 0 for affiliated services) 4.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 4.5 Accreditation and Certification (incl $ 0 for affiliated services) 4.6 Other Expenses (incl $ 4.7 Subtotal before Reimbursements and Taxes (Lines 4.1 to 4.6) 4.8 Reimbursements by uninsured plans and fiscal intermediaries 4.9 Taxes, Licenses and Fees (in total, for tying purposes) 4.10 Total (4.7 to 4.9) 4.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Mini-Med Plans Expenses: 0 for affiliated services) 5.1 Salaries (including $ 5.2 Outsourced Services 0 for affiliated services) 5.3 EDP Equipment and Software (incl $ 0 for affiliated services) 5.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 5.5 Accreditation and Certification (incl $ 0 for affiliated services) 5.6 Other Expenses (incl $ 5.7 Subtotal before Reimbursements and Taxes (Lines 5.1 to 5.6) 5.8 Reimbursements by uninsured plans and fiscal intermediaries 5.9 Taxes, Licenses and Fees (in total, for tying purposes) 5.10 Total (5.7 to 5.9) 5.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Mini-Med Plans Expenses: 0 for affiliated services) 6.1 Salaries (including $ 6.2 Outsourced Services 0 for affiliated services) 6.3 EDP Equipment and Software (incl $ 0 for affiliated services) 6.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 6.5 Accreditation and Certification (incl $ 0 for affiliated services) 6.6 Other Expenses (incl $ 6.7 Subtotal before Reimbursements and Taxes (Lines 6.1 to 6.6) 6.8 Reimbursements by uninsured plans and fiscal intermediaries 6.9 Taxes, Licenses and Fees (in total, for tying purposes) 6.10 Total (6.7 to 6.9) 6.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 7. 8. 216-6.GU 9. Small Group Expatriate Plans Expenses: 0 for affiliated services) 7.1 Salaries (including $ 7.2 Outsourced Services 0 for affiliated services) 7.3 EDP Equipment and Software (incl $ 0 for affiliated services) 7.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 7.5 Accreditation and Certification (incl $ 0 for affiliated services) 7.6 Other Expenses (incl $ 7.7 Subtotal before Reimbursements and Taxes (Lines 7.1 to 7.6) 7.8 Reimbursements by uninsured plans and fiscal intermediaries 7.9 Taxes, Licenses and Fees (in total, for tying purposes) 7.10 Total (7.7 to 7.9) 7.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Expatriate Plans Expenses: 0 for affiliated services) 8.1 Salaries (including $ 8.2 Outsourced Services 0 for affiliated services) 8.3 EDP Equipment and Software (incl $ 0 for affiliated services) 8.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 8.5 Accreditation and Certification (incl $ 0 for affiliated services) 8.6 Other Expenses (incl $ 8.7 Subtotal before Reimbursements and Taxes (Lines 8.1 to 8.6) 8.8 Reimbursements by uninsured plans and fiscal intermediaries 8.9 Taxes, Licenses and Fees (in total, for tying purposes) 8.10 Total (8.7 to 8.9) 8.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Student Health Plans Expenses: 0 for affiliated services) 9.1 Salaries (including $ 9.2 Outsourced Services 0 for affiliated services) 9.3 EDP Equipment and Software (incl $ 0 for affiliated services) 9.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 9.5 Accreditation and Certification (incl $ 0 for affiliated services) 9.6 Other Expenses (incl $ 9.7 Subtotal before Reimbursements and Taxes (Lines 9.1 to 9.6) 9.8 Reimbursements by uninsured plans and fiscal intermediaries 9.9 Taxes, Licenses and Fees (in total, for tying purposes) 9.10 Total (9.7 to 9.9) 9.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 *79413201821654100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes - See Cautionary Statement at http://www.naic.org/documents/committees_e_app_blanks_related_shce_cautionary_statement.pdf) UnitedHealthcare Insurance Company 2. 185 Asylum Street Hartford, CT 061033408 (LOCATION) BUSINESS IN THE STATE OF Puerto Rico DURING THE YEAR 2018 NAIC Company Code Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 2 Small Group Employer Individual 1. 216-1.PR 2. 3. 4. 5. 6. 7. 8. 9. Premium: 1.1 Health premiums earned (From Part 2, Line 1.11) 1.2 Federal high risk pools 1.3 State high risk pools 1.4 Premiums earned including state and federal high risk programs (Lines 1.1 + 1.2 + 1.3) 1.5 Federal taxes and federal assessments 1.6 State insurance, premium and other taxes (Similar local taxes of 2,622 ) $ 1.6a Community Benefit Expenditures (informational only) 1.7 Regulatory authority licenses and fees 1.8 Adjusted Premiums Earned (Lines 1.4 - 1.5 - 1.6 - 1.7) 1.9 Net Assumed less Ceded reinsurance premiums earned 1.10 Other Adjustments due to MLR calculations - Premiums 1.11 Risk Revenue 1.12 Net adjusted premiums earned after reinsurance (Lines 1.8 + 1.9 + 1.10 + 1.11) Claims: 2.1 Incurred claims excluding prescription drugs 2.2 Prescription drugs 2.3 Pharmaceutical rebates 2.4 State stop loss, market stabilization and claim/census based assessments (informational only) Incurred medical incentive pools and bonuses Deductible Fraud and Abuse Detection/Recovery Expenses (for MLR use only) 5.0 Total Incurred Claims (Lines 2.1 + 2.2 - 2.3 + 3) (From Part 2, Line 2.15) 5.1 Net Assumed less Ceded reinsurance claims incurred 5.2 Other Adjustments due to MLR calculations - Claims 5.3 Rebates paid 5.4 Estimated rebates unpaid prior year 5.5 Estimated rebates unpaid current year 5.6 Fee for service and co-pay revenue 5.7 Net incurred claims after reinsurance (Lines 5.0 + 5.1 + 5.2 + 5.3 - 5.4 + 5.5 - 5.6) Improving Health Care Quality Expenses Incurred: 6.1 Improve health outcomes 6.2 Activities to prevent hospital readmissions 6.3 Improve patient safety and reduce medical errors 6.4 Wellness and health promotion activities 6.5 Health Information Technology expenses related to health improvement 6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5) Preliminary Medical Loss Ratio: MLR ((Lines 4 + 5.0 + 6.6 - Footnote 2.0)/Line 1.8 Claims Adjustment Expenses: 8.1 Cost containment expenses not included in quality of care expenses in Line 6.6 8.2 All other claims adjustment expenses 8.3 Total claims adjustment expenses (Lines 8.1 + 8.2) Claims Adjustment Expense Ratio (Line 8.3/Line 1.8) 3 Large Group Employer 4 5 Small Group Employer Individual Expatriate Plans 6 Large Group Employer 7 11 Government Business (excluded by statute) Other Health Business 9 8 Small Group 10 Student Health Plans Large Group 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 79413 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10,149,657 0 5,968 4,584,598 0 0 14,734,255 0 5,968 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10,155,625 86,804 4,584,598 271,530 14,740,223 358,333 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 161,429 0 (2,529) 9,909,921 0 0 0 9,909,921 598 0 0 4,312,471 0 10,902 0 4,323,373 162,027 0 (2,529) 14,222,392 0 10,902 0 14,233,294 XXX XXX XXX XXX XXX 162,027 0 (2,529) 14,222,392 0 10,902 0 14,233,294 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6,735,683 64,678 20,172 (119) 6,049,905 3,112,066 6,735,565 6,114,583 3,132,238 XXX XXX XXX 6,735,565 6,114,583 3,132,238 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,937,721 0 0 0 0 0 0 2,937,721 0 0 0 9,717,910 0 0 0 0 0 0 9,717,910 XXX XXX 0 0 0 0 0 6,780,189 0 0 XXX XXX XXX 0 6,780,189 0 0 0 9,717,910 0 0 0 0 0 0 9,717,910 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 24,996 13 15 114,047 5,081 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 144,152 XXX 38,417 0.690 182,570 XXX 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 1,660 306,074 307,734 0.031 167,611 363,684 531,295 0.123 169,271 669,758 839,029 XXX XXX XXX XXX XXX 0 0 0 0.000 7,631 2,253 17,132 (4,663) 16,065 14,734,255 0 5,968 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 32,627 2,266 17,146 109,384 21,145 0 0 0 0 0 32,627 2,266 17,146 109,384 21,145 0 182,570 XXX 0 0 0 169,271 669,758 839,029 XXX XXX XXX 14,740,223 358,333 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 (Continued) Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 2 Small Group Employer Individual 10. General and Administrative (G&A) Expenses: 10.1 Direct sales salaries and benefits 10.2 Agents and brokers fees and commissions 10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below) 10.4 Other general and administrative expenses 10.4a Community Benefit Expenditures (informational only) 10.5 Total general and administrative (Lines 10.1 +10.2 + 10.3 + 10.4) 0 0 0 0 0 0 3 Large Group Employer 0 0 0 0 0 0 4 5 Small Group Employer Individual 0 0 0 0 0 0 0 0 0 0 0 0 Expatriate Plans 6 Large Group Employer 0 0 0 0 0 0 7 8 Small Group 0 0 0 0 0 0 Student Health Plans Large Group 0 0 0 0 0 0 10 11 Government Business (excluded by statute) Other Health Business 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 28,673 506,285 42,741 1,750,919 0 2,328,619 12,536 275 9,545 266,177 0 288,533 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 41,209 506,560 52,286 2,017,096 0 2,617,151 0 0 0 0 0 0 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) 12. Income from fees of uninsured plans XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 13. Net investment and other gain/(loss) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 14. Federal income taxes (excluding taxes on Line 1.5 above) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 0 XXX 0 15. Net gain or (loss) (Lines 11 + 12 + 13 - 14) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 876,269 XXX 876,269 16. ICD-10 Implementation Expenses (informational only; already included in general expenses and line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16. 16a ICD-10 Implementation Expenses (informational only; already included in line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 349,228 527,407 876,634 XXX 41,209 506,560 52,286 2,017,096 0 2,617,151 XXX 876,634 0 (366) XXX 0 (366) OTHER INDICATORS: 216-2.PR 1. Number of certificates/policies 0 0 0 0 0 0 0 0 0 0 11,229 5,457 16,686 0 16,686 2. Number of Covered Lives 0 0 0 0 0 0 0 0 0 0 10,652 5,457 16,109 0 16,109 3. Number of Groups 0 0 0 0 0 0 0 0 0 0 0 0 0 4. Member Months 0 0 0 0 0 0 0 0 129,971 66,606 196,577 0 196,577 XXX 0 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ XXX 0 ] If yes, show the amount of premiums and claims included. Premiums $ 0 Claims $ 0 AFFORDABLE CARE ACT (ACA) RECEIPTS, PAYMENTS, RECEIVABLES and PAYABLES Current Year Prior Year Comprehensive Health Coverage Comprehensive Health Coverage 1 2 3 4 Small Group Small Group Employer Plans Employer Plans Individual Plans Individual Plans ACA Receivables and Payables 1. Permanent ACA Risk Adjustment Program 1.0 Premium adjustments receivable/(payable) 0 2. Transitional ACA Reinsurance Program 2.0 Total amounts recoverable for claims (paid & unpaid) 0 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 0 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 XXX ACA Receipts and Payments 4. Permanent ACA Risk Adjustment Program 4.0 Premium adjustments receipts/(payments) 0 5. Transitional ACA Reinsurance Program 5.0 Amounts received for claims 0 6. Temporary ACA Risk Corridors Program 6.1 Retrospective premium received 6.2 Rate credits or policy experience refunds paid 0 0 XXX 0 0 0 0 0 XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF 185 Asylum Street Hartford, CT 061033408 Puerto Rico DURING THE YEAR Comprehensive Health Coverage 1 2 3 Individual Small Group Employer Large Group Employer Small Group Employer Individual Expatriate Plans: 7 8 6 Large Group Employer Small Group 10 11 Government Business (excluded by statute) Other Health Business 9 Student Health Plans Large Group 79413 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.PR Health Premiums Earned: 0 1.1 Direct premiums written 0 1.2 Unearned premium prior year 0 1.3 Unearned premium current year 0 1.4 Change in unearned premium (Lines 1.2 - 1.3) 0 1.5 Paid rate credits 0 1.6 Reserve for rate credits current year 0 1.7 Reserve for rate credits prior year 0 1.8 Change in reserve for rate credits (Lines 1.6 - 1.7) 0 1.9 Premium balances written off 0 1.10 Group conversion charge 0 1.11 Total direct premiums earned (Lines 1.1 + 1.4 - 1.9 + 1.10) 0 1.12 Assumed premiums earned from non-affiliates 0 1.13 Net Assumed less Ceded premiums earned from affiliates 0 1.14 Ceded premiums earned to non-affiliates 0 1.15 Other Adjustments due to MLR calculation - Premiums 0 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 0 2.1 Paid claims during the year 0 2.2 Direct claim liability current year 0 2.3 Direct claim liability prior year 0 2.4 Direct claim reserves current year 0 2.5 Direct claim reserves prior year 0 2.6 Direct contract reserves current year 0 2.7 Direct contract reserves prior year 0 2.8 Paid rate credits 0 2.9 Reserve for rate credits current year 0 2.10 Reserve for rate credits prior year 0 2.11 Incurred medical incentive pools and bonuses (Lines 2.11a + 2.11b - 2.11c) 0 2.11a Paid medical incentive pools and bonuses current year 0 2.11b Accrued medical incentive pools and bonuses current year 0 2.11c Accrued medical incentive pools and bonuses prior year 0 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 0 2.12a Healthcare receivables current year 0 2.12b Healthcare receivables prior year 0 2.13 Group conversion charge 0 2.14 Multi-option coverage blended rate adjustment 2.15 Total incurred claims (Lines 2.1 + 2.2 - 2.3 + 2.4 - 2.5 + 2.6 - 2.7 + 2.8 + 2.9 0 2.10 + 2.11 - 2.12 + 2.13 + 2.14) 0 2.16 Assumed incurred claims from non-affiliates 0 2.17 Net assumed less ceded incurred claims from affiliates 0 2.18 Ceded incurred claims to non-affiliates 0 2.19 Other adjustments due to MLR calculation - Claims 0 2.20 Net Incurred Claims (Lines 2.15 - 2.8 - 2.9 + 2.10 + 2.16 + 2.17 - 2.18 + 2.19) 3. Fraud and Abuse Recoveries that Reduced PAID Claims in Line 2.1 above 0 (informational only) 0 for stand-alone dental and $ (a) Column 13, Line 1.1 includes direct written premium of $ 4 Business Subject to MLR Mini-Med Plans 5 (LOCATION) NAIC Company Code 2018 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10,149,657 0 0 0 (1,076,002) 0 0 0 0 0 10,149,657 0 0 0 0 11,225,659 4,595,500 0 0 0 5,798 25,858 31,514 (5,656) 10,902 0 4,584,598 0 0 0 10,902 4,595,358 14,745,157 0 0 0 (1,070,204) 25,858 31,514 (5,656) 10,902 0 14,734,255 0 0 0 10,902 15,821,016 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7,742,531 903,717 816,382 231,847 199,777 0 75 (1,076,002) 0 0 0 0 0 0 5,671 5,671 0 0 0 3,210,185 80,157 323,135 0 0 0 0 5,798 25,858 31,514 0 0 0 0 29,629 1,220,280 1,190,651 0 0 10,952,717 983,875 1,139,516 231,847 199,777 0 75 (1,070,204) 25,858 31,514 0 0 0 0 35,301 1,225,951 1,190,651 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6,780,189 0 0 0 0 7,856,191 2,937,721 0 0 0 0 2,937,578 9,717,910 0 0 0 0 10,793,769 0 0 0 0 0 for stand-alone vision policies. 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF Puerto Rico DURING THE YEAR All Expenses 1 2. 216-4.PR 3. Individual Comprehensive Coverage Expenses: 0 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 0 for affiliated services) 1.3 EDP Equipment and Software (incl $ 0 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 1.5 Accreditation and Certification (incl $ 0 for affiliated services) 1.6 Other Expenses (incl $ 1.7 Subtotal before Reimbursements and Taxes (Lines 1.1 to 1.6) 1.8 Reimbursements by uninsured plans and fiscal intermediaries 1.9 Taxes, Licenses and Fees (in total, for tying purposes) 1.10 Total (1.7 to 1.9) 1.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Comprehensive Coverage Expenses: 0 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 0 for affiliated services) 2.3 EDP Equipment and Software (incl $ 0 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 2.5 Accreditation and Certification (incl $ 0 for affiliated services) 2.6 Other Expenses (incl $ 2.7 Subtotal before Reimbursements and Taxes (Lines 2.1 to 2.6) 2.8 Reimbursements by uninsured plans and fiscal intermediaries 2.9 Taxes, Licenses and Fees (in total, for tying purposes) 2.10 Total (2.7 to 2.9) 2.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Comprehensive Coverage Expenses: 0 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 0 for affiliated services) 3.3 EDP Equipment and Software (incl $ 0 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 3.5 Accreditation and Certification (incl $ 0 for affiliated services) 3.6 Other Expenses (incl $ 3.7 Subtotal before Reimbursements and Taxes (Lines 3.1 to 3.6) 3.8 Reimbursements by uninsured plans and fiscal intermediaries 3.9 Taxes, Licenses and Fees (in total, for tying purposes) 3.10 Total (3.7 to 3.9) 3.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions Improve Health Outcomes 1. 185 Asylum Street Hartford, CT 061033408 0 0 0 0 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX Total (1 to 5) 0 0 0 0 0 0 0 0 XXX 0 0 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 0 0 0 0 0 0 0 XXX (LOCATION) NAIC Company Code 2018 XXX 0 0 0 0 0 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 79413 9 10 General Administrative Expenses Total Expenses (6 to 9) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 4. 5. 216-5.PR 6. Individual Mini-Med Plans Expenses: 0 for affiliated services) 4.1 Salaries (including $ 4.2 Outsourced Services 0 for affiliated services) 4.3 EDP Equipment and Software (incl $ 0 for affiliated services) 4.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 4.5 Accreditation and Certification (incl $ 0 for affiliated services) 4.6 Other Expenses (incl $ 4.7 Subtotal before Reimbursements and Taxes (Lines 4.1 to 4.6) 4.8 Reimbursements by uninsured plans and fiscal intermediaries 4.9 Taxes, Licenses and Fees (in total, for tying purposes) 4.10 Total (4.7 to 4.9) 4.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Mini-Med Plans Expenses: 0 for affiliated services) 5.1 Salaries (including $ 5.2 Outsourced Services 0 for affiliated services) 5.3 EDP Equipment and Software (incl $ 0 for affiliated services) 5.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 5.5 Accreditation and Certification (incl $ 0 for affiliated services) 5.6 Other Expenses (incl $ 5.7 Subtotal before Reimbursements and Taxes (Lines 5.1 to 5.6) 5.8 Reimbursements by uninsured plans and fiscal intermediaries 5.9 Taxes, Licenses and Fees (in total, for tying purposes) 5.10 Total (5.7 to 5.9) 5.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Mini-Med Plans Expenses: 0 for affiliated services) 6.1 Salaries (including $ 6.2 Outsourced Services 0 for affiliated services) 6.3 EDP Equipment and Software (incl $ 0 for affiliated services) 6.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 6.5 Accreditation and Certification (incl $ 0 for affiliated services) 6.6 Other Expenses (incl $ 6.7 Subtotal before Reimbursements and Taxes (Lines 6.1 to 6.6) 6.8 Reimbursements by uninsured plans and fiscal intermediaries 6.9 Taxes, Licenses and Fees (in total, for tying purposes) 6.10 Total (6.7 to 6.9) 6.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 7. 8. 216-6.PR 9. Small Group Expatriate Plans Expenses: 0 for affiliated services) 7.1 Salaries (including $ 7.2 Outsourced Services 0 for affiliated services) 7.3 EDP Equipment and Software (incl $ 0 for affiliated services) 7.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 7.5 Accreditation and Certification (incl $ 0 for affiliated services) 7.6 Other Expenses (incl $ 7.7 Subtotal before Reimbursements and Taxes (Lines 7.1 to 7.6) 7.8 Reimbursements by uninsured plans and fiscal intermediaries 7.9 Taxes, Licenses and Fees (in total, for tying purposes) 7.10 Total (7.7 to 7.9) 7.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Expatriate Plans Expenses: 0 for affiliated services) 8.1 Salaries (including $ 8.2 Outsourced Services 0 for affiliated services) 8.3 EDP Equipment and Software (incl $ 0 for affiliated services) 8.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 8.5 Accreditation and Certification (incl $ 0 for affiliated services) 8.6 Other Expenses (incl $ 8.7 Subtotal before Reimbursements and Taxes (Lines 8.1 to 8.6) 8.8 Reimbursements by uninsured plans and fiscal intermediaries 8.9 Taxes, Licenses and Fees (in total, for tying purposes) 8.10 Total (8.7 to 8.9) 8.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Student Health Plans Expenses: 0 for affiliated services) 9.1 Salaries (including $ 9.2 Outsourced Services 0 for affiliated services) 9.3 EDP Equipment and Software (incl $ 0 for affiliated services) 9.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 9.5 Accreditation and Certification (incl $ 0 for affiliated services) 9.6 Other Expenses (incl $ 9.7 Subtotal before Reimbursements and Taxes (Lines 9.1 to 9.6) 9.8 Reimbursements by uninsured plans and fiscal intermediaries 9.9 Taxes, Licenses and Fees (in total, for tying purposes) 9.10 Total (9.7 to 9.9) 9.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 *79413201821655100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes - See Cautionary Statement at http://www.naic.org/documents/committees_e_app_blanks_related_shce_cautionary_statement.pdf) UnitedHealthcare Insurance Company 2. 185 Asylum Street Hartford, CT 061033408 (LOCATION) BUSINESS IN THE STATE OF U.S. Virgin Islands DURING THE YEAR 2018 NAIC Company Code Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 Individual 1. 216-1.VI 2. 3. 4. 5. 6. 7. 8. 9. Premium: 1.1 Health premiums earned (From Part 2, Line 1.11) 1.2 Federal high risk pools 1.3 State high risk pools 1.4 Premiums earned including state and federal high risk programs (Lines 1.1 + 1.2 + 1.3) 1.5 Federal taxes and federal assessments 1.6 State insurance, premium and other taxes (Similar local taxes of 9,534 ) $ 1.6a Community Benefit Expenditures (informational only) 1.7 Regulatory authority licenses and fees 1.8 Adjusted Premiums Earned (Lines 1.4 - 1.5 - 1.6 - 1.7) 1.9 Net Assumed less Ceded reinsurance premiums earned 1.10 Other Adjustments due to MLR calculations - Premiums 1.11 Risk Revenue 1.12 Net adjusted premiums earned after reinsurance (Lines 1.8 + 1.9 + 1.10 + 1.11) Claims: 2.1 Incurred claims excluding prescription drugs 2.2 Prescription drugs 2.3 Pharmaceutical rebates 2.4 State stop loss, market stabilization and claim/census based assessments (informational only) Incurred medical incentive pools and bonuses Deductible Fraud and Abuse Detection/Recovery Expenses (for MLR use only) 5.0 Total Incurred Claims (Lines 2.1 + 2.2 - 2.3 + 3) (From Part 2, Line 2.15) 5.1 Net Assumed less Ceded reinsurance claims incurred 5.2 Other Adjustments due to MLR calculations - Claims 5.3 Rebates paid 5.4 Estimated rebates unpaid prior year 5.5 Estimated rebates unpaid current year 5.6 Fee for service and co-pay revenue 5.7 Net incurred claims after reinsurance (Lines 5.0 + 5.1 + 5.2 + 5.3 - 5.4 + 5.5 - 5.6) Improving Health Care Quality Expenses Incurred: 6.1 Improve health outcomes 6.2 Activities to prevent hospital readmissions 6.3 Improve patient safety and reduce medical errors 6.4 Wellness and health promotion activities 6.5 Health Information Technology expenses related to health improvement 6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5) Preliminary Medical Loss Ratio: MLR ((Lines 4 + 5.0 + 6.6 - Footnote 2.0)/Line 1.8 Claims Adjustment Expenses: 8.1 Cost containment expenses not included in quality of care expenses in Line 6.6 8.2 All other claims adjustment expenses 8.3 Total claims adjustment expenses (Lines 8.1 + 8.2) Claims Adjustment Expense Ratio (Line 8.3/Line 1.8) 2 Small Group Employer 3 Large Group Employer 4 5 Small Group Employer Individual Expatriate Plans 6 Large Group Employer 7 11 Government Business (excluded by statute) Other Health Business 9 8 Small Group 10 Student Health Plans Large Group 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 79413 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 310,182 0 (1) 32,330,308 0 (96) 11,679,930 0 (7) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 22,291,001 0 8,760 23,103,880 0 0 89,715,301 0 8,656 XXX XXX XXX 310,181 (12,789) 32,330,212 219,956 11,679,924 418,443 0 0 0 0 0 0 0 0 0 0 0 0 0 0 22,299,761 394,996 23,103,880 1,116,123 89,723,957 2,136,731 XXX 14,916 0 1 308,052 0 0 0 308,052 1,552,683 0 145 30,557,427 0 2,902 0 30,560,329 577,301 0 45 10,684,135 (172,091) 0 0 10,512,043 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 612,805 0 (3,717) 21,295,676 0 187 0 21,295,864 1,650 0 0 21,986,106 0 16,406 0 22,002,512 2,759,356 0 (3,526) 84,831,396 (172,091) 19,495 0 84,678,800 XXX XXX XXX XXX XXX 2,759,356 0 (3,526) 84,831,396 (172,091) 19,495 0 84,678,800 315,499 19,446 4,137 25,049,075 3,552,852 709,131 6,798,251 2,320,522 358,536 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 11,904,497 3,983,026 3,959 11,151,878 11,556,659 6,181,269 55,219,199 21,432,505 7,257,032 XXX XXX XXX 55,219,199 21,432,505 7,257,032 0 0 0 330,809 0 0 0 0 0 0 330,809 47,747 906 87 27,893,702 0 0 0 0 0 0 27,893,702 30,519 93 41 8,760,330 (96,547) 0 0 0 0 0 8,663,783 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 15,388 16,527,268 0 0 0 0 0 0 16,527,268 78,266 999 15,516 69,395,671 (96,547) 0 0 0 0 0 69,299,125 XXX XXX 0 0 0 0 0 15,883,563 0 0 XXX XXX XXX 0 15,883,563 78,266 999 15,516 69,395,671 (96,547) 0 0 0 0 0 69,299,125 2,481 0 0 0 0 258,642 0 0 0 0 93,439 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 210,548 228,308 170,978 170,458 48,466 55,108 24,192 43,920 24,228 76,919 620,219 252,500 214,899 194,687 125,385 2,481 1.082 258,642 0.921 93,439 0.829 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 828,760 XXX 224,367 0.763 1,407,690 XXX 3,132 4,830 7,962 0.026 323,659 446,969 770,628 0.025 146,352 179,466 325,818 0.030 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 37,039 375,147 412,185 0.019 235,541 854,939 1,090,480 0.050 745,723 1,861,351 2,607,074 XXX XXX XXX XXX XXX 0 0 0 0.000 89,715,301 0 8,656 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 620,219 252,500 214,899 194,687 125,385 0 1,407,690 XXX 0 0 0 745,723 1,861,351 2,607,074 XXX XXX XXX 89,723,957 2,136,731 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 (Continued) Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 2 Small Group Employer Individual 10. General and Administrative (G&A) Expenses: 10.1 Direct sales salaries and benefits 10.2 Agents and brokers fees and commissions 10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below) 10.4 Other general and administrative expenses 10.4a Community Benefit Expenditures (informational only) 10.5 Total general and administrative (Lines 10.1 +10.2 + 10.3 + 10.4) 1,131 14,710 425 12,009 0 28,276 3 Large Group Employer 108,704 1,793,633 46,662 1,917,119 0 3,866,119 4 5 Small Group Employer Individual 48,128 485,850 14,846 640,505 0 1,189,329 0 0 0 0 0 0 Expatriate Plans 6 Large Group Employer 0 0 0 0 0 0 7 8 Small Group 0 0 0 0 0 0 Student Health Plans Large Group 0 0 0 0 0 0 10 11 Government Business (excluded by statute) Other Health Business 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 49,065 991,185 57,659 2,402,490 0 3,500,399 40,111 27,557 17,818 507,193 0 592,679 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 247,138 3,312,935 137,411 5,479,316 0 9,176,801 0 0 0 0 0 0 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) 12. Income from fees of uninsured plans XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 13. Net investment and other gain/(loss) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 14. Federal income taxes (excluding taxes on Line 1.5 above) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 0 XXX 0 15. Net gain or (loss) (Lines 11 + 12 + 13 - 14) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 2,187,575 XXX 2,187,575 16. ICD-10 Implementation Expenses (informational only; already included in general expenses and line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16. 16a ICD-10 Implementation Expenses (informational only; already included in line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (61,475) (2,228,762) 239,674 0 0 0 0 0 0 0 670,956 3,567,718 2,188,111 XXX 247,138 3,312,935 137,411 5,479,316 0 9,176,801 XXX 2,188,111 0 (535) XXX 0 (535) OTHER INDICATORS: 216-2.VI 1. Number of certificates/policies 32 3,087 1,033 0 0 0 0 0 0 0 17,636 12,250 34,038 0 34,038 2. Number of Covered Lives 56 5,099 2,040 0 0 0 0 0 0 0 21,558 12,250 41,003 0 41,003 3. Number of Groups 573 33 0 0 0 0 0 0 830 7 1,443 0 1,443 4. Member Months 633 60,832 26,477 0 0 0 0 0 0 265,465 147,631 501,038 0 501,038 XXX Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ XXX 0 ] If yes, show the amount of premiums and claims included. Premiums $ 0 Claims $ 0 AFFORDABLE CARE ACT (ACA) RECEIPTS, PAYMENTS, RECEIVABLES and PAYABLES Current Year Prior Year Comprehensive Health Coverage Comprehensive Health Coverage 1 2 3 4 Small Group Small Group Employer Plans Employer Plans Individual Plans Individual Plans ACA Receivables and Payables 1. Permanent ACA Risk Adjustment Program 1.0 Premium adjustments receivable/(payable) 0 2. Transitional ACA Reinsurance Program 2.0 Total amounts recoverable for claims (paid & unpaid) 0 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 0 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 XXX ACA Receipts and Payments 4. Permanent ACA Risk Adjustment Program 4.0 Premium adjustments receipts/(payments) 0 5. Transitional ACA Reinsurance Program 5.0 Amounts received for claims 0 6. Temporary ACA Risk Corridors Program 6.1 Retrospective premium received 6.2 Rate credits or policy experience refunds paid 0 0 XXX 0 0 0 0 0 XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF 185 Asylum Street Hartford, CT 061033408 U.S. Virgin Islands DURING THE YEAR Comprehensive Health Coverage 1 2 3 Individual Small Group Employer Large Group Employer Small Group Employer Individual Expatriate Plans: 7 8 6 Large Group Employer Small Group 10 11 Government Business (excluded by statute) Other Health Business 9 Student Health Plans Large Group 79413 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.VI Health Premiums Earned: 310,182 32,320,442 1.1 Direct premiums written 0 11,965 1.2 Unearned premium prior year 0 (803) 1.3 Unearned premium current year 0 12,768 1.4 Change in unearned premium (Lines 1.2 - 1.3) 0 0 1.5 Paid rate credits 0 0 1.6 Reserve for rate credits current year 0 0 1.7 Reserve for rate credits prior year 0 0 1.8 Change in reserve for rate credits (Lines 1.6 - 1.7) 0 2,902 1.9 Premium balances written off 0 0 1.10 Group conversion charge 310,182 32,330,308 1.11 Total direct premiums earned (Lines 1.1 + 1.4 - 1.9 + 1.10) 0 0 1.12 Assumed premiums earned from non-affiliates 0 0 1.13 Net Assumed less Ceded premiums earned from affiliates 0 0 1.14 Ceded premiums earned to non-affiliates 0 2,902 1.15 Other Adjustments due to MLR calculation - Premiums 310,182 32,333,210 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 330,810 27,044,416 2.1 Paid claims during the year (1) 4,528,830 2.2 Direct claim liability current year 0 3,729,506 2.3 Direct claim liability prior year 0 170,972 2.4 Direct claim reserves current year 0 77,411 2.5 Direct claim reserves prior year 0 0 2.6 Direct contract reserves current year 0 0 2.7 Direct contract reserves prior year 0 0 2.8 Paid rate credits 0 0 2.9 Reserve for rate credits current year 0 0 2.10 Reserve for rate credits prior year 0 906 2.11 Incurred medical incentive pools and bonuses (Lines 2.11a + 2.11b - 2.11c) 0 472 2.11a Paid medical incentive pools and bonuses current year 0 622 2.11b Accrued medical incentive pools and bonuses current year 0 188 2.11c Accrued medical incentive pools and bonuses prior year 0 44,505 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 0 374,531 2.12a Healthcare receivables current year 0 330,026 2.12b Healthcare receivables prior year 0 0 2.13 Group conversion charge 0 0 2.14 Multi-option coverage blended rate adjustment 2.15 Total incurred claims (Lines 2.1 + 2.2 - 2.3 + 2.4 - 2.5 + 2.6 - 2.7 + 2.8 + 2.9 330,809 27,893,702 2.10 + 2.11 - 2.12 + 2.13 + 2.14) 0 0 2.16 Assumed incurred claims from non-affiliates 0 0 2.17 Net assumed less ceded incurred claims from affiliates 0 0 2.18 Ceded incurred claims to non-affiliates 0 0 2.19 Other adjustments due to MLR calculation - Claims 330,809 27,893,702 2.20 Net Incurred Claims (Lines 2.15 - 2.8 - 2.9 + 2.10 + 2.16 + 2.17 - 2.18 + 2.19) 3. Fraud and Abuse Recoveries that Reduced PAID Claims in Line 2.1 above 0 87 (informational only) 2,169,124 for stand-alone dental and $ (a) Column 13, Line 1.1 includes direct written premium of $ 4 Business Subject to MLR Mini-Med Plans 5 (LOCATION) NAIC Company Code 2018 11,679,930 0 0 0 0 0 0 0 0 0 11,679,930 0 0 172,091 0 11,507,839 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 22,290,321 872 4 868 376,547 0 0 0 187 0 22,291,001 0 0 0 187 21,914,641 23,120,285 0 0 0 (2,777) (438,003) 4,651 (442,654) 16,406 0 23,103,880 0 0 0 16,406 23,565,716 89,721,160 12,836 (799) 13,636 373,770 (438,003) 4,651 (442,654) 19,495 0 89,715,301 0 0 172,091 19,495 89,631,588 8,460,945 972,520 638,074 (26,042) 6,805 0 0 0 0 0 93 27 66 0 2,307 109,403 107,096 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 15,683,780 2,077,499 2,231,031 344,642 357,515 98,109 107,290 376,547 0 0 0 0 0 0 1,177 1,177 0 0 0 15,985,082 1,620,487 350,529 1,891 0 0 0 (2,777) (438,003) 4,651 0 0 0 0 284,231 1,931,812 1,647,581 0 0 67,505,032 9,199,334 6,949,139 491,463 441,731 98,109 107,290 373,770 (438,003) 4,651 999 499 688 188 332,221 2,416,924 2,084,703 0 0 8,760,330 0 0 96,547 0 8,663,783 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 15,883,563 0 0 0 0 15,507,016 16,527,268 0 0 0 0 16,972,699 69,395,671 0 0 96,547 0 69,368,008 41 0 0 391,647 for stand-alone vision policies. 0 0 0 0 0 0 30,263 30,391 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF U.S. Virgin Islands DURING THE YEAR All Expenses 1 Improve Health Outcomes 1. Individual Comprehensive Coverage Expenses: 0 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 0 for affiliated services) 1.3 EDP Equipment and Software (incl $ 0 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 1.5 Accreditation and Certification (incl $ 22,885 for affiliated services) 1.6 Other Expenses (incl $ 1.7 Subtotal before Reimbursements and Taxes (Lines 1.1 to 1.6) 1.8 Reimbursements by uninsured plans and fiscal intermediaries 1.9 Taxes, Licenses and Fees (in total, for tying purposes) 1.10 Total (1.7 to 1.9) 1.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 2. 216-4.VI 2.7 Subtotal before Reimbursements and Taxes (Lines 2.1 to 2.6) 2.8 Reimbursements by uninsured plans and fiscal intermediaries 2.9 Taxes, Licenses and Fees (in total, for tying purposes) 2.10 Total (2.7 to 2.9) 2.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 3. 0 0 0 0 0 2,481 2,481 0 XXX Small Group Comprehensive Coverage Expenses: 0 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 0 for affiliated services) 2.3 EDP Equipment and Software (incl $ 0 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 2.5 Accreditation and Certification (incl $ 2,352,431 for affiliated services) 2.6 Other Expenses (incl $ 3.7 Subtotal before Reimbursements and Taxes (Lines 3.1 to 3.6) 3.8 Reimbursements by uninsured plans and fiscal intermediaries 3.9 Taxes, Licenses and Fees (in total, for tying purposes) 3.10 Total (3.7 to 3.9) 3.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX Total (1 to 5) 0 0 0 0 0 2,481 2,481 0 XXX 0 0 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 0 0 0 0 0 0 0 XXX (LOCATION) NAIC Company Code 2018 XXX 0 0 0 0 0 3,027 3,027 0 XXX 0 0 0 0 0 4,718 4,718 0 XXX 2,481 0 0 0 0 0 0 0 0 0 2,481 0 3,027 910 4,718 0 0 0 0 0 0 258,642 258,642 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 258,642 258,642 0 0 18,450 0 0 0 295,076 313,526 0 0 0 0 0 0 436,181 436,181 0 XXX Large Group Comprehensive Coverage Expenses: 0 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 0 for affiliated services) 3.3 EDP Equipment and Software (incl $ 0 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 3.5 Accreditation and Certification (incl $ 851,202 for affiliated services) 3.6 Other Expenses (incl $ 185 Asylum Street Hartford, CT 061033408 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX XXX XXX 258,642 0 0 0 0 0 0 0 0 0 258,642 0 313,526 87,484 436,181 0 0 0 0 0 0 93,439 93,439 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 93,439 93,439 0 0 16,401 0 0 0 125,570 141,971 0 0 0 0 0 0 174,887 174,887 0 XXX XXX XXX 0 0 0 XXX 93,439 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 93,439 0 XXX 141,971 38,061 174,887 0 79413 9 10 General Administrative Expenses Total Expenses (6 to 9) 0 0 0 0 0 27,771 27,771 0 15,640 43,411 0 0 0 0 0 0 37,997 37,997 0 15,640 53,637 910 0 610,915 0 0 0 3,200,854 3,811,769 0 1,628,099 5,439,868 0 0 629,366 0 0 0 4,190,753 4,820,119 0 1,628,099 6,448,218 87,484 0 234,031 0 0 0 937,077 1,171,109 0 604,526 1,775,635 0 0 250,433 0 0 0 1,330,973 1,581,406 0 604,526 2,185,932 38,061 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 4. 5. 216-5.VI 6. Individual Mini-Med Plans Expenses: 0 for affiliated services) 4.1 Salaries (including $ 4.2 Outsourced Services 0 for affiliated services) 4.3 EDP Equipment and Software (incl $ 0 for affiliated services) 4.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 4.5 Accreditation and Certification (incl $ 0 for affiliated services) 4.6 Other Expenses (incl $ 4.7 Subtotal before Reimbursements and Taxes (Lines 4.1 to 4.6) 4.8 Reimbursements by uninsured plans and fiscal intermediaries 4.9 Taxes, Licenses and Fees (in total, for tying purposes) 4.10 Total (4.7 to 4.9) 4.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Mini-Med Plans Expenses: 0 for affiliated services) 5.1 Salaries (including $ 5.2 Outsourced Services 0 for affiliated services) 5.3 EDP Equipment and Software (incl $ 0 for affiliated services) 5.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 5.5 Accreditation and Certification (incl $ 0 for affiliated services) 5.6 Other Expenses (incl $ 5.7 Subtotal before Reimbursements and Taxes (Lines 5.1 to 5.6) 5.8 Reimbursements by uninsured plans and fiscal intermediaries 5.9 Taxes, Licenses and Fees (in total, for tying purposes) 5.10 Total (5.7 to 5.9) 5.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Mini-Med Plans Expenses: 0 for affiliated services) 6.1 Salaries (including $ 6.2 Outsourced Services 0 for affiliated services) 6.3 EDP Equipment and Software (incl $ 0 for affiliated services) 6.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 6.5 Accreditation and Certification (incl $ 0 for affiliated services) 6.6 Other Expenses (incl $ 6.7 Subtotal before Reimbursements and Taxes (Lines 6.1 to 6.6) 6.8 Reimbursements by uninsured plans and fiscal intermediaries 6.9 Taxes, Licenses and Fees (in total, for tying purposes) 6.10 Total (6.7 to 6.9) 6.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 7. 8. 216-6.VI 9. Small Group Expatriate Plans Expenses: 0 for affiliated services) 7.1 Salaries (including $ 7.2 Outsourced Services 0 for affiliated services) 7.3 EDP Equipment and Software (incl $ 0 for affiliated services) 7.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 7.5 Accreditation and Certification (incl $ 0 for affiliated services) 7.6 Other Expenses (incl $ 7.7 Subtotal before Reimbursements and Taxes (Lines 7.1 to 7.6) 7.8 Reimbursements by uninsured plans and fiscal intermediaries 7.9 Taxes, Licenses and Fees (in total, for tying purposes) 7.10 Total (7.7 to 7.9) 7.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Expatriate Plans Expenses: 0 for affiliated services) 8.1 Salaries (including $ 8.2 Outsourced Services 0 for affiliated services) 8.3 EDP Equipment and Software (incl $ 0 for affiliated services) 8.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 8.5 Accreditation and Certification (incl $ 0 for affiliated services) 8.6 Other Expenses (incl $ 8.7 Subtotal before Reimbursements and Taxes (Lines 8.1 to 8.6) 8.8 Reimbursements by uninsured plans and fiscal intermediaries 8.9 Taxes, Licenses and Fees (in total, for tying purposes) 8.10 Total (8.7 to 8.9) 8.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Student Health Plans Expenses: 0 for affiliated services) 9.1 Salaries (including $ 9.2 Outsourced Services 0 for affiliated services) 9.3 EDP Equipment and Software (incl $ 0 for affiliated services) 9.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 9.5 Accreditation and Certification (incl $ 0 for affiliated services) 9.6 Other Expenses (incl $ 9.7 Subtotal before Reimbursements and Taxes (Lines 9.1 to 9.6) 9.8 Reimbursements by uninsured plans and fiscal intermediaries 9.9 Taxes, Licenses and Fees (in total, for tying purposes) 9.10 Total (9.7 to 9.9) 9.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 *79413201821656100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes - See Cautionary Statement at http://www.naic.org/documents/committees_e_app_blanks_related_shce_cautionary_statement.pdf) UnitedHealthcare Insurance Company 2. 185 Asylum Street Hartford, CT 061033408 (LOCATION) BUSINESS IN THE STATE OF Northern Mariana Islands DURING THE YEAR 2018 NAIC Company Code Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 2 Small Group Employer Individual 1. 216-1.MP 2. 3. 4. 5. 6. 7. 8. 9. Premium: 1.1 Health premiums earned (From Part 2, Line 1.11) 1.2 Federal high risk pools 1.3 State high risk pools 1.4 Premiums earned including state and federal high risk programs (Lines 1.1 + 1.2 + 1.3) 1.5 Federal taxes and federal assessments 1.6 State insurance, premium and other taxes (Similar local taxes of 29 ) $ 1.6a Community Benefit Expenditures (informational only) 1.7 Regulatory authority licenses and fees 1.8 Adjusted Premiums Earned (Lines 1.4 - 1.5 - 1.6 - 1.7) 1.9 Net Assumed less Ceded reinsurance premiums earned 1.10 Other Adjustments due to MLR calculations - Premiums 1.11 Risk Revenue 1.12 Net adjusted premiums earned after reinsurance (Lines 1.8 + 1.9 + 1.10 + 1.11) Claims: 2.1 Incurred claims excluding prescription drugs 2.2 Prescription drugs 2.3 Pharmaceutical rebates 2.4 State stop loss, market stabilization and claim/census based assessments (informational only) Incurred medical incentive pools and bonuses Deductible Fraud and Abuse Detection/Recovery Expenses (for MLR use only) 5.0 Total Incurred Claims (Lines 2.1 + 2.2 - 2.3 + 3) (From Part 2, Line 2.15) 5.1 Net Assumed less Ceded reinsurance claims incurred 5.2 Other Adjustments due to MLR calculations - Claims 5.3 Rebates paid 5.4 Estimated rebates unpaid prior year 5.5 Estimated rebates unpaid current year 5.6 Fee for service and co-pay revenue 5.7 Net incurred claims after reinsurance (Lines 5.0 + 5.1 + 5.2 + 5.3 - 5.4 + 5.5 - 5.6) Improving Health Care Quality Expenses Incurred: 6.1 Improve health outcomes 6.2 Activities to prevent hospital readmissions 6.3 Improve patient safety and reduce medical errors 6.4 Wellness and health promotion activities 6.5 Health Information Technology expenses related to health improvement 6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5) Preliminary Medical Loss Ratio: MLR ((Lines 4 + 5.0 + 6.6 - Footnote 2.0)/Line 1.8 Claims Adjustment Expenses: 8.1 Cost containment expenses not included in quality of care expenses in Line 6.6 8.2 All other claims adjustment expenses 8.3 Total claims adjustment expenses (Lines 8.1 + 8.2) Claims Adjustment Expense Ratio (Line 8.3/Line 1.8) 3 Large Group Employer 4 5 Small Group Employer Individual Expatriate Plans 6 Large Group Employer 7 11 Government Business (excluded by statute) Other Health Business 9 8 Small Group 10 Student Health Plans Large Group 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 79413 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 60,520 0 36 182,855 0 0 243,374 0 36 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 60,555 426 182,855 17,045 243,410 17,470 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 958 0 (15) 59,187 0 0 0 59,187 22 0 0 165,788 0 460 0 166,248 979 0 (15) 224,975 0 460 0 225,436 XXX XXX XXX XXX XXX 979 0 (15) 224,975 0 460 0 225,436 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 44,767 0 0 14,993 191,720 108,908 59,760 191,720 108,908 XXX XXX XXX 59,760 191,720 108,908 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 97,805 0 0 0 0 0 0 97,805 0 0 0 142,572 0 0 0 0 0 0 142,572 XXX XXX 0 0 0 0 0 44,767 0 0 XXX XXX XXX 0 44,767 0 0 0 142,572 0 0 0 0 0 0 142,572 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 157 0 0 716 30 447 155 1,021 (312) 981 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 902 2,291 0.604 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 XXX XXX XXX 0 XXX XXX 0 0 0 0.000 9 1,226 1,235 0.021 (3,428) 21,785 18,357 0.111 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 603 155 1,021 404 1,011 (3,419) 23,011 19,592 XXX 243,410 17,470 0 0 0 0 0 3,194 XXX 243,374 0 36 603 155 1,021 404 1,011 0 XXX 0 0 0 XXX 3,194 XXX (3,419) 23,011 19,592 XXX SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 (Continued) Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 2 Small Group Employer Individual 10. General and Administrative (G&A) Expenses: 10.1 Direct sales salaries and benefits 10.2 Agents and brokers fees and commissions 10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below) 10.4 Other general and administrative expenses 10.4a Community Benefit Expenditures (informational only) 10.5 Total general and administrative (Lines 10.1 +10.2 + 10.3 + 10.4) 0 0 0 0 0 0 3 Large Group Employer 0 0 0 0 0 0 4 5 Small Group Employer Individual 0 0 0 0 0 0 0 0 0 0 0 0 Expatriate Plans 6 Large Group Employer 0 0 0 0 0 0 7 8 Small Group 0 0 0 0 0 0 Student Health Plans Large Group 0 0 0 0 0 0 10 11 Government Business (excluded by statute) Other Health Business 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 100 3,178 150 7,142 0 10,570 855 0 251 5,238 0 6,343 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 955 3,178 400 12,380 0 16,913 0 0 0 0 0 0 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) 12. Income from fees of uninsured plans XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 13. Net investment and other gain/(loss) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 14. Federal income taxes (excluding taxes on Line 1.5 above) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 15. Net gain or (loss) (Lines 11 + 12 + 13 - 14) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 16. ICD-10 Implementation Expenses (informational only; already included in general expenses and line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16. 16a ICD-10 Implementation Expenses (informational only; already included in line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,713 41,452 43,165 XXX 955 3,178 400 12,380 0 16,913 XXX 43,165 0 0 (2) XXX XXX 0 XXX 0 XXX 43,163 XXX 43,163 (2) OTHER INDICATORS: 216-2.MP 1. Number of certificates/policies 0 0 0 0 0 0 0 0 0 0 39 367 406 0 406 2. Number of Covered Lives 0 0 0 0 0 0 0 0 0 0 39 367 406 0 406 3. Number of Groups 0 0 0 0 0 0 0 0 0 0 0 0 0 4. Member Months 0 0 0 0 0 0 0 0 455 4,541 4,996 0 4,996 XXX 0 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ XXX 0 ] If yes, show the amount of premiums and claims included. Premiums $ 0 Claims $ 0 AFFORDABLE CARE ACT (ACA) RECEIPTS, PAYMENTS, RECEIVABLES and PAYABLES Current Year Prior Year Comprehensive Health Coverage Comprehensive Health Coverage 1 2 3 4 Small Group Small Group Employer Plans Employer Plans Individual Plans Individual Plans ACA Receivables and Payables 1. Permanent ACA Risk Adjustment Program 1.0 Premium adjustments receivable/(payable) 0 2. Transitional ACA Reinsurance Program 2.0 Total amounts recoverable for claims (paid & unpaid) 0 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 0 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 XXX ACA Receipts and Payments 4. Permanent ACA Risk Adjustment Program 4.0 Premium adjustments receipts/(payments) 0 5. Transitional ACA Reinsurance Program 5.0 Amounts received for claims 0 6. Temporary ACA Risk Corridors Program 6.1 Retrospective premium received 6.2 Rate credits or policy experience refunds paid 0 0 XXX 0 0 0 0 0 XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF 185 Asylum Street Hartford, CT 061033408 Northern Mariana Islands DURING THE YEAR Comprehensive Health Coverage 1 2 3 Individual Small Group Employer Large Group Employer Small Group Employer Individual Expatriate Plans: 7 8 6 Large Group Employer Small Group 10 11 Government Business (excluded by statute) Other Health Business 9 Student Health Plans Large Group 79413 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.MP Health Premiums Earned: 0 1.1 Direct premiums written 0 1.2 Unearned premium prior year 0 1.3 Unearned premium current year 0 1.4 Change in unearned premium (Lines 1.2 - 1.3) 0 1.5 Paid rate credits 0 1.6 Reserve for rate credits current year 0 1.7 Reserve for rate credits prior year 0 1.8 Change in reserve for rate credits (Lines 1.6 - 1.7) 0 1.9 Premium balances written off 0 1.10 Group conversion charge 0 1.11 Total direct premiums earned (Lines 1.1 + 1.4 - 1.9 + 1.10) 0 1.12 Assumed premiums earned from non-affiliates 0 1.13 Net Assumed less Ceded premiums earned from affiliates 0 1.14 Ceded premiums earned to non-affiliates 0 1.15 Other Adjustments due to MLR calculation - Premiums 0 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 0 2.1 Paid claims during the year 0 2.2 Direct claim liability current year 0 2.3 Direct claim liability prior year 0 2.4 Direct claim reserves current year 0 2.5 Direct claim reserves prior year 0 2.6 Direct contract reserves current year 0 2.7 Direct contract reserves prior year 0 2.8 Paid rate credits 0 2.9 Reserve for rate credits current year 0 2.10 Reserve for rate credits prior year 0 2.11 Incurred medical incentive pools and bonuses (Lines 2.11a + 2.11b - 2.11c) 0 2.11a Paid medical incentive pools and bonuses current year 0 2.11b Accrued medical incentive pools and bonuses current year 0 2.11c Accrued medical incentive pools and bonuses prior year 0 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 0 2.12a Healthcare receivables current year 0 2.12b Healthcare receivables prior year 0 2.13 Group conversion charge 0 2.14 Multi-option coverage blended rate adjustment 2.15 Total incurred claims (Lines 2.1 + 2.2 - 2.3 + 2.4 - 2.5 + 2.6 - 2.7 + 2.8 + 2.9 0 2.10 + 2.11 - 2.12 + 2.13 + 2.14) 0 2.16 Assumed incurred claims from non-affiliates 0 2.17 Net assumed less ceded incurred claims from affiliates 0 2.18 Ceded incurred claims to non-affiliates 0 2.19 Other adjustments due to MLR calculation - Claims 0 2.20 Net Incurred Claims (Lines 2.15 - 2.8 - 2.9 + 2.10 + 2.16 + 2.17 - 2.18 + 2.19) 3. Fraud and Abuse Recoveries that Reduced PAID Claims in Line 2.1 above 0 (informational only) 0 for stand-alone dental and $ (a) Column 13, Line 1.1 includes direct written premium of $ 4 Business Subject to MLR Mini-Med Plans 5 (LOCATION) NAIC Company Code 2018 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 60,520 0 0 0 6,799 0 0 0 0 0 60,520 0 0 0 0 53,720 183,315 0 0 0 54,862 15,210 55,059 (39,849) 460 0 182,855 0 0 0 460 168,301 243,835 0 0 0 61,662 15,210 55,059 (39,849) 460 0 243,374 0 0 0 460 222,022 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 41,457 4,041 7,800 1,092 822 0 0 6,799 0 0 0 0 0 0 0 0 0 0 0 95,753 1,567 7,274 0 0 0 0 54,862 15,210 55,059 0 0 0 0 7,255 42,524 35,269 0 0 137,210 5,608 15,074 1,092 822 0 0 61,662 15,210 55,059 0 0 0 0 7,255 42,524 35,269 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 44,767 0 0 0 0 37,968 97,805 0 0 0 0 82,791 142,572 0 0 0 0 120,759 0 0 0 0 0 for stand-alone vision policies. 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF Northern Mariana Islands DURING THE YEAR All Expenses 1 1. 2. 216-4.MP 3. Individual Comprehensive Coverage Expenses: 0 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 0 for affiliated services) 1.3 EDP Equipment and Software (incl $ 0 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 1.5 Accreditation and Certification (incl $ 0 for affiliated services) 1.6 Other Expenses (incl $ 1.7 Subtotal before Reimbursements and Taxes (Lines 1.1 to 1.6) 1.8 Reimbursements by uninsured plans and fiscal intermediaries 1.9 Taxes, Licenses and Fees (in total, for tying purposes) 1.10 Total (1.7 to 1.9) 1.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Comprehensive Coverage Expenses: 0 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 0 for affiliated services) 2.3 EDP Equipment and Software (incl $ 0 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 2.5 Accreditation and Certification (incl $ 0 for affiliated services) 2.6 Other Expenses (incl $ 2.7 Subtotal before Reimbursements and Taxes (Lines 2.1 to 2.6) 2.8 Reimbursements by uninsured plans and fiscal intermediaries 2.9 Taxes, Licenses and Fees (in total, for tying purposes) 2.10 Total (2.7 to 2.9) 2.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Comprehensive Coverage Expenses: 0 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 0 for affiliated services) 3.3 EDP Equipment and Software (incl $ 0 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 3.5 Accreditation and Certification (incl $ 0 for affiliated services) 3.6 Other Expenses (incl $ 3.7 Subtotal before Reimbursements and Taxes (Lines 3.1 to 3.6) 3.8 Reimbursements by uninsured plans and fiscal intermediaries 3.9 Taxes, Licenses and Fees (in total, for tying purposes) 3.10 Total (3.7 to 3.9) 3.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions Improve Health Outcomes 0 0 0 0 0 0 0 0 XXX 185 Asylum Street Hartford, CT 061033408 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX Total (1 to 5) 0 0 0 0 0 0 0 0 XXX 0 0 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 0 0 0 0 0 0 0 XXX (LOCATION) NAIC Company Code 2018 XXX 0 0 0 0 0 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 79413 9 10 General Administrative Expenses Total Expenses (6 to 9) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 4. 5. 216-5.MP 6. Individual Mini-Med Plans Expenses: 0 for affiliated services) 4.1 Salaries (including $ 4.2 Outsourced Services 0 for affiliated services) 4.3 EDP Equipment and Software (incl $ 0 for affiliated services) 4.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 4.5 Accreditation and Certification (incl $ 0 for affiliated services) 4.6 Other Expenses (incl $ 4.7 Subtotal before Reimbursements and Taxes (Lines 4.1 to 4.6) 4.8 Reimbursements by uninsured plans and fiscal intermediaries 4.9 Taxes, Licenses and Fees (in total, for tying purposes) 4.10 Total (4.7 to 4.9) 4.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Mini-Med Plans Expenses: 0 for affiliated services) 5.1 Salaries (including $ 5.2 Outsourced Services 0 for affiliated services) 5.3 EDP Equipment and Software (incl $ 0 for affiliated services) 5.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 5.5 Accreditation and Certification (incl $ 0 for affiliated services) 5.6 Other Expenses (incl $ 5.7 Subtotal before Reimbursements and Taxes (Lines 5.1 to 5.6) 5.8 Reimbursements by uninsured plans and fiscal intermediaries 5.9 Taxes, Licenses and Fees (in total, for tying purposes) 5.10 Total (5.7 to 5.9) 5.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Mini-Med Plans Expenses: 0 for affiliated services) 6.1 Salaries (including $ 6.2 Outsourced Services 0 for affiliated services) 6.3 EDP Equipment and Software (incl $ 0 for affiliated services) 6.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 6.5 Accreditation and Certification (incl $ 0 for affiliated services) 6.6 Other Expenses (incl $ 6.7 Subtotal before Reimbursements and Taxes (Lines 6.1 to 6.6) 6.8 Reimbursements by uninsured plans and fiscal intermediaries 6.9 Taxes, Licenses and Fees (in total, for tying purposes) 6.10 Total (6.7 to 6.9) 6.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 7. 8. 216-6.MP 9. Small Group Expatriate Plans Expenses: 0 for affiliated services) 7.1 Salaries (including $ 7.2 Outsourced Services 0 for affiliated services) 7.3 EDP Equipment and Software (incl $ 0 for affiliated services) 7.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 7.5 Accreditation and Certification (incl $ 0 for affiliated services) 7.6 Other Expenses (incl $ 7.7 Subtotal before Reimbursements and Taxes (Lines 7.1 to 7.6) 7.8 Reimbursements by uninsured plans and fiscal intermediaries 7.9 Taxes, Licenses and Fees (in total, for tying purposes) 7.10 Total (7.7 to 7.9) 7.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Expatriate Plans Expenses: 0 for affiliated services) 8.1 Salaries (including $ 8.2 Outsourced Services 0 for affiliated services) 8.3 EDP Equipment and Software (incl $ 0 for affiliated services) 8.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 8.5 Accreditation and Certification (incl $ 0 for affiliated services) 8.6 Other Expenses (incl $ 8.7 Subtotal before Reimbursements and Taxes (Lines 8.1 to 8.6) 8.8 Reimbursements by uninsured plans and fiscal intermediaries 8.9 Taxes, Licenses and Fees (in total, for tying purposes) 8.10 Total (8.7 to 8.9) 8.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Student Health Plans Expenses: 0 for affiliated services) 9.1 Salaries (including $ 9.2 Outsourced Services 0 for affiliated services) 9.3 EDP Equipment and Software (incl $ 0 for affiliated services) 9.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 9.5 Accreditation and Certification (incl $ 0 for affiliated services) 9.6 Other Expenses (incl $ 9.7 Subtotal before Reimbursements and Taxes (Lines 9.1 to 9.6) 9.8 Reimbursements by uninsured plans and fiscal intermediaries 9.9 Taxes, Licenses and Fees (in total, for tying purposes) 9.10 Total (9.7 to 9.9) 9.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 *79413201821659100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes - See Cautionary Statement at http://www.naic.org/documents/committees_e_app_blanks_related_shce_cautionary_statement.pdf) UnitedHealthcare Insurance Company 2. 185 Asylum Street Hartford, CT 061033408 (LOCATION) BUSINESS IN THE STATE OF Grand Total DURING THE YEAR 2018 NAIC Company Code Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 1. 216-1.GT 2. 3. 4. 5. 6. 7. 8. 9. Premium: 1.1 Health premiums earned (From Part 2, Line 1.11) 1.2 Federal high risk pools 1.3 State high risk pools 1.4 Premiums earned including state and federal high risk programs (Lines 1.1 + 1.2 + 1.3) 1.5 Federal taxes and federal assessments 1.6 State insurance, premium and other taxes (Similar local taxes of 48,858,437 ) $ 1.6a Community Benefit Expenditures (informational only) 1.7 Regulatory authority licenses and fees 1.8 Adjusted Premiums Earned (Lines 1.4 - 1.5 - 1.6 - 1.7) 1.9 Net Assumed less Ceded reinsurance premiums earned 1.10 Other Adjustments due to MLR calculations - Premiums 1.11 Risk Revenue 1.12 Net adjusted premiums earned after reinsurance (Lines 1.8 + 1.9 + 1.10 + 1.11) Claims: 2.1 Incurred claims excluding prescription drugs 2.2 Prescription drugs 2.3 Pharmaceutical rebates 2.4 State stop loss, market stabilization and claim/census based assessments (informational only) Incurred medical incentive pools and bonuses Deductible Fraud and Abuse Detection/Recovery Expenses (for MLR use only) 5.0 Total Incurred Claims (Lines 2.1 + 2.2 - 2.3 + 3) (From Part 2, Line 2.15) 5.1 Net Assumed less Ceded reinsurance claims incurred 5.2 Other Adjustments due to MLR calculations - Claims 5.3 Rebates paid 5.4 Estimated rebates unpaid prior year 5.5 Estimated rebates unpaid current year 5.6 Fee for service and co-pay revenue 5.7 Net incurred claims after reinsurance (Lines 5.0 + 5.1 + 5.2 + 5.3 - 5.4 + 5.5 - 5.6) Improving Health Care Quality Expenses Incurred: 6.1 Improve health outcomes 6.2 Activities to prevent hospital readmissions 6.3 Improve patient safety and reduce medical errors 6.4 Wellness and health promotion activities 6.5 Health Information Technology expenses related to health improvement 6.6 Total of Defined Expenses Incurred for Improving Health Care Quality (Lines 6.1+6.2+6.3+6.4+6.5) Preliminary Medical Loss Ratio: MLR ((Lines 4 + 5.0 + 6.6 - Footnote 2.0)/Line 1.8 Claims Adjustment Expenses: 8.1 Cost containment expenses not included in quality of care expenses in Line 6.6 8.2 All other claims adjustment expenses 8.3 Total claims adjustment expenses (Lines 8.1 + 8.2) Claims Adjustment Expense Ratio (Line 8.3/Line 1.8) 5 Small Group Employer 7 Government Business (excluded by statute) Other Health Business 9 8 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 79413 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 3 Large Group Employer 77,867,794 0 (47,504) 6,348,163,503 0 (2,053,039) 15,159,085,983 0 (4,054,240) 0 0 0 0 0 0 0 0 0 0 0 0 132,159,401 0 (2,401) 692,561,479 0 (44,600) 2,599,057,760 0 0 13,320,269,166 0 5,122,282 15,710,885,765 0 (7) 54,040,050,851 0 (1,079,509) XXX XXX XXX 54,040,050,851 0 (1,079,509) 77,820,290 881,243 6,346,110,463 256,299,515 15,155,031,743 546,158,765 0 0 0 0 0 0 0 0 132,157,000 2,385,659 692,516,879 26,990,189 2,599,057,760 8,671,606 13,325,391,448 136,233,429 15,710,885,758 630,938,273 54,038,971,342 1,608,558,678 XXX 12,603,431 54,038,971,342 1,621,162,109 825,574 0 364,593 75,748,881 1,067,472 196,278 0 77,012,631 81,993,120 0 (146,223) 6,007,964,051 11,119,783 2,633,318 0 6,021,717,152 206,109,516 0 1,112,198 14,401,651,264 (1,620,185,481) 13,168,156 0 12,794,633,938 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 817,898 0 78,291 128,875,152 2,640,920 1,727 0 131,517,799 10,234,442 0 52,967 655,239,281 38,338,525 0 0 693,577,807 51,087,730 0 466,967 2,538,831,457 1,034,038,909 2,063,283 0 3,574,933,649 207,504,951 0 (2,089,565) 12,983,742,634 619,993,459 (167,693) 0 13,603,568,400 20,812,392 0 92 15,059,135,001 176,806,029 47,036,077 0 15,282,977,107 579,385,623 0 (160,680) 51,851,187,721 263,819,615 64,931,146 0 52,179,938,482 50,633 0 0 XXX XXX XXX XXX XXX 579,436,256 0 (160,680) 51,838,533,656 263,819,615 64,931,146 0 52,167,284,418 58,975,569 15,496,629 4,347,792 4,079,337,665 1,002,300,320 313,420,234 10,610,631,434 2,510,822,280 775,079,933 0 0 0 0 0 0 0 0 0 0 0 0 73,251,490 9,570,049 2,434,518 457,050,573 110,993,103 26,524,436 2,130,955,506 273,524,418 2,507,068 9,679,023,947 1,070,758,648 3,353,332 9,148,292,735 7,259,278,658 4,129,713,215 36,237,518,919 12,252,744,106 5,257,380,528 XXX XXX XXX 36,237,518,919 12,252,744,106 5,257,380,528 20,153 1,967 1,203 70,126,373 842,902 (21,423) 0 0 21,423 0 70,969,275 5,648,868 7,537,682 3,306,836 4,775,755,434 10,534,854 (55,263,963) 46,182,331 41,456,706 50,538,553 0 4,786,290,501 19,054,297 23,326,445 6,199,410 12,369,700,226 (1,457,469,379) (24,165,169) 20,002,298 24,526,214 28,692,974 0 10,912,234,736 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 332,239 83,489 0 80,470,510 1,566,985 0 0 0 0 0 82,037,495 722,084 23,051 40 541,542,292 32,521,741 0 0 0 0 0 574,064,033 (6) 804,385 24,807 2,402,777,241 863,549,104 0 XXX XXX XXX 0 3,266,326,345 2,204,559 118,025 0 10,746,547,289 493,823,040 145 XXX XXX XXX 0 11,240,370,474 0 51,464,786 1,805,131 12,329,322,963 108,024,067 (80,382,360) 39,931,404 24,844,554 65,295,510 0 12,437,347,030 27,982,193 83,359,831 11,337,426 43,316,242,328 53,393,313 (159,832,769) 106,116,032 90,827,474 144,548,460 0 43,369,639,889 XXX XXX 27,982,193 83,359,831 11,337,426 43,316,242,328 53,393,313 (159,832,769) 106,116,032 90,827,474 144,548,460 0 43,369,639,889 Individual 6 Large Group Employer 11 2 Small Group Employer Individual 4 Expatriate Plans 10 Small Group Large Group Student Health Plans 0 XXX XXX XXX XXX XXX XXX XXX XXX 622,942 0 0 0 0 50,785,308 0 0 0 0 121,272,688 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,057,275 0 0 0 0 5,540,492 0 0 0 0 39,123,986 23,818,777 19,883,345 14,882,313 3,873,638 28,935,929 10,743,056 8,627,490 79,480,027 7,542,152 90,126,651 24,029,406 32,072,531 19,497,244 42,740,422 337,465,271 58,591,239 60,583,366 113,859,584 54,156,212 5,785,681 2,234,671 3,227,237 2,346,160 3,282,820 343,250,952 60,825,910 63,810,602 116,205,744 57,439,031 622,942 0.933 50,785,308 0.804 121,272,688 0.868 0 0.000 0 0.000 0 0.000 0 0.000 1,057,275 0.633 5,540,492 0.835 101,582,059 XXX 135,328,654 XXX 208,466,253 0.833 624,655,671 XXX 16,876,568 XXX 641,532,239 XXX 647,512 1,222,591 1,870,103 0.025 71,164,485 100,957,825 172,122,310 0.029 170,969,542 220,329,517 391,299,059 0.027 0 0 0 0.000 0 0 0 0.000 0 0 0 0.000 0 0 0 (2.000) 43,839 147,337 191,176 0.001 5,522,654 9,827,368 15,350,023 0.023 15,964,056 32,990,557 48,954,613 0.019 22,097,455 194,954,119 217,051,574 0.017 157,111,443 431,932,593 589,044,036 0.039 443,520,987 992,361,906 1,435,882,893 XXX 16,325,957 22,047,483 38,373,439 XXX 459,846,943 1,014,409,389 1,474,256,332 XXX SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 (Continued) Business Subject to MLR Mini-Med Plans Comprehensive Health Coverage 1 2 Small Group Employer Individual 10. General and Administrative (G&A) Expenses: 10.1 Direct sales salaries and benefits 10.2 Agents and brokers fees and commissions 10.3 Other taxes (excluding taxes on Lines 1.5 through 1.7 and Line 14 below) 10.4 Other general and administrative expenses 10.4a Community Benefit Expenditures (informational only) 10.5 Total general and administrative (Lines 10.1 +10.2 + 10.3 + 10.4) 3 Large Group Employer 4 5 Small Group Employer Individual 208,046 2,207,091 (91,835) 4,269,214 0 6,592,516 23,134,113 254,249,250 3,586,185 311,388,883 0 592,358,431 66,245,193 206,623,737 16,381,187 460,580,750 0 749,830,866 0 0 0 0 0 0 Expatriate Plans 6 Large Group Employer 0 0 0 0 0 0 7 8 Small Group 0 0 0 0 0 0 Student Health Plans Large Group 0 0 0 0 0 0 10 11 Government Business (excluded by statute) Other Health Business 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 9 0 8,310,286 1,085,302 29,403,649 0 38,799,236 3,989,247 15,014,453 993,553 34,572,685 0 54,569,938 2,777,350 14,085 2,810,345 219,238,948 0 224,840,729 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 25,114,532 461,925,764 21,474,029 1,202,006,407 0 1,710,520,732 31,528,997 235,790,665 24,118,662 810,602,542 0 1,102,040,866 152,997,478 1,184,135,331 70,357,427 3,072,063,077 0 4,479,553,313 2,270,206,716 7,791,934 34 1,483,407 42,606,188 0 51,881,563 160,789,412 1,184,135,364 71,840,835 3,114,669,265 0 4,531,434,876 XXX 2,150,421,081 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) (3,042,205) 420,160,601 619,996,589 44,053,321 (66,770,098) 300,296,967 946,078,923 12. Income from fees of uninsured plans XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 169,105,136 169,105,136 13. Net investment and other gain/(loss) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 769,748,944 XXX 769,748,944 14. Federal income taxes (excluding taxes on Line 1.5 above) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 11,318,312 XXX 11,318,312 15. Net gain or (loss) (Lines 11 + 12 + 13 - 14) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 3,028,637,348 XXX 3,077,956,849 16. ICD-10 Implementation Expenses (informational only; already included in general expenses and line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16. 16a ICD-10 Implementation Expenses (informational only; already included in line 10.4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6,800 667,214 1,773,602 0 0 0 0 632 348,552 257,008 10,151,999 4,770,633 17,976,440 162,533 18,138,973 11,616 1,172,717 3,215,270 0 0 0 0 31,944 359,124 257,019 14,907,821 4,770,633 24,726,144 189,492 24,915,636 119,229 34,393 0 0 0 632 470 5 129,571 423 284,723 1,486 286,209 13,761,614 39,199,688 0 0 0 384,695 4,135,606 3,036,511 178,858,195 57,495,837 297,010,102 2,266,012 299,276,114 0 0 0 0 9,432,616 OTHER INDICATORS: 216-2.GT 1. Number of certificates/policies 2. Number of Covered Lives 3. Number of Groups 4. Member Months XXX 137,956 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ XXX 0 ] If yes, show the amount of premiums and claims included. Premiums $ 0 Claims $ 0 AFFORDABLE CARE ACT (ACA) RECEIPTS, PAYMENTS, RECEIVABLES and PAYABLES Current Year Prior Year Comprehensive Health Coverage Comprehensive Health Coverage 1 2 3 4 Small Group Small Group Employer Plans Employer Plans Individual Plans Individual Plans ACA Receivables and Payables 1. Permanent ACA Risk Adjustment Program 1.0 Premium adjustments receivable/(payable) 2. Transitional ACA Reinsurance Program 2.0 Total amounts recoverable for claims (paid & unpaid) 41,674 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 0 0 0 0 40,008,432 2,318,310 2,599,025 XXX 2,096,822 1,450,753 (20,438,175) XXX 0 0 0 0 ACA Receipts and Payments 4. Permanent ACA Risk Adjustment Program 4.0 Premium adjustments receipts/(payments) 3,355,775 5. Transitional ACA Reinsurance Program 5.0 Amounts received for claims 1,409,080 6. Temporary ACA Risk Corridors Program 6.1 Retrospective premium received 6.2 Rate credits or policy experience refunds paid 0 0 XXX (8,663,574) 7,396,000 99 0 0 0 (1,146,604) XXX 0 34,243 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF 185 Asylum Street Hartford, CT 061033408 Grand Total DURING THE YEAR Comprehensive Health Coverage 1 2 3 Individual Small Group Employer Small Group Employer Individual Expatriate Plans: 7 8 6 Large Group Employer Small Group 10 11 Government Business (excluded by statute) Other Health Business 9 Student Health Plans Large Group 79413 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.GT Health Premiums Earned: 78,053,535 6,350,311,815 1.1 Direct premiums written 77,862 1,129,910 1.2 Unearned premium prior year 67,325 644,904 1.3 Unearned premium current year 10,537 485,006 1.4 Change in unearned premium (Lines 1.2 - 1.3) (729,479) 46,182,018 1.5 Paid rate credits 21,423 50,496,869 1.6 Reserve for rate credits current year 0 41,415,023 1.7 Reserve for rate credits prior year 21,423 9,081,846 1.8 Change in reserve for rate credits (Lines 1.6 - 1.7) 196,278 2,633,318 1.9 Premium balances written off 0 0 1.10 Group conversion charge 77,867,794 6,348,163,503 1.11 Total direct premiums earned (Lines 1.1 + 1.4 - 1.9 + 1.10) 0 0 1.12 Assumed premiums earned from non-affiliates 1,067,472 11,118,076 1.13 Net Assumed less Ceded premiums earned from affiliates 0 (1,707) 1.14 Ceded premiums earned to non-affiliates 196,278 2,633,318 1.15 Other Adjustments due to MLR calculation - Premiums 79,839,600 6,306,652,739 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 74,449,424 4,652,268,783 2.1 Paid claims during the year 1,833,690 627,674,257 2.2 Direct claim liability current year 2,733,760 561,132,826 2.3 Direct claim liability prior year 198,361 20,580,973 2.4 Direct claim reserves current year 269,041 15,545,123 2.5 Direct claim reserves prior year 9,085,555 0 2.6 Direct contract reserves current year 11,832,252 0 2.7 Direct contract reserves prior year (729,479) 46,182,018 2.8 Paid rate credits 21,423 50,496,869 2.9 Reserve for rate credits current year 0 41,415,023 2.10 Reserve for rate credits prior year 1,967 7,537,682 2.11 Incurred medical incentive pools and bonuses (Lines 2.11a + 2.11b - 2.11c) 2,238 5,805,173 2.11a Paid medical incentive pools and bonuses current year 664 9,329,966 2.11b Accrued medical incentive pools and bonuses current year 935 7,597,456 2.11c Accrued medical incentive pools and bonuses prior year (100,486) 10,892,177 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 102,991 135,721,053 2.12a Healthcare receivables current year 203,476 124,828,876 2.12b Healthcare receivables prior year 0 0 2.13 Group conversion charge 0 0 2.14 Multi-option coverage blended rate adjustment 2.15 Total incurred claims (Lines 2.1 + 2.2 - 2.3 + 2.4 - 2.5 + 2.6 - 2.7 + 2.8 + 2.9 70,126,373 4,775,755,434 2.10 + 2.11 - 2.12 + 2.13 + 2.14) 0 0 2.16 Assumed incurred claims from non-affiliates 854,595 10,534,852 2.17 Net assumed less ceded incurred claims from affiliates 11,693 (3) 2.18 Ceded incurred claims to non-affiliates 0 0 2.19 Other adjustments due to MLR calculation - Claims 71,677,331 4,731,026,423 2.20 Net Incurred Claims (Lines 2.15 - 2.8 - 2.9 + 2.10 + 2.16 + 2.17 - 2.18 + 2.19) 3. Fraud and Abuse Recoveries that Reduced PAID Claims in Line 2.1 above 1,203 3,627,201 (informational only) 906,541,195 for stand-alone dental and $ (a) Column 13, Line 1.1 includes direct written premium of $ Large Group Employer 4 Business Subject to MLR Mini-Med Plans 5 (LOCATION) NAIC Company Code 2018 15,172,835,347 (543,562) 37,646 (581,208) 16,943,970 78,302,407 59,756,750 18,545,657 13,168,156 0 15,159,085,983 97,012,331 340,612,497 2,057,810,309 13,168,156 13,516,579,031 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 132,161,128 0 0 0 0 0 0 0 1,727 0 132,159,401 0 2,640,920 0 1,727 134,802,048 716,540,489 224,427,367 248,406,377 (23,979,010) 0 2,834,678 0 2,834,678 0 0 692,561,479 12,774,339 23,302,597 (2,261,589) 0 728,065,326 2,601,121,042 0 0 0 (1,057,949) 11,982,530 14,429,463 (2,446,934) 2,063,283 0 2,599,057,759 0 1,034,038,909 0 2,063,283 3,638,664,834 13,322,256,496 4,488,070 6,643,093 (2,155,023) (59,233,578) 1,703,779,322 1,720,535,645 (16,756,322) (167,693) 0 13,320,269,166 11,545,988 631,379,390 22,931,919 (167,693) 14,016,084,832 15,757,921,844 0 0 0 243,939,270 126,452,971 238,999,444 (112,546,473) 47,036,077 0 15,710,885,767 0 176,806,029 0 47,036,077 15,803,335,076 54,131,201,696 229,579,647 255,799,345 (26,219,698) 246,044,252 1,973,870,199 2,075,136,325 (101,266,125) 64,931,146 0 54,040,050,853 121,332,658 2,220,965,889 2,078,478,932 64,931,146 54,224,023,487 12,272,299,166 1,542,933,945 1,521,586,213 31,307,555 31,908,158 0 3,808 16,943,970 78,302,407 59,756,750 23,326,445 13,393,047 35,841,563 25,908,165 (17,841,668) 332,007,036 349,848,704 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 80,266,360 19,623,252 19,365,846 265,678 234,308 0 0 0 0 0 83,489 34,561 147,741 98,813 168,116 866,050 697,935 0 0 535,736,429 99,550,684 95,580,258 11,357 5,055 0 0 0 2,834,678 0 23,051 3,484 24,264 4,697 1,028,594 9,503,359 8,474,765 0 0 2,372,930,753 209,516,951 180,939,376 705,679 763,653 0 0 (1,057,949) 11,982,530 14,429,463 804,385 575,184 647,767 418,566 (4,027,385) 6,004,945 10,032,330 0 0 10,688,777,192 1,188,437,588 1,137,171,090 502,911,926 482,756,607 659,668,156 598,902,096 (59,233,578) 1,703,779,322 1,720,535,645 118,025 119,528 453 1,956 (1,454,094) 396,542 1,850,636 0 0 12,274,201,526 1,227,674,507 1,375,075,202 5,748,121 2,309,508 0 6 243,939,270 126,452,971 238,999,444 51,464,786 51,642,809 50,324,217 50,502,241 (16,225,943) 1,634,770,048 1,650,995,991 0 0 42,950,929,633 4,917,244,875 4,893,584,570 561,729,650 533,791,454 668,753,712 610,738,162 246,044,252 1,973,870,199 2,075,136,325 83,359,831 71,576,024 96,316,635 84,532,828 (27,560,689) 2,119,372,025 2,146,932,713 0 0 12,369,700,227 82,740,953 262,807,911 1,803,018,243 0 10,876,741,221 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 80,470,510 0 1,567,389 404 0 82,037,495 541,542,292 9,190,277 21,167,562 (2,163,902) 0 571,229,355 2,402,777,242 0 863,549,104 0 0 3,269,831,228 10,746,547,289 9,982,623 496,552,991 12,712,574 0 11,316,360,229 12,329,322,963 0 108,024,067 0 0 12,305,954,233 43,316,242,330 101,913,854 1,765,058,470 1,813,579,010 0 43,224,857,516 6,427,869 0 0 366,191,257 for stand-alone vision policies. 0 0 0 33,573 0 2,936,317 13,026,203 40 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0707 (To Be Filed by April 1 - Not for Rebate Purposes) 2. UnitedHealthcare Insurance Company BUSINESS IN THE STATE OF Grand Total DURING THE YEAR All Expenses 1 Improve Health Outcomes 1. Individual Comprehensive Coverage Expenses: 1,930,066 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 115,036 for affiliated services) 1.3 EDP Equipment and Software (incl $ 11,042 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 1,201 for affiliated services) 1.5 Accreditation and Certification (incl $ 3,516,911 for affiliated services) 1.6 Other Expenses (incl $ 1.7 Subtotal before Reimbursements and Taxes (Lines 1.1 to 1.6) 1.8 Reimbursements by uninsured plans and fiscal intermediaries 1.9 Taxes, Licenses and Fees (in total, for tying purposes) 1.10 Total (1.7 to 1.9) 1.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 2. 216-4.GT Small Group Comprehensive Coverage Expenses: 186,202,423 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 13,188,062 for affiliated services) 2.3 EDP Equipment and Software (incl $ 1,265,899 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 137,454 for affiliated services) 2.5 Accreditation and Certification (incl $ 301,901,237 for affiliated services) 2.6 Other Expenses (incl $ 2.7 Subtotal before Reimbursements and Taxes (Lines 2.1 to 2.6) 2.8 Reimbursements by uninsured plans and fiscal intermediaries 2.9 Taxes, Licenses and Fees (in total, for tying purposes) 2.10 Total (2.7 to 2.9) 2.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 3. Large Group Comprehensive Coverage Expenses: 283,125,649 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 18,820,456 for affiliated services) 3.3 EDP Equipment and Software (incl $ 1,806,539 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 196,153 for affiliated services) 3.5 Accreditation and Certification (incl $ 768,434,108 for affiliated services) 3.6 Other Expenses (incl $ 3.7 Subtotal before Reimbursements and Taxes (Lines 3.1 to 3.6) 3.8 Reimbursements by uninsured plans and fiscal intermediaries 3.9 Taxes, Licenses and Fees (in total, for tying purposes) 3.10 Total (3.7 to 3.9) 3.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 185 Asylum Street Hartford, CT 061033408 0 0 0 0 0 622,942 622,942 0 XXX Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 XXX 0 0 0 0 XXX 0 0 0 XXX 0 0 0 0 XXX 0 0 0 Total (1 to 5) 0 0 0 0 0 622,942 622,942 0 XXX 0 0 0 0 0 0 622,942 0 628,296 163,500 XXX 1,201,740 0 0 0 0 0 0 50,785,308 50,785,308 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 50,785,308 50,785,308 0 23,154,515 7,446,023 1,933,510 185,594 20,152 36,268,570 69,008,364 60 36,106,346 4,137,930 3,015,048 289,409 31,424 55,082,910 98,663,068 582 0 0 0 0 0 121,272,688 121,272,688 0 XXX 121,272,688 0 XXX 0 0 0 XXX XXX XXX 0 0 0 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 50,785,308 0 XXX 69,008,425 18,635,290 XXX 98,663,649 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 121,272,688 121,272,688 0 39,055,722 15,931,028 3,261,335 313,050 33,991 107,176,760 165,771,886 932 55,043,520 6,339,107 4,596,391 441,199 47,905 149,390,866 215,858,989 3,449 XXX 165,772,818 48,043,514 XXX 215,862,437 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 XXX XXX 421,937 34,689 24,962 2,396 260 717,542 1,201,787 (47) 0 0 XXX XXX 0 0 0 177,353 34,840 14,810 1,422 154 399,721 628,300 (5) 622,942 0 XXX 50,785,308 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 0 0 0 0 0 0 0 (LOCATION) NAIC Company Code 2018 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 121,272,688 0 79413 9 10 General Administrative Expenses Total Expenses (6 to 9) 1,330,771 108,313 75,262 6,657 784 5,148,005 6,669,793 0 1,152,957 7,822,750 0 1,930,062 177,842 115,035 10,474 1,199 6,888,211 9,122,823 (52) 1,152,957 10,275,728 163,500 126,941,560 14,414,520 8,239,500 790,895 85,875 436,664,013 587,136,364 5 91,519,195 678,655,565 0 186,202,421 25,998,474 13,188,058 1,265,899 137,451 578,800,801 805,593,104 647 91,519,195 897,112,946 18,635,290 189,026,408 20,347,767 10,962,726 1,052,293 114,258 507,477,275 728,980,726 22,912 237,712,746 966,716,385 0 283,125,651 42,617,901 18,820,451 1,806,542 196,154 885,317,589 1,231,884,289 27,293 237,712,746 1,469,624,328 48,043,514 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 4. 5. 216-5.GT 6. Individual Mini-Med Plans Expenses: 0 for affiliated services) 4.1 Salaries (including $ 4.2 Outsourced Services 0 for affiliated services) 4.3 EDP Equipment and Software (incl $ 0 for affiliated services) 4.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 4.5 Accreditation and Certification (incl $ 0 for affiliated services) 4.6 Other Expenses (incl $ 4.7 Subtotal before Reimbursements and Taxes (Lines 4.1 to 4.6) 4.8 Reimbursements by uninsured plans and fiscal intermediaries 4.9 Taxes, Licenses and Fees (in total, for tying purposes) 4.10 Total (4.7 to 4.9) 4.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Small Group Mini-Med Plans Expenses: 0 for affiliated services) 5.1 Salaries (including $ 5.2 Outsourced Services 0 for affiliated services) 5.3 EDP Equipment and Software (incl $ 0 for affiliated services) 5.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 5.5 Accreditation and Certification (incl $ 0 for affiliated services) 5.6 Other Expenses (incl $ 5.7 Subtotal before Reimbursements and Taxes (Lines 5.1 to 5.6) 5.8 Reimbursements by uninsured plans and fiscal intermediaries 5.9 Taxes, Licenses and Fees (in total, for tying purposes) 5.10 Total (5.7 to 5.9) 5.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Mini-Med Plans Expenses: 0 for affiliated services) 6.1 Salaries (including $ 6.2 Outsourced Services 0 for affiliated services) 6.3 EDP Equipment and Software (incl $ 0 for affiliated services) 6.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 6.5 Accreditation and Certification (incl $ 0 for affiliated services) 6.6 Other Expenses (incl $ 6.7 Subtotal before Reimbursements and Taxes (Lines 6.1 to 6.6) 6.8 Reimbursements by uninsured plans and fiscal intermediaries 6.9 Taxes, Licenses and Fees (in total, for tying purposes) 6.10 Total (6.7 to 6.9) 6.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 7. 8. Small Group Expatriate Plans Expenses: 0 for affiliated services) 7.1 Salaries (including $ 7.2 Outsourced Services 0 for affiliated services) 7.3 EDP Equipment and Software (incl $ 0 for affiliated services) 7.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 7.5 Accreditation and Certification (incl $ 0 for affiliated services) 7.6 Other Expenses (incl $ 7.7 Subtotal before Reimbursements and Taxes (Lines 7.1 to 7.6) 7.8 Reimbursements by uninsured plans and fiscal intermediaries 7.9 Taxes, Licenses and Fees (in total, for tying purposes) 7.10 Total (7.7 to 7.9) 7.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Large Group Expatriate Plans Expenses: 8,518,248 for affiliated services) 8.1 Salaries (including $ 8.2 Outsourced Services 711,313 for affiliated services) 8.3 EDP Equipment and Software (incl $ 68,278 for affiliated services) 8.4 Other Equipment (excl. EDP) (incl $ 7,414 for affiliated services) 8.5 Accreditation and Certification (incl $ 19,598,134 for affiliated services) 8.6 Other Expenses (incl $ 216-6.GT 8.7 Subtotal before Reimbursements and Taxes (Lines 8.1 to 8.6) 8.8 Reimbursements by uninsured plans and fiscal intermediaries 8.9 Taxes, Licenses and Fees (in total, for tying purposes) 8.10 Total (8.7 to 8.9) 8.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) 9. Student Health Plans Expenses: 17,060,918 for affiliated services) 9.1 Salaries (including $ 9.2 Outsourced Services 1,103,525 for affiliated services) 9.3 EDP Equipment and Software (incl $ 105,925 for affiliated services) 9.4 Other Equipment (excl. EDP) (incl $ 11,501 for affiliated services) 9.5 Accreditation and Certification (incl $ 33,113,789 for affiliated services) 9.6 Other Expenses (incl $ 9.7 Subtotal before Reimbursements and Taxes (Lines 9.1 to 9.6) 9.8 Reimbursements by uninsured plans and fiscal intermediaries 9.9 Taxes, Licenses and Fees (in total, for tying purposes) 9.10 Total (9.7 to 9.9) 9.11 Total Fraud and Abuse Detection/Recovery Expenses included in Column 7 (informational only) Improving Health Care Quality Expenses 3 4 5 Improve Wellness & Patient Safety Health HIT and Reduce Promotion Expenses Medical Errors Activities 2 Activities to Prevent Hospital Readmissions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 12,731 1,459 42,786 4,903 8,462,731 971,050 8,518,248 977,413 0 0 0 1,057,275 1,057,275 0 0 0 0 0 0 0 0 0 0 0 0 1,057,275 1,057,275 0 1,063 102 11 28,473 43,839 0 3,573 343 37 95,694 147,337 0 706,677 67,833 7,365 27,498,278 37,713,934 0 1,981,491 39,695,425 0 711,313 68,278 7,414 28,679,721 38,962,386 0 1,981,491 40,943,876 81 12,736,282 1,020,596 742,398 71,261 7,738 38,799,939 53,378,213 0 11,932,485 65,310,699 0 17,060,918 1,520,099 1,103,525 105,925 11,501 54,013,408 73,815,376 0 11,932,485 85,747,861 103,357 XXX 1,057,275 0 0 0 0 0 0 5,540,492 5,540,492 0 XXX 5,540,492 0 XXX XXX XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 XXX 0 0 0 XXX 0 0 0 0 0 0 0 0 XXX XXX 0 0 0 0 0 0 0 0 Total Expenses (6 to 9) 0 0 XXX XXX 0 0 0 0 0 0 0 General Administrative Expenses 0 0 XXX 0 0 0 0 0 0 0 10 0 0 XXX 0 0 0 0 Total (1 to 5) 9 0 0 0 0 0 0 0 0 0 0 0 XXX 0 0 0 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 XXX XXX XXX 0 0 0 0 0 0 0 0 1,057,275 0 43,839 81 147,337 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5,540,492 5,540,492 0 1,548,787 181,385 129,331 12,414 1,348 3,464,607 5,337,872 0 2,775,849 318,118 231,796 22,250 2,416 6,208,370 9,558,798 0 5,540,492 0 XXX 5,337,872 103,357 XXX 9,558,798 0 XXX XXX 0 0 0 XXX XXX 0 0 0 XXX 0 0 XXX 0 0 0 XXX 0 0 0 0 0 XXX 0 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 *79413201828500100* SUPPLEMENTAL INVESTMENT RISKS INTERROGATORIES For The Year Ended December 31, 2018 (To Be Filed by April 1) Of The UnitedHealthcare Insurance Company ADDRESS (City, State and Zip Code) NAIC Group Code Hartford , CT 06103-3408 0707 NAIC Company Code 79413 36-2739571 Federal Employer's Identification Number (FEIN) The Investment Risks Interrogatories are to be filed by April 1. They are also to be included with the Audited Statutory Financial Statements. Answer the following interrogatories by reporting the applicable U.S. dollar amounts and percentages of the reporting entity’s total admitted assets held in that category of investments. 1. Reporting entity’s total admitted assets as reported on Page 2 of this annual statement. 2. Ten largest exposures to a single issuer/borrower/investment. 20,752,474,121 $ 1 2 3 Issuer Description of Exposure Amount 2.01 UHC Liquidity Pool $ 2,292,412,303 11.0 % 2.02 Oxford Health Insurance, Inc Common Common Stocks Stock $ 1,350,114,222 6.5 % 2.03 UnitedHealthcare Ins Co of NY Common Common Stocks Stock $ 606,521,436 2.9 % 2.04 FNMA Bonds $ 524,379,438 2.5 % 2.05 FHLMC Bonds $ 452,488,779 2.2 % 2.06 UnitedHealthcare Ins Co of IL Common Common Stocks Stock $ 163,863,016 0.8 % 2.07 UnitedHealthcare of New Mexico, Inc Common Stocks Common Stock $ 161,455,498 0.8 % 2.08 GOLDMAN SACHS GP Bonds $ 72,355,127 0.3 % 2.09 MORGAN STANLEY Bonds $ 67,229,636 0.3 % 2.10 BANK OF AMERICA Bonds $ 64,673,437 0.3 % 3. Bonds 4 Percentage of Total Admitted Assets Amounts and percentages of the reporting entity’s total admitted assets held in bonds and preferred stocks by NAIC designation. Bonds 1 2 Preferred Stocks 3 4 3.01 NAIC-1 $ 9,404,302,777 45.3 % 3.07 P/RP-1 $ 0 0.0 % 3.02 NAIC-2 $ 1,286,294,359 6.2 % 3.08 P/RP-2 $ 16,577,158 0.1 % 3.03 NAIC-3 $ 384,231,916 1.9 % 3.09 P/RP-3 $ 918,500 0.0 % 3.04 NAIC-4 $ 215,723,440 1.0 % 3.10 P/RP-4 $ 0 0.0 % 3.05 NAIC-5 $ 192,889 0.0 % 3.11 P/RP-5 $ 0 0.0 % 3.06 NAIC-6 $ 0 0.0 % 3.12 P/RP-6 $ 0 0.0 % 4. 4.01 Assets held in foreign investments: Yes [ Are assets held in foreign investments less than 2.5% of the reporting entity’s total admitted assets? ] No [ X ] If response to 4.01 above is yes, responses are not required for interrogatories 5 - 10. 4.02 Total admitted assets held in foreign investments $ 950,326,684 4.6 % 4.03 Foreign-currency-denominated investments $ 0 0.0 % 4.04 Insurance liabilities denominated in that same foreign currency $ 0 0.0 % 285 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company 5. Aggregate foreign investment exposure categorized by NAIC sovereign designation: 1 5.01 5.02 5.03 6. Countries designated NAIC-1 Countries designated NAIC-2 Countries designated NAIC-3 or below $ $ $ 2 928,776,108 21,550,576 0 4.5 % 0.1 % 0.0 % Largest foreign investment exposures by country, categorized by the country’s NAIC sovereign designation: 1 2 Countries designated NAIC - 1: 6.01 6.02 Country 1: CAYMAN ISLANDS Country 2: UNITED KINGDOM Countries designated NAIC - 2: $ $ 192,390,486 142,722,794 0.9 % 0.7 % 6.03 6.04 Country 1: MEXICO Country 2: ITALY Countries designated NAIC - 3 or below: $ $ 10,899,054 9,834,958 0.1 % 0.0 % 6.05 6.06 Country 1: Country 2: $ $ 0 0 0.0 % 0.0 % 7. Aggregate unhedged foreign currency exposure $ 8. Aggregate unhedged foreign currency exposure categorized by NAIC sovereign designation: 1 2 0 1 8.01 8.02 8.03 9. Countries designated NAIC-1 Countries designated NAIC-2 Countries designated NAIC-3 or below 0.0 % 2 0 0 0 $ $ $ 0.0 % 0.0 % 0.0 % Largest unhedged foreign currency exposures by country, categorized by the country’s NAIC sovereign designation: 1 2 Countries designated NAIC - 1: 9.01 9.02 Country 1: Country 2: Countries designated NAIC - 2: $ $ 0 0 0.0 % 0.0 % 9.03 9.04 Country 1: Country 2: Countries designated NAIC - 3 or below: $ $ 0 0 0.0 % 0.0 % 9.05 9.06 Country 1: Country 2: $ $ 0 0 0.0 % 0.0 % 10. Ten largest non-sovereign (i.e. non-governmental) foreign issues: 1 Issuer 10.01 10.02 10.03 10.04 10.05 10.06 10.07 10.08 10.09 10.10 HSBC HOLDINGS Sumitomo Mitsui Banking Corp LLOYDS BK GR PLC MIZUHO BANK LTD SVENSKA HANDELSBANKEN NY UBS GROUP FUNDIN NORDEA BANK AB BNP Paribas ING BANK NV BANQ FED CRD MUT 2 NAIC Designation 1 1 1 1 1 1 1 1 1 1 3 $ $ $ $ $ $ $ $ $ $ 285.1 28,534,366 28,130,034 18,523,911 18,407,199 17,201,036 17,180,252 14,879,464 13,556,991 13,313,290 12,484,153 4 0.1 0.1 0.1 0.1 0.1 0.1 0.1 0.1 0.1 0.1 % % % % % % % % % % SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company 11. Amounts and percentages of the reporting entity’s total admitted assets held in Canadian investments and unhedged Canadian currency exposure: 11.01 Are assets held in Canadian investments less than 2.5% of the reporting entity’s total admitted assets? Yes [ X ] No [ ] If response to 11.01 is yes, detail is not required for the remainder of interrogatory 11. 1 11.02 11.03 11.04 11.05 12. Total admitted assets held in Canadian investments Canadian-currency-denominated investments Canadian-denominated insurance liabilities Unhedged Canadian currency exposure 2 0 0 0 0 $ $ $ $ 0.0 0.0 0.0 0.0 % % % % Report aggregate amounts and percentages of the reporting entity’s total admitted assets held in investments with contractual sales restrictions: Yes [ X ] No [ 12.01 Are assets held in investments with contractual sales restrictions less than 2.5% of the reporting entity’s total admitted assets? ] If response to 12.01 is yes, responses are not required for the remainder of Interrogatory 12. 1 12.02 Aggregate statement value of investments with contractual sales restrictions Largest three investments with contractual sales restrictions: $ 0 0.0 % 12.03 12.04 12.05 $ $ $ 0 0 0 0.0 % 0.0 % 0.0 % 13. 2 3 Amounts and percentages of admitted assets held in the ten largest equity interests: Yes [ 13.01 Are assets held in equity interests less than 2.5% of the reporting entity’s total admitted assets? ] No [ X ] If response to 13.01 above is yes, responses are not required for the remainder of Interrogatory 13. 1 Issuer 13.02 13.03 13.04 13.05 13.06 13.07 13.08 13.09 13.10 13.11 2 Oxford Health Insurance, Inc Common Stock UnitedHealthcare Ins Co of NY Common Stock UnitedHealthcare Ins Co of IL Common Stock UnitedHealthcare of New Mexico, Inc Common Stock Unimerica Life Ins Co of New York Common Stock PEPSICO INC Common Stock McDonalds Corporation Common Stock COCA-COLA CO/THE Common Stock JOHNSON&JOHNSON Common Stock MICROSOFT CORP Common Stock $ $ $ $ $ $ $ $ $ $ 285.2 1,350,114,222 606,521,436 163,863,016 161,455,498 22,611,920 11,730,435 11,721,396 11,326,451 11,198,830 9,912,115 3 6.5 2.9 0.8 0.8 0.1 0.1 0.1 0.1 0.1 0.0 % % % % % % % % % % SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company 14. Amounts and percentages of the reporting entity’s total admitted assets held in nonaffiliated, privately placed equities: Yes [ X ] No [ 14.01 Are assets held in nonaffiliated, privately placed equities less than 2.5% of the reporting entity’s total admitted assets? ] If response to 14.01 above is yes, responses are not required for the remainder of Interrogatory 14. 1 14.02 Aggregate statement value of investments held in nonaffiliated, privately placed equities Largest three investments held in nonaffiliated, privately placed equities: $ 0 0.0 % 14.03 14.04 14.05 $ $ $ 0 0 0 0.0 % 0.0 % 0.0 % 15. 2 3 Amounts and percentages of the reporting entity’s total admitted assets held in general partnership interests: Yes [ X ] No [ 15.01 Are assets held in general partnership interests less than 2.5% of the reporting entity’s total admitted assets? If response to 15.01 above is yes, responses are not required for the remainder of Interrogatory 15. 1 2 ] 3 15.02 Aggregate statement value of investments held in general partnership interests Largest three investments in general partnership interests: $ 0 0.0 % 15.03 15.04 15.05 $ $ $ 0 0 0 0.0 % 0.0 % 0.0 % 16. Amounts and percentages of the reporting entity's total admitted assets held in mortgage loans: Yes [ X ] No [ 16.01 Are mortgage loans reported in Schedule B less than 2.5% of the reporting entity’s total admitted assets? ] If response to 16.01 above is yes, responses are not required for the remainder of Interrogatory 16 and Interrogatory 17. 1 Type (Residential, Commercial, Agricultural) 2 16.02 16.03 16.04 16.05 16.06 16.07 16.08 16.09 16.10 16.11 $ $ $ $ $ $ $ $ $ $ 285.3 3 0 0 0 0 0 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 % % % % % % % % % % SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company Amount and percentage of the reporting entity's total admitted assets held in the following categories of mortgage loans: Loans 16.12 Construction loans $ 16.13 16.14 16.15 16.16 $ $ $ $ 17. Mortgage loans over 90 days past due Mortgage loans in the process of foreclosure Mortgage loans foreclosed Restructured mortgage loans Residential 18. 0.0 0.0 0.0 0.0 0.0 % 0.0 0.0 0.0 0.0 0.0 % % % % % % % % % Aggregate mortgage loans having the following loan-to-value ratios as determined from the most current appraisal as of the annual statement date: Loan to Value 17.01 17.02 17.03 17.04 17.05 0 0 0 0 0 above 95% 91 to 95% 81 to 90% 71 to 80% below 70% 1 $ $ $ $ $ Commercial 2 0 0 0 0 0 3 0.0 0.0 0.0 0.0 0.0 % % % % % 0 0 0 0 0 $ $ $ $ $ Agricultural 4 5 0.0 0.0 0.0 0.0 0.0 % % % % % 6 0 0 0 0 0 $ $ $ $ $ Amounts and percentages of the reporting entity’s total admitted assets held in each of the five largest investments in real estate: Yes [ X ] No [ 18.01 Are assets held in real estate reported less than 2.5% of the reporting entity’s total admitted assets? ] If response to 18.01 above is yes, responses are not required for the remainder of Interrogatory 18. Largest five investments in any one parcel or group of contiguous parcels of real estate. Description 1 19. 2 3 0 0 0 0 0 $ $ $ $ $ 18.02 18.03 18.04 18.05 18.06 0.0 0.0 0.0 0.0 0.0 % % % % % Report aggregate amounts and percentages of the reporting entity’s total admitted assets held in investments held in mezzanine real estate loans: Yes [ X ] No [ 19.01 Are assets held in investments held in mezzanine real estate loans less than 2.5% of the reporting entity’s total admitted assets? If response to 19.01 is yes, responses are not required for the remainder of Interrogatory 19. 1 2 ] 3 19.02 Aggregate statement value of investments held in mezzanine real estate loans: Largest three investments held in mezzanine real estate loans: $ 0 0.0 % 19.03 19.04 19.05 $ $ $ 0 0 0 0.0 % 0.0 % 0.0 % 285.4 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company 20. Amounts and percentages of the reporting entity’s total admitted assets subject to the following types of agreements: At Year End 1 20.01 Securities lending agreements (do not include assets held as collateral for such transactions) 20.02 Repurchase agreements 20.03 Reverse repurchase agreements 20.04 Dollar repurchase agreements 20.05 Dollar reverse repurchase agreements 21. 2 0 0 0 0 0 $ $ $ $ $ At End of Each Quarter 2nd Quarter 4 1st Quarter 3 0.0 0.0 0.0 0.0 0.0 % % % % % 0 0 0 0 0 $ $ $ $ $ 0 0 0 0 0 $ $ $ $ $ Owned 21.01 Hedging 21.02 Income generation 21.03 Other Written 2 $ $ $ 3 0 0 0 0.0 % 0.0 % 0.0 % Hedging Income generation Replications Other 2 0 0 0 0 $ $ $ $ At End of Each Quarter 2nd Quarter 4 1st Quarter 3 0.0 0.0 0.0 0.0 % % % % 0 0 0 0 $ $ $ $ $ $ $ $ 0 0 0 0 3rd Quarter 5 0 0 0 0 $ $ $ $ Amounts and percentages of the reporting entity's total admitted assets of potential exposure for futures contracts: At Year End 1 23.01 23.02 23.03 23.04 0.0 % 0.0 % 0.0 % Amounts and percentages of the reporting entity's total admitted assets of potential exposure for collars, swaps, and forwards: 1 23. 4 0 0 0 $ $ $ At Year End 22.01 22.02 22.03 22.04 0 0 0 0 0 $ $ $ $ $ Amounts and percentages of the reporting entity's total admitted assets for warrants not attached to other financial instruments, options, caps, and floors: 1 22. 3rd Quarter 5 Hedging Income generation Replications Other $ $ $ $ 2 0 0 0 0 0.0 0.0 0.0 0.0 285.5 At End of Each Quarter 2nd Quarter 4 1st Quarter 3 % % % % $ $ $ $ 0 0 0 0 $ $ $ $ 0 0 0 0 $ $ $ $ 3rd Quarter 5 0 0 0 0 *79413201829001100* LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Alabama 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 3.501. 3.502. 3.503. 3.598. 3.599. 0601. 0602. 0603. 0698. 0699. 0901. 0902. 0903. 0998. 0999. PREMIUMS, CONSIDERATIONS AND DEPOSITS Premiums, considerations and deposits from Schedule T or Exhibit of Premiums and Losses Premiums, considerations and deposits NOT reported in Schedule T or Exhibit of Premiums and Losses, including investment contract receipts credited to a liability account 2.1 Contract fees for variable contracts with guarantees 2.2 Any other premiums, considerations and deposits not reported in Schedule T or Exhibit of Premiums and Losses Amounts, if applicable, that were deducted prior to determining amounts included in Lines 1 or 2 which are in the following categories: 3.1 Transfers to guaranteed Separate Accounts 3.2 Roll over of GICs or annuities into other companies 3.3 Surrenders or other benefits paid out 3.4 Excess interest credited to accounts 3.5 Aggregate write-ins for other amounts deducted prior to determining amounts included in Lines 1 or 2 3.99 Total (Lines 3.1 through 3.5) Transfers: 4.1 Enter in Column 2, as a negative number, and Column 4, as a positive number, the total of all amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, that are included in Column 2, Lines 1, 2 and 3.99 4.2 Enter in Column 2, as a positive number, and Column 4, as a negative number, any amounts reported in Column 4, Lines 1, 2 and 3.99 that are allocated. (Note: amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, should not be included in line 4.2) 4.3 Enter in Column 4, as a positive number, and Column 2, as a negative number, any amounts reported in Column 2, Lines 1, 2 and 3.99 that are unallocated 4.99 Total (Lines 4.1 + 4.2 + 4.3) Total (Lines 1 + 2 + 3.99 + 4.99) 1 2 3 Life Insurance Premiums Annuity Considerations A & H Premiums 4 Deposit-Type Contract Funds and Other Considerations 731,135 0 407,200,399 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 731,135 0 407,200,399 DEVELOPMENT OF AMOUNTS INCLUDED IN LINES 1 THROUGH 5 THAT SHOULD BE DEDUCTED IN DETERMINING THE BASE Do not include any amount more than once in Lines 6 through 9 Aggregate write-ins for amounts where the insurer is not subject to risk. Premiums for portions of policies or contracts NOT guaranteed or under which the entire investment risk is borne by the policyholder. (Please specify such deductions and indicate where such amounts were reported in the Annual Statement) Amounts NOT allocated to individuals or individual certificate holders or amounts received for such contracts in excess of limits: 7.1 Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans 7.2 Unallocated funding obligations that fund any employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation 7.3 Unallocated funding obligations that fund governmental lotteries or employee, union, or association of natural persons benefit plans in excess of $5 million per contract which are NOT: (a) government retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation 7.4 Total (Lines 7.1 + 7.2 + 7.3) Dividends/Experience rating credits paid or credited, but only if NOT guaranteed in advance (include only amounts NOT already deducted in determining Lines 1 and 2) Aggregate write-ins for Other Deductions Total (Lines 6 + 7.4 + 8 + 9) Current Year DETAILS OF WRITE-INS 0 0 0 0 0 0 0 XXX XXX XXX 0 XXX XXX XXX 0 XXX XXX XXX XXX XXX XXX 0 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 731,135 0 0 0 0 85,914,203 85,914,203 0 0 0 0 321,286,196 0 Summary of remaining write-ins for Line 3.5 from overflow page Totals (Lines 3.501 thru 3.503 plus 3.598)(Line 3.5 above) 0 0 0 0 0 0 0 0 Summary of remaining write-ins for Line 6 from overflow page Totals (Lines 0601 thru 0603 plus 0698)(Line 6 above) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 83,452,922 2,461,281 0 0 85,914,203 0 0 0 0 0 0 0 Medicare Part C & D Stop Loss Medicaid Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.AL *79413201830001100* ADJUSTMENTS TO THE LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Alabama 1 2 Allocated Annuity and Other Allocated Fund Deposits Life Insurance Premiums 4 Unallocated Annuity & Other Unallocated Fund Deposits Accident & Health Premium 731,135 0 321,286,196 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. MODEL ACT BASE ( Line 11 of the Reconciliation Exhibit) 2. Enter in Column 2, as a positive number, and Column 4, as a negative number, the total of all amounts received to fund allocated contracts established under Section 403(b) of the U.S. Internal Revenue Code that are included in Column 4, Line 1 above 3. Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans: 4. 3 0 XXX 0 XXX 0 3.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 3.2 All amounts XXX XXX XXX 0 0 4.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 0 4.2 Amounts in excess of $1 million but NOT in excess of $5 million per contract XXX XXX XXX 4.3 Amounts in excess of $5 million per contract XXX XXX XXX 4.4 Total (Lines 4.1 + 4.2 + 4.3) XXX XXX XXX 4.5 Amounts up to $7.5 million, per contract (Minnesota only) XXX XXX XXX 0 0 0 0 5.1 Amounts in excess of $1 million per contract XXX XXX XXX 5.2 All amounts XXX XXX XXX 5.3 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 5.4 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 6.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 6.2 Amounts in excess of $1 million per contract XXX XXX XXX 6.3 Total (Lines 6.1 + 6.2) XXX XXX XXX 6.4 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 6.5 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 7.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 7.2 All amounts XXX XXX XXX Unallocated funding obligations issued to fund government lotteries or employee, union, or association of natural persons benefit plans which are NOT: (a) governmental retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation: 5. 6. 7. Unallocated funding obligations issued to fund governmental retirement plans established under Sections 401 and 457 of the U.S. Internal Revenue Code: 0 0 0 0 Unallocated funding obligations issued to fund governmental retirement plans established under Sections 403(b) of the U.S. Internal Revenue Code: 0 0 0 0 0 Unallocated funding obligations that fund employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation: 7.3 Amounts NOT in excess of $2 million per contract (New Jersey only) XXX XXX XXX 0 0 0 8. Unallocated funding obligations issued to fund government lotteries NOT in excess of $5 million per contractholder (New Jersey Only) XXX XXX XXX 0 9. Unallocated funding obligations that fund employee or association of natural persons benefit plans in excess of $2 million but NOT in excess of $5 million per contract (New Jersey Only) XXX 10. Aggregate write-ins for other deductions 0 0 0 0 0 731,135 0 321,286,196 0 0 0 0 0 0 0 0 0 XXX XXX BASE 11. Current Year (2018) DETAILS OF WRITE-INS 1001. 1002. 1003. 1098. Summary of remaining write-ins for Line 10 from overflow page 1099. Totals (Lines 1001 thru 1003 plus 1098)(Line 10 above) 300.AL *79413201829002100* LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Alaska 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 3.501. 3.502. 3.503. 3.598. 3.599. 0601. 0602. 0603. 0698. 0699. 0901. 0902. 0903. 0998. 0999. PREMIUMS, CONSIDERATIONS AND DEPOSITS Premiums, considerations and deposits from Schedule T or Exhibit of Premiums and Losses Premiums, considerations and deposits NOT reported in Schedule T or Exhibit of Premiums and Losses, including investment contract receipts credited to a liability account 2.1 Contract fees for variable contracts with guarantees 2.2 Any other premiums, considerations and deposits not reported in Schedule T or Exhibit of Premiums and Losses Amounts, if applicable, that were deducted prior to determining amounts included in Lines 1 or 2 which are in the following categories: 3.1 Transfers to guaranteed Separate Accounts 3.2 Roll over of GICs or annuities into other companies 3.3 Surrenders or other benefits paid out 3.4 Excess interest credited to accounts 3.5 Aggregate write-ins for other amounts deducted prior to determining amounts included in Lines 1 or 2 3.99 Total (Lines 3.1 through 3.5) Transfers: 4.1 Enter in Column 2, as a negative number, and Column 4, as a positive number, the total of all amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, that are included in Column 2, Lines 1, 2 and 3.99 4.2 Enter in Column 2, as a positive number, and Column 4, as a negative number, any amounts reported in Column 4, Lines 1, 2 and 3.99 that are allocated. (Note: amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, should not be included in line 4.2) 4.3 Enter in Column 4, as a positive number, and Column 2, as a negative number, any amounts reported in Column 2, Lines 1, 2 and 3.99 that are unallocated 4.99 Total (Lines 4.1 + 4.2 + 4.3) Total (Lines 1 + 2 + 3.99 + 4.99) 1 2 3 Life Insurance Premiums Annuity Considerations A & H Premiums 4 Deposit-Type Contract Funds and Other Considerations 22,648 0 42,844,980 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 22,648 0 42,844,980 DEVELOPMENT OF AMOUNTS INCLUDED IN LINES 1 THROUGH 5 THAT SHOULD BE DEDUCTED IN DETERMINING THE BASE Do not include any amount more than once in Lines 6 through 9 Aggregate write-ins for amounts where the insurer is not subject to risk. Premiums for portions of policies or contracts NOT guaranteed or under which the entire investment risk is borne by the policyholder. (Please specify such deductions and indicate where such amounts were reported in the Annual Statement) Amounts NOT allocated to individuals or individual certificate holders or amounts received for such contracts in excess of limits: 7.1 Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans 7.2 Unallocated funding obligations that fund any employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation 7.3 Unallocated funding obligations that fund governmental lotteries or employee, union, or association of natural persons benefit plans in excess of $5 million per contract which are NOT: (a) government retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation 7.4 Total (Lines 7.1 + 7.2 + 7.3) Dividends/Experience rating credits paid or credited, but only if NOT guaranteed in advance (include only amounts NOT already deducted in determining Lines 1 and 2) Aggregate write-ins for Other Deductions Total (Lines 6 + 7.4 + 8 + 9) Current Year DETAILS OF WRITE-INS 0 0 0 0 0 0 0 XXX XXX XXX 0 XXX XXX XXX 0 XXX XXX XXX XXX XXX XXX 0 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 22,648 0 0 0 0 8,428,364 8,428,364 0 0 0 0 34,416,616 0 Summary of remaining write-ins for Line 3.5 from overflow page Totals (Lines 3.501 thru 3.503 plus 3.598)(Line 3.5 above) 0 0 0 0 0 0 0 0 Summary of remaining write-ins for Line 6 from overflow page Totals (Lines 0601 thru 0603 plus 0698)(Line 6 above) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8,197,174 231,190 0 0 8,428,364 0 0 0 0 0 0 0 Medicare Part C & D Stop Loss Medicaid Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.AK *79413201830002100* ADJUSTMENTS TO THE LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Alaska 1 2 Allocated Annuity and Other Allocated Fund Deposits Life Insurance Premiums MODEL ACT BASE ( Line 11 of the Reconciliation Exhibit) 2. Enter in Column 2, as a positive number, and Column 4, as a negative number, the total of all amounts received to fund allocated contracts established under Section 403(b) of the U.S. Internal Revenue Code that are included in Column 4, Line 1 above 3. Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans: 0 XXX 4 Unallocated Annuity & Other Unallocated Fund Deposits Accident & Health Premium 22,648 0 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. 4. 3 34,416,616 0 XXX 0 3.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 3.2 All amounts XXX XXX XXX 0 0 4.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 0 4.2 Amounts in excess of $1 million but NOT in excess of $5 million per contract XXX XXX XXX 4.3 Amounts in excess of $5 million per contract XXX XXX XXX 4.4 Total (Lines 4.1 + 4.2 + 4.3) XXX XXX XXX 4.5 Amounts up to $7.5 million, per contract (Minnesota only) XXX XXX XXX 0 0 0 0 5.1 Amounts in excess of $1 million per contract XXX XXX XXX 5.2 All amounts XXX XXX XXX 5.3 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 5.4 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 6.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 6.2 Amounts in excess of $1 million per contract XXX XXX XXX 6.3 Total (Lines 6.1 + 6.2) XXX XXX XXX 6.4 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 6.5 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 7.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 7.2 All amounts XXX XXX XXX Unallocated funding obligations issued to fund government lotteries or employee, union, or association of natural persons benefit plans which are NOT: (a) governmental retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation: 5. 6. 7. Unallocated funding obligations issued to fund governmental retirement plans established under Sections 401 and 457 of the U.S. Internal Revenue Code: 0 0 0 0 Unallocated funding obligations issued to fund governmental retirement plans established under Sections 403(b) of the U.S. Internal Revenue Code: 0 0 0 0 0 Unallocated funding obligations that fund employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation: 7.3 Amounts NOT in excess of $2 million per contract (New Jersey only) XXX XXX XXX 0 0 0 8. Unallocated funding obligations issued to fund government lotteries NOT in excess of $5 million per contractholder (New Jersey Only) XXX XXX XXX 0 9. Unallocated funding obligations that fund employee or association of natural persons benefit plans in excess of $2 million but NOT in excess of $5 million per contract (New Jersey Only) XXX 10. Aggregate write-ins for other deductions 0 0 0 0 0 22,648 0 34,416,616 0 0 0 0 0 0 0 0 0 XXX XXX BASE 11. Current Year (2018) DETAILS OF WRITE-INS 1001. 1002. 1003. 1098. Summary of remaining write-ins for Line 10 from overflow page 1099. Totals (Lines 1001 thru 1003 plus 1098)(Line 10 above) 300.AK *79413201829003100* LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Arizona 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 3.501. 3.502. 3.503. 3.598. 3.599. 0601. 0602. 0603. 0698. 0699. 0901. 0902. 0903. 0998. 0999. PREMIUMS, CONSIDERATIONS AND DEPOSITS Premiums, considerations and deposits from Schedule T or Exhibit of Premiums and Losses Premiums, considerations and deposits NOT reported in Schedule T or Exhibit of Premiums and Losses, including investment contract receipts credited to a liability account 2.1 Contract fees for variable contracts with guarantees 2.2 Any other premiums, considerations and deposits not reported in Schedule T or Exhibit of Premiums and Losses Amounts, if applicable, that were deducted prior to determining amounts included in Lines 1 or 2 which are in the following categories: 3.1 Transfers to guaranteed Separate Accounts 3.2 Roll over of GICs or annuities into other companies 3.3 Surrenders or other benefits paid out 3.4 Excess interest credited to accounts 3.5 Aggregate write-ins for other amounts deducted prior to determining amounts included in Lines 1 or 2 3.99 Total (Lines 3.1 through 3.5) Transfers: 4.1 Enter in Column 2, as a negative number, and Column 4, as a positive number, the total of all amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, that are included in Column 2, Lines 1, 2 and 3.99 4.2 Enter in Column 2, as a positive number, and Column 4, as a negative number, any amounts reported in Column 4, Lines 1, 2 and 3.99 that are allocated. (Note: amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, should not be included in line 4.2) 4.3 Enter in Column 4, as a positive number, and Column 2, as a negative number, any amounts reported in Column 2, Lines 1, 2 and 3.99 that are unallocated 4.99 Total (Lines 4.1 + 4.2 + 4.3) Total (Lines 1 + 2 + 3.99 + 4.99) 1 2 3 Life Insurance Premiums Annuity Considerations A & H Premiums 4 Deposit-Type Contract Funds and Other Considerations 5,355,767 0 1,606,298,100 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5,355,767 0 1,606,298,100 DEVELOPMENT OF AMOUNTS INCLUDED IN LINES 1 THROUGH 5 THAT SHOULD BE DEDUCTED IN DETERMINING THE BASE Do not include any amount more than once in Lines 6 through 9 Aggregate write-ins for amounts where the insurer is not subject to risk. Premiums for portions of policies or contracts NOT guaranteed or under which the entire investment risk is borne by the policyholder. (Please specify such deductions and indicate where such amounts were reported in the Annual Statement) Amounts NOT allocated to individuals or individual certificate holders or amounts received for such contracts in excess of limits: 7.1 Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans 7.2 Unallocated funding obligations that fund any employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation 7.3 Unallocated funding obligations that fund governmental lotteries or employee, union, or association of natural persons benefit plans in excess of $5 million per contract which are NOT: (a) government retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation 7.4 Total (Lines 7.1 + 7.2 + 7.3) Dividends/Experience rating credits paid or credited, but only if NOT guaranteed in advance (include only amounts NOT already deducted in determining Lines 1 and 2) Aggregate write-ins for Other Deductions Total (Lines 6 + 7.4 + 8 + 9) Current Year DETAILS OF WRITE-INS 0 0 0 0 0 0 0 XXX XXX XXX 0 XXX XXX XXX 0 XXX XXX XXX XXX XXX XXX 0 0 0 0 0 0 180,395,529 180,395,529 0 0 0 0 1,425,902,571 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 5,355,767 Summary of remaining write-ins for Line 3.5 from overflow page Totals (Lines 3.501 thru 3.503 plus 3.598)(Line 3.5 above) 0 0 0 0 0 0 0 0 Summary of remaining write-ins for Line 6 from overflow page Totals (Lines 0601 thru 0603 plus 0698)(Line 6 above) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 162,642,799 17,752,730 0 0 180,395,529 0 0 0 0 0 0 0 Medicare Part C & D Stop Loss Medicaid Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.AZ *79413201830003100* ADJUSTMENTS TO THE LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Arizona 1 2 Allocated Annuity and Other Allocated Fund Deposits Life Insurance Premiums 4 Unallocated Annuity & Other Unallocated Fund Deposits Accident & Health Premium 5,355,767 0 1,425,902,571 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. MODEL ACT BASE ( Line 11 of the Reconciliation Exhibit) 2. Enter in Column 2, as a positive number, and Column 4, as a negative number, the total of all amounts received to fund allocated contracts established under Section 403(b) of the U.S. Internal Revenue Code that are included in Column 4, Line 1 above 3. Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans: 4. 3 0 XXX 0 XXX 0 3.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 3.2 All amounts XXX XXX XXX 0 0 4.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 0 4.2 Amounts in excess of $1 million but NOT in excess of $5 million per contract XXX XXX XXX 4.3 Amounts in excess of $5 million per contract XXX XXX XXX 4.4 Total (Lines 4.1 + 4.2 + 4.3) XXX XXX XXX 4.5 Amounts up to $7.5 million, per contract (Minnesota only) XXX XXX XXX 0 0 0 0 5.1 Amounts in excess of $1 million per contract XXX XXX XXX 5.2 All amounts XXX XXX XXX 5.3 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 5.4 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 6.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 6.2 Amounts in excess of $1 million per contract XXX XXX XXX 6.3 Total (Lines 6.1 + 6.2) XXX XXX XXX 6.4 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 6.5 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 7.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 7.2 All amounts XXX XXX XXX Unallocated funding obligations issued to fund government lotteries or employee, union, or association of natural persons benefit plans which are NOT: (a) governmental retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation: 5. 6. 7. Unallocated funding obligations issued to fund governmental retirement plans established under Sections 401 and 457 of the U.S. Internal Revenue Code: 0 0 0 0 Unallocated funding obligations issued to fund governmental retirement plans established under Sections 403(b) of the U.S. Internal Revenue Code: 0 0 0 0 0 Unallocated funding obligations that fund employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation: 7.3 Amounts NOT in excess of $2 million per contract (New Jersey only) XXX XXX XXX 0 0 0 8. Unallocated funding obligations issued to fund government lotteries NOT in excess of $5 million per contractholder (New Jersey Only) XXX XXX XXX 0 9. Unallocated funding obligations that fund employee or association of natural persons benefit plans in excess of $2 million but NOT in excess of $5 million per contract (New Jersey Only) XXX 10. Aggregate write-ins for other deductions 0 0 0 0 0 5,355,767 0 1,425,902,571 0 0 0 0 0 0 0 0 0 XXX XXX BASE 11. Current Year (2018) DETAILS OF WRITE-INS 1001. 1002. 1003. 1098. Summary of remaining write-ins for Line 10 from overflow page 1099. Totals (Lines 1001 thru 1003 plus 1098)(Line 10 above) 300.AZ *79413201829004100* LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Arkansas 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 3.501. 3.502. 3.503. 3.598. 3.599. 0601. 0602. 0603. 0698. 0699. 0901. 0902. 0903. 0998. 0999. PREMIUMS, CONSIDERATIONS AND DEPOSITS Premiums, considerations and deposits from Schedule T or Exhibit of Premiums and Losses Premiums, considerations and deposits NOT reported in Schedule T or Exhibit of Premiums and Losses, including investment contract receipts credited to a liability account 2.1 Contract fees for variable contracts with guarantees 2.2 Any other premiums, considerations and deposits not reported in Schedule T or Exhibit of Premiums and Losses Amounts, if applicable, that were deducted prior to determining amounts included in Lines 1 or 2 which are in the following categories: 3.1 Transfers to guaranteed Separate Accounts 3.2 Roll over of GICs or annuities into other companies 3.3 Surrenders or other benefits paid out 3.4 Excess interest credited to accounts 3.5 Aggregate write-ins for other amounts deducted prior to determining amounts included in Lines 1 or 2 3.99 Total (Lines 3.1 through 3.5) Transfers: 4.1 Enter in Column 2, as a negative number, and Column 4, as a positive number, the total of all amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, that are included in Column 2, Lines 1, 2 and 3.99 4.2 Enter in Column 2, as a positive number, and Column 4, as a negative number, any amounts reported in Column 4, Lines 1, 2 and 3.99 that are allocated. (Note: amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, should not be included in line 4.2) 4.3 Enter in Column 4, as a positive number, and Column 2, as a negative number, any amounts reported in Column 2, Lines 1, 2 and 3.99 that are unallocated 4.99 Total (Lines 4.1 + 4.2 + 4.3) Total (Lines 1 + 2 + 3.99 + 4.99) 1 2 3 Life Insurance Premiums Annuity Considerations A & H Premiums 4 Deposit-Type Contract Funds and Other Considerations 1,296,267 0 230,566,773 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,296,267 0 230,566,773 DEVELOPMENT OF AMOUNTS INCLUDED IN LINES 1 THROUGH 5 THAT SHOULD BE DEDUCTED IN DETERMINING THE BASE Do not include any amount more than once in Lines 6 through 9 Aggregate write-ins for amounts where the insurer is not subject to risk. Premiums for portions of policies or contracts NOT guaranteed or under which the entire investment risk is borne by the policyholder. (Please specify such deductions and indicate where such amounts were reported in the Annual Statement) Amounts NOT allocated to individuals or individual certificate holders or amounts received for such contracts in excess of limits: 7.1 Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans 7.2 Unallocated funding obligations that fund any employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation 7.3 Unallocated funding obligations that fund governmental lotteries or employee, union, or association of natural persons benefit plans in excess of $5 million per contract which are NOT: (a) government retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation 7.4 Total (Lines 7.1 + 7.2 + 7.3) Dividends/Experience rating credits paid or credited, but only if NOT guaranteed in advance (include only amounts NOT already deducted in determining Lines 1 and 2) Aggregate write-ins for Other Deductions Total (Lines 6 + 7.4 + 8 + 9) Current Year DETAILS OF WRITE-INS 0 0 0 0 0 0 0 XXX XXX XXX 0 XXX XXX XXX 0 XXX XXX XXX XXX XXX XXX 0 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 1,296,267 0 0 0 0 29,241,123 29,241,123 0 0 0 0 201,325,650 0 Summary of remaining write-ins for Line 3.5 from overflow page Totals (Lines 3.501 thru 3.503 plus 3.598)(Line 3.5 above) 0 0 0 0 0 0 0 0 Summary of remaining write-ins for Line 6 from overflow page Totals (Lines 0601 thru 0603 plus 0698)(Line 6 above) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 21,932,357 7,308,766 0 0 29,241,123 0 0 0 0 0 0 0 Medicare Part C & D Stop Loss Medicaid Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.AR *79413201830004100* ADJUSTMENTS TO THE LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Arkansas 1 2 Allocated Annuity and Other Allocated Fund Deposits Life Insurance Premiums 4 Unallocated Annuity & Other Unallocated Fund Deposits Accident & Health Premium 1,296,267 0 201,325,650 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. MODEL ACT BASE ( Line 11 of the Reconciliation Exhibit) 2. Enter in Column 2, as a positive number, and Column 4, as a negative number, the total of all amounts received to fund allocated contracts established under Section 403(b) of the U.S. Internal Revenue Code that are included in Column 4, Line 1 above 3. Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans: 4. 3 0 XXX 0 XXX 0 3.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 3.2 All amounts XXX XXX XXX 0 0 4.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 0 4.2 Amounts in excess of $1 million but NOT in excess of $5 million per contract XXX XXX XXX 4.3 Amounts in excess of $5 million per contract XXX XXX XXX 4.4 Total (Lines 4.1 + 4.2 + 4.3) XXX XXX XXX 4.5 Amounts up to $7.5 million, per contract (Minnesota only) XXX XXX XXX 0 0 0 0 5.1 Amounts in excess of $1 million per contract XXX XXX XXX 5.2 All amounts XXX XXX XXX 5.3 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 5.4 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 6.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 6.2 Amounts in excess of $1 million per contract XXX XXX XXX 6.3 Total (Lines 6.1 + 6.2) XXX XXX XXX 6.4 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 6.5 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 7.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 7.2 All amounts XXX XXX XXX Unallocated funding obligations issued to fund government lotteries or employee, union, or association of natural persons benefit plans which are NOT: (a) governmental retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation: 5. 6. 7. Unallocated funding obligations issued to fund governmental retirement plans established under Sections 401 and 457 of the U.S. Internal Revenue Code: 0 0 0 0 Unallocated funding obligations issued to fund governmental retirement plans established under Sections 403(b) of the U.S. Internal Revenue Code: 0 0 0 0 0 Unallocated funding obligations that fund employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation: 7.3 Amounts NOT in excess of $2 million per contract (New Jersey only) XXX XXX XXX 0 0 0 8. Unallocated funding obligations issued to fund government lotteries NOT in excess of $5 million per contractholder (New Jersey Only) XXX XXX XXX 0 9. Unallocated funding obligations that fund employee or association of natural persons benefit plans in excess of $2 million but NOT in excess of $5 million per contract (New Jersey Only) XXX 10. Aggregate write-ins for other deductions 0 0 0 0 0 1,296,267 0 201,325,650 0 0 0 0 0 0 0 0 0 XXX XXX BASE 11. Current Year (2018) DETAILS OF WRITE-INS 1001. 1002. 1003. 1098. Summary of remaining write-ins for Line 10 from overflow page 1099. Totals (Lines 1001 thru 1003 plus 1098)(Line 10 above) 300.AR *79413201829005100* LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: California 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 3.501. 3.502. 3.503. 3.598. 3.599. 0601. 0602. 0603. 0698. 0699. 0901. 0902. 0903. 0998. 0999. PREMIUMS, CONSIDERATIONS AND DEPOSITS Premiums, considerations and deposits from Schedule T or Exhibit of Premiums and Losses Premiums, considerations and deposits NOT reported in Schedule T or Exhibit of Premiums and Losses, including investment contract receipts credited to a liability account 2.1 Contract fees for variable contracts with guarantees 2.2 Any other premiums, considerations and deposits not reported in Schedule T or Exhibit of Premiums and Losses Amounts, if applicable, that were deducted prior to determining amounts included in Lines 1 or 2 which are in the following categories: 3.1 Transfers to guaranteed Separate Accounts 3.2 Roll over of GICs or annuities into other companies 3.3 Surrenders or other benefits paid out 3.4 Excess interest credited to accounts 3.5 Aggregate write-ins for other amounts deducted prior to determining amounts included in Lines 1 or 2 3.99 Total (Lines 3.1 through 3.5) Transfers: 4.1 Enter in Column 2, as a negative number, and Column 4, as a positive number, the total of all amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, that are included in Column 2, Lines 1, 2 and 3.99 4.2 Enter in Column 2, as a positive number, and Column 4, as a negative number, any amounts reported in Column 4, Lines 1, 2 and 3.99 that are allocated. (Note: amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, should not be included in line 4.2) 4.3 Enter in Column 4, as a positive number, and Column 2, as a negative number, any amounts reported in Column 2, Lines 1, 2 and 3.99 that are unallocated 4.99 Total (Lines 4.1 + 4.2 + 4.3) Total (Lines 1 + 2 + 3.99 + 4.99) 1 2 3 Life Insurance Premiums Annuity Considerations A & H Premiums 4 Deposit-Type Contract Funds and Other Considerations 7,305,205 0 3,401,784,846 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7,305,205 0 3,401,784,846 DEVELOPMENT OF AMOUNTS INCLUDED IN LINES 1 THROUGH 5 THAT SHOULD BE DEDUCTED IN DETERMINING THE BASE Do not include any amount more than once in Lines 6 through 9 Aggregate write-ins for amounts where the insurer is not subject to risk. Premiums for portions of policies or contracts NOT guaranteed or under which the entire investment risk is borne by the policyholder. (Please specify such deductions and indicate where such amounts were reported in the Annual Statement) Amounts NOT allocated to individuals or individual certificate holders or amounts received for such contracts in excess of limits: 7.1 Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans 7.2 Unallocated funding obligations that fund any employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation 7.3 Unallocated funding obligations that fund governmental lotteries or employee, union, or association of natural persons benefit plans in excess of $5 million per contract which are NOT: (a) government retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation 7.4 Total (Lines 7.1 + 7.2 + 7.3) Dividends/Experience rating credits paid or credited, but only if NOT guaranteed in advance (include only amounts NOT already deducted in determining Lines 1 and 2) Aggregate write-ins for Other Deductions Total (Lines 6 + 7.4 + 8 + 9) Current Year DETAILS OF WRITE-INS 0 0 0 0 0 0 0 XXX XXX XXX 0 XXX XXX XXX 0 XXX XXX XXX XXX XXX XXX 0 0 0 0 0 0 408,569,051 408,569,051 0 0 0 0 2,993,215,795 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 7,305,205 Summary of remaining write-ins for Line 3.5 from overflow page Totals (Lines 3.501 thru 3.503 plus 3.598)(Line 3.5 above) 0 0 0 0 0 0 0 0 Summary of remaining write-ins for Line 6 from overflow page Totals (Lines 0601 thru 0603 plus 0698)(Line 6 above) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 371,091,949 37,477,102 0 0 408,569,051 0 0 0 0 0 0 0 Medicare Part C & D Stop Loss Medicaid Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.CA *79413201830005100* ADJUSTMENTS TO THE LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: California 1 2 Allocated Annuity and Other Allocated Fund Deposits Life Insurance Premiums 4 Unallocated Annuity & Other Unallocated Fund Deposits Accident & Health Premium 7,305,205 0 2,993,215,795 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. MODEL ACT BASE ( Line 11 of the Reconciliation Exhibit) 2. Enter in Column 2, as a positive number, and Column 4, as a negative number, the total of all amounts received to fund allocated contracts established under Section 403(b) of the U.S. Internal Revenue Code that are included in Column 4, Line 1 above 3. Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans: 4. 3 0 XXX 0 XXX 0 3.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 3.2 All amounts XXX XXX XXX 0 0 4.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 0 4.2 Amounts in excess of $1 million but NOT in excess of $5 million per contract XXX XXX XXX 4.3 Amounts in excess of $5 million per contract XXX XXX XXX 4.4 Total (Lines 4.1 + 4.2 + 4.3) XXX XXX XXX 4.5 Amounts up to $7.5 million, per contract (Minnesota only) XXX XXX XXX 0 0 0 0 5.1 Amounts in excess of $1 million per contract XXX XXX XXX 5.2 All amounts XXX XXX XXX 5.3 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 5.4 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 6.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 6.2 Amounts in excess of $1 million per contract XXX XXX XXX 6.3 Total (Lines 6.1 + 6.2) XXX XXX XXX 6.4 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 6.5 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 7.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 7.2 All amounts XXX XXX XXX Unallocated funding obligations issued to fund government lotteries or employee, union, or association of natural persons benefit plans which are NOT: (a) governmental retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation: 5. 6. 7. Unallocated funding obligations issued to fund governmental retirement plans established under Sections 401 and 457 of the U.S. Internal Revenue Code: 0 0 0 0 Unallocated funding obligations issued to fund governmental retirement plans established under Sections 403(b) of the U.S. Internal Revenue Code: 0 0 0 0 0 Unallocated funding obligations that fund employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation: 7.3 Amounts NOT in excess of $2 million per contract (New Jersey only) XXX XXX XXX 0 0 0 8. Unallocated funding obligations issued to fund government lotteries NOT in excess of $5 million per contractholder (New Jersey Only) XXX XXX XXX 0 9. Unallocated funding obligations that fund employee or association of natural persons benefit plans in excess of $2 million but NOT in excess of $5 million per contract (New Jersey Only) XXX 10. Aggregate write-ins for other deductions 0 0 0 0 0 7,305,205 0 2,993,215,795 0 0 0 0 0 0 0 0 0 XXX XXX BASE 11. Current Year (2018) DETAILS OF WRITE-INS 1001. 1002. 1003. 1098. Summary of remaining write-ins for Line 10 from overflow page 1099. Totals (Lines 1001 thru 1003 plus 1098)(Line 10 above) 300.CA *79413201829006100* LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Colorado 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 3.501. 3.502. 3.503. 3.598. 3.599. 0601. 0602. 0603. 0698. 0699. 0901. 0902. 0903. 0998. 0999. PREMIUMS, CONSIDERATIONS AND DEPOSITS Premiums, considerations and deposits from Schedule T or Exhibit of Premiums and Losses Premiums, considerations and deposits NOT reported in Schedule T or Exhibit of Premiums and Losses, including investment contract receipts credited to a liability account 2.1 Contract fees for variable contracts with guarantees 2.2 Any other premiums, considerations and deposits not reported in Schedule T or Exhibit of Premiums and Losses Amounts, if applicable, that were deducted prior to determining amounts included in Lines 1 or 2 which are in the following categories: 3.1 Transfers to guaranteed Separate Accounts 3.2 Roll over of GICs or annuities into other companies 3.3 Surrenders or other benefits paid out 3.4 Excess interest credited to accounts 3.5 Aggregate write-ins for other amounts deducted prior to determining amounts included in Lines 1 or 2 3.99 Total (Lines 3.1 through 3.5) Transfers: 4.1 Enter in Column 2, as a negative number, and Column 4, as a positive number, the total of all amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, that are included in Column 2, Lines 1, 2 and 3.99 4.2 Enter in Column 2, as a positive number, and Column 4, as a negative number, any amounts reported in Column 4, Lines 1, 2 and 3.99 that are allocated. (Note: amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, should not be included in line 4.2) 4.3 Enter in Column 4, as a positive number, and Column 2, as a negative number, any amounts reported in Column 2, Lines 1, 2 and 3.99 that are unallocated 4.99 Total (Lines 4.1 + 4.2 + 4.3) Total (Lines 1 + 2 + 3.99 + 4.99) 1 2 3 Life Insurance Premiums Annuity Considerations A & H Premiums 4 Deposit-Type Contract Funds and Other Considerations 3,771,823 0 1,479,132,679 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3,771,823 0 1,479,132,679 DEVELOPMENT OF AMOUNTS INCLUDED IN LINES 1 THROUGH 5 THAT SHOULD BE DEDUCTED IN DETERMINING THE BASE Do not include any amount more than once in Lines 6 through 9 Aggregate write-ins for amounts where the insurer is not subject to risk. Premiums for portions of policies or contracts NOT guaranteed or under which the entire investment risk is borne by the policyholder. (Please specify such deductions and indicate where such amounts were reported in the Annual Statement) Amounts NOT allocated to individuals or individual certificate holders or amounts received for such contracts in excess of limits: 7.1 Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans 7.2 Unallocated funding obligations that fund any employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation 7.3 Unallocated funding obligations that fund governmental lotteries or employee, union, or association of natural persons benefit plans in excess of $5 million per contract which are NOT: (a) government retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation 7.4 Total (Lines 7.1 + 7.2 + 7.3) Dividends/Experience rating credits paid or credited, but only if NOT guaranteed in advance (include only amounts NOT already deducted in determining Lines 1 and 2) Aggregate write-ins for Other Deductions Total (Lines 6 + 7.4 + 8 + 9) Current Year DETAILS OF WRITE-INS 0 0 0 0 0 0 0 XXX XXX XXX 0 XXX XXX XXX 0 XXX XXX XXX XXX XXX XXX 0 0 0 0 0 0 312,190,180 312,190,180 0 0 0 0 1,166,942,499 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 3,771,823 Summary of remaining write-ins for Line 3.5 from overflow page Totals (Lines 3.501 thru 3.503 plus 3.598)(Line 3.5 above) 0 0 0 0 0 0 0 0 Summary of remaining write-ins for Line 6 from overflow page Totals (Lines 0601 thru 0603 plus 0698)(Line 6 above) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 283,124,583 29,065,597 0 0 312,190,180 0 0 0 0 0 0 0 Medicare Part C & D Stop Loss Medicaid Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.CO *79413201830006100* ADJUSTMENTS TO THE LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Colorado 1 2 Allocated Annuity and Other Allocated Fund Deposits Life Insurance Premiums 4 Unallocated Annuity & Other Unallocated Fund Deposits Accident & Health Premium 3,771,823 0 1,166,942,499 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. MODEL ACT BASE ( Line 11 of the Reconciliation Exhibit) 2. Enter in Column 2, as a positive number, and Column 4, as a negative number, the total of all amounts received to fund allocated contracts established under Section 403(b) of the U.S. Internal Revenue Code that are included in Column 4, Line 1 above 3. Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans: 4. 3 0 XXX 0 XXX 0 3.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 3.2 All amounts XXX XXX XXX 0 0 4.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 0 4.2 Amounts in excess of $1 million but NOT in excess of $5 million per contract XXX XXX XXX 4.3 Amounts in excess of $5 million per contract XXX XXX XXX 4.4 Total (Lines 4.1 + 4.2 + 4.3) XXX XXX XXX 4.5 Amounts up to $7.5 million, per contract (Minnesota only) XXX XXX XXX 0 0 0 0 5.1 Amounts in excess of $1 million per contract XXX XXX XXX 5.2 All amounts XXX XXX XXX 5.3 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 5.4 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 6.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 6.2 Amounts in excess of $1 million per contract XXX XXX XXX 6.3 Total (Lines 6.1 + 6.2) XXX XXX XXX 6.4 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 6.5 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 7.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 7.2 All amounts XXX XXX XXX Unallocated funding obligations issued to fund government lotteries or employee, union, or association of natural persons benefit plans which are NOT: (a) governmental retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation: 5. 6. 7. Unallocated funding obligations issued to fund governmental retirement plans established under Sections 401 and 457 of the U.S. Internal Revenue Code: 0 0 0 0 Unallocated funding obligations issued to fund governmental retirement plans established under Sections 403(b) of the U.S. Internal Revenue Code: 0 0 0 0 0 Unallocated funding obligations that fund employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation: 7.3 Amounts NOT in excess of $2 million per contract (New Jersey only) XXX XXX XXX 0 0 0 8. Unallocated funding obligations issued to fund government lotteries NOT in excess of $5 million per contractholder (New Jersey Only) XXX XXX XXX 0 9. Unallocated funding obligations that fund employee or association of natural persons benefit plans in excess of $2 million but NOT in excess of $5 million per contract (New Jersey Only) XXX 10. Aggregate write-ins for other deductions 0 0 0 0 0 3,771,823 0 1,166,942,499 0 0 0 0 0 0 0 0 0 XXX XXX BASE 11. Current Year (2018) DETAILS OF WRITE-INS 1001. 1002. 1003. 1098. Summary of remaining write-ins for Line 10 from overflow page 1099. Totals (Lines 1001 thru 1003 plus 1098)(Line 10 above) 300.CO *79413201829007100* LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Connecticut 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 3.501. 3.502. 3.503. 3.598. 3.599. 0601. 0602. 0603. 0698. 0699. 0901. 0902. 0903. 0998. 0999. PREMIUMS, CONSIDERATIONS AND DEPOSITS Premiums, considerations and deposits from Schedule T or Exhibit of Premiums and Losses Premiums, considerations and deposits NOT reported in Schedule T or Exhibit of Premiums and Losses, including investment contract receipts credited to a liability account 2.1 Contract fees for variable contracts with guarantees 2.2 Any other premiums, considerations and deposits not reported in Schedule T or Exhibit of Premiums and Losses Amounts, if applicable, that were deducted prior to determining amounts included in Lines 1 or 2 which are in the following categories: 3.1 Transfers to guaranteed Separate Accounts 3.2 Roll over of GICs or annuities into other companies 3.3 Surrenders or other benefits paid out 3.4 Excess interest credited to accounts 3.5 Aggregate write-ins for other amounts deducted prior to determining amounts included in Lines 1 or 2 3.99 Total (Lines 3.1 through 3.5) Transfers: 4.1 Enter in Column 2, as a negative number, and Column 4, as a positive number, the total of all amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, that are included in Column 2, Lines 1, 2 and 3.99 4.2 Enter in Column 2, as a positive number, and Column 4, as a negative number, any amounts reported in Column 4, Lines 1, 2 and 3.99 that are allocated. (Note: amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, should not be included in line 4.2) 4.3 Enter in Column 4, as a positive number, and Column 2, as a negative number, any amounts reported in Column 2, Lines 1, 2 and 3.99 that are unallocated 4.99 Total (Lines 4.1 + 4.2 + 4.3) Total (Lines 1 + 2 + 3.99 + 4.99) 1 2 3 Life Insurance Premiums Annuity Considerations A & H Premiums 4 Deposit-Type Contract Funds and Other Considerations 2,504,755 0 927,001,839 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,504,755 0 927,001,839 DEVELOPMENT OF AMOUNTS INCLUDED IN LINES 1 THROUGH 5 THAT SHOULD BE DEDUCTED IN DETERMINING THE BASE Do not include any amount more than once in Lines 6 through 9 Aggregate write-ins for amounts where the insurer is not subject to risk. Premiums for portions of policies or contracts NOT guaranteed or under which the entire investment risk is borne by the policyholder. (Please specify such deductions and indicate where such amounts were reported in the Annual Statement) Amounts NOT allocated to individuals or individual certificate holders or amounts received for such contracts in excess of limits: 7.1 Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans 7.2 Unallocated funding obligations that fund any employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation 7.3 Unallocated funding obligations that fund governmental lotteries or employee, union, or association of natural persons benefit plans in excess of $5 million per contract which are NOT: (a) government retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation 7.4 Total (Lines 7.1 + 7.2 + 7.3) Dividends/Experience rating credits paid or credited, but only if NOT guaranteed in advance (include only amounts NOT already deducted in determining Lines 1 and 2) Aggregate write-ins for Other Deductions Total (Lines 6 + 7.4 + 8 + 9) Current Year DETAILS OF WRITE-INS 0 0 0 0 0 0 0 XXX XXX XXX 0 XXX XXX XXX 0 XXX XXX XXX XXX XXX XXX 0 0 0 0 0 0 220,329,919 220,329,919 0 0 0 0 706,671,920 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 2,504,755 Summary of remaining write-ins for Line 3.5 from overflow page Totals (Lines 3.501 thru 3.503 plus 3.598)(Line 3.5 above) 0 0 0 0 0 0 0 0 Summary of remaining write-ins for Line 6 from overflow page Totals (Lines 0601 thru 0603 plus 0698)(Line 6 above) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 212,719,387 7,610,532 0 0 220,329,919 0 0 0 0 0 0 0 Medicare Part C & D Stop Loss Medicaid Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.CT *79413201830007100* ADJUSTMENTS TO THE LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Connecticut 1 2 Allocated Annuity and Other Allocated Fund Deposits Life Insurance Premiums 4 Unallocated Annuity & Other Unallocated Fund Deposits Accident & Health Premium 2,504,755 0 706,671,920 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. MODEL ACT BASE ( Line 11 of the Reconciliation Exhibit) 2. Enter in Column 2, as a positive number, and Column 4, as a negative number, the total of all amounts received to fund allocated contracts established under Section 403(b) of the U.S. Internal Revenue Code that are included in Column 4, Line 1 above 3. Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans: 4. 3 0 XXX 0 XXX 0 3.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 3.2 All amounts XXX XXX XXX 0 0 4.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 0 4.2 Amounts in excess of $1 million but NOT in excess of $5 million per contract XXX XXX XXX 4.3 Amounts in excess of $5 million per contract XXX XXX XXX 4.4 Total (Lines 4.1 + 4.2 + 4.3) XXX XXX XXX 4.5 Amounts up to $7.5 million, per contract (Minnesota only) XXX XXX XXX 0 0 0 0 5.1 Amounts in excess of $1 million per contract XXX XXX XXX 5.2 All amounts XXX XXX XXX 5.3 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 5.4 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 6.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 6.2 Amounts in excess of $1 million per contract XXX XXX XXX 6.3 Total (Lines 6.1 + 6.2) XXX XXX XXX 6.4 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 6.5 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 7.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 7.2 All amounts XXX XXX XXX Unallocated funding obligations issued to fund government lotteries or employee, union, or association of natural persons benefit plans which are NOT: (a) governmental retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation: 5. 6. 7. Unallocated funding obligations issued to fund governmental retirement plans established under Sections 401 and 457 of the U.S. Internal Revenue Code: 0 0 0 0 Unallocated funding obligations issued to fund governmental retirement plans established under Sections 403(b) of the U.S. Internal Revenue Code: 0 0 0 0 0 Unallocated funding obligations that fund employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation: 7.3 Amounts NOT in excess of $2 million per contract (New Jersey only) XXX XXX XXX 0 0 0 8. Unallocated funding obligations issued to fund government lotteries NOT in excess of $5 million per contractholder (New Jersey Only) XXX XXX XXX 0 9. Unallocated funding obligations that fund employee or association of natural persons benefit plans in excess of $2 million but NOT in excess of $5 million per contract (New Jersey Only) XXX 10. Aggregate write-ins for other deductions 0 0 0 0 0 2,504,755 0 706,671,920 0 0 0 0 0 0 0 0 0 XXX XXX BASE 11. Current Year (2018) DETAILS OF WRITE-INS 1001. 1002. 1003. 1098. Summary of remaining write-ins for Line 10 from overflow page 1099. Totals (Lines 1001 thru 1003 plus 1098)(Line 10 above) 300.CT *79413201829008100* LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Delaware 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 3.501. 3.502. 3.503. 3.598. 3.599. 0601. 0602. 0603. 0698. 0699. 0901. 0902. 0903. 0998. 0999. PREMIUMS, CONSIDERATIONS AND DEPOSITS Premiums, considerations and deposits from Schedule T or Exhibit of Premiums and Losses Premiums, considerations and deposits NOT reported in Schedule T or Exhibit of Premiums and Losses, including investment contract receipts credited to a liability account 2.1 Contract fees for variable contracts with guarantees 2.2 Any other premiums, considerations and deposits not reported in Schedule T or Exhibit of Premiums and Losses Amounts, if applicable, that were deducted prior to determining amounts included in Lines 1 or 2 which are in the following categories: 3.1 Transfers to guaranteed Separate Accounts 3.2 Roll over of GICs or annuities into other companies 3.3 Surrenders or other benefits paid out 3.4 Excess interest credited to accounts 3.5 Aggregate write-ins for other amounts deducted prior to determining amounts included in Lines 1 or 2 3.99 Total (Lines 3.1 through 3.5) Transfers: 4.1 Enter in Column 2, as a negative number, and Column 4, as a positive number, the total of all amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, that are included in Column 2, Lines 1, 2 and 3.99 4.2 Enter in Column 2, as a positive number, and Column 4, as a negative number, any amounts reported in Column 4, Lines 1, 2 and 3.99 that are allocated. (Note: amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, should not be included in line 4.2) 4.3 Enter in Column 4, as a positive number, and Column 2, as a negative number, any amounts reported in Column 2, Lines 1, 2 and 3.99 that are unallocated 4.99 Total (Lines 4.1 + 4.2 + 4.3) Total (Lines 1 + 2 + 3.99 + 4.99) 1 2 3 Life Insurance Premiums Annuity Considerations A & H Premiums 4 Deposit-Type Contract Funds and Other Considerations 124,060 0 173,938,173 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 124,060 0 173,938,173 DEVELOPMENT OF AMOUNTS INCLUDED IN LINES 1 THROUGH 5 THAT SHOULD BE DEDUCTED IN DETERMINING THE BASE Do not include any amount more than once in Lines 6 through 9 Aggregate write-ins for amounts where the insurer is not subject to risk. Premiums for portions of policies or contracts NOT guaranteed or under which the entire investment risk is borne by the policyholder. (Please specify such deductions and indicate where such amounts were reported in the Annual Statement) Amounts NOT allocated to individuals or individual certificate holders or amounts received for such contracts in excess of limits: 7.1 Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans 7.2 Unallocated funding obligations that fund any employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation 7.3 Unallocated funding obligations that fund governmental lotteries or employee, union, or association of natural persons benefit plans in excess of $5 million per contract which are NOT: (a) government retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation 7.4 Total (Lines 7.1 + 7.2 + 7.3) Dividends/Experience rating credits paid or credited, but only if NOT guaranteed in advance (include only amounts NOT already deducted in determining Lines 1 and 2) Aggregate write-ins for Other Deductions Total (Lines 6 + 7.4 + 8 + 9) Current Year DETAILS OF WRITE-INS 0 0 0 0 0 0 0 XXX XXX XXX 0 XXX XXX XXX 0 XXX XXX XXX XXX XXX XXX 0 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 124,060 0 0 0 0 45,345,437 45,345,437 0 0 0 0 128,592,736 0 Summary of remaining write-ins for Line 3.5 from overflow page Totals (Lines 3.501 thru 3.503 plus 3.598)(Line 3.5 above) 0 0 0 0 0 0 0 0 Summary of remaining write-ins for Line 6 from overflow page Totals (Lines 0601 thru 0603 plus 0698)(Line 6 above) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 44,942,860 402,577 0 0 45,345,437 0 0 0 0 0 0 0 Medicare Part C & D Stop Loss Medicaid Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.DE *79413201830008100* ADJUSTMENTS TO THE LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Delaware 1 2 Allocated Annuity and Other Allocated Fund Deposits Life Insurance Premiums 4 Unallocated Annuity & Other Unallocated Fund Deposits Accident & Health Premium 124,060 0 128,592,736 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. MODEL ACT BASE ( Line 11 of the Reconciliation Exhibit) 2. Enter in Column 2, as a positive number, and Column 4, as a negative number, the total of all amounts received to fund allocated contracts established under Section 403(b) of the U.S. Internal Revenue Code that are included in Column 4, Line 1 above 3. Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans: 4. 3 0 XXX 0 XXX 0 3.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 3.2 All amounts XXX XXX XXX 0 0 4.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 0 4.2 Amounts in excess of $1 million but NOT in excess of $5 million per contract XXX XXX XXX 4.3 Amounts in excess of $5 million per contract XXX XXX XXX 4.4 Total (Lines 4.1 + 4.2 + 4.3) XXX XXX XXX 4.5 Amounts up to $7.5 million, per contract (Minnesota only) XXX XXX XXX 0 0 0 0 5.1 Amounts in excess of $1 million per contract XXX XXX XXX 5.2 All amounts XXX XXX XXX 5.3 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 5.4 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 6.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 6.2 Amounts in excess of $1 million per contract XXX XXX XXX 6.3 Total (Lines 6.1 + 6.2) XXX XXX XXX 6.4 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 6.5 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 7.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 7.2 All amounts XXX XXX XXX Unallocated funding obligations issued to fund government lotteries or employee, union, or association of natural persons benefit plans which are NOT: (a) governmental retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation: 5. 6. 7. Unallocated funding obligations issued to fund governmental retirement plans established under Sections 401 and 457 of the U.S. Internal Revenue Code: 0 0 0 0 Unallocated funding obligations issued to fund governmental retirement plans established under Sections 403(b) of the U.S. Internal Revenue Code: 0 0 0 0 0 Unallocated funding obligations that fund employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation: 7.3 Amounts NOT in excess of $2 million per contract (New Jersey only) XXX XXX XXX 0 0 0 8. Unallocated funding obligations issued to fund government lotteries NOT in excess of $5 million per contractholder (New Jersey Only) XXX XXX XXX 0 9. Unallocated funding obligations that fund employee or association of natural persons benefit plans in excess of $2 million but NOT in excess of $5 million per contract (New Jersey Only) XXX 10. Aggregate write-ins for other deductions 0 0 0 0 0 124,060 0 128,592,736 0 0 0 0 0 0 0 0 0 XXX XXX BASE 11. Current Year (2018) DETAILS OF WRITE-INS 1001. 1002. 1003. 1098. Summary of remaining write-ins for Line 10 from overflow page 1099. Totals (Lines 1001 thru 1003 plus 1098)(Line 10 above) 300.DE *79413201829009100* LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: District of Columbia 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 3.501. 3.502. 3.503. 3.598. 3.599. 0601. 0602. 0603. 0698. 0699. 0901. 0902. 0903. 0998. 0999. PREMIUMS, CONSIDERATIONS AND DEPOSITS Premiums, considerations and deposits from Schedule T or Exhibit of Premiums and Losses Premiums, considerations and deposits NOT reported in Schedule T or Exhibit of Premiums and Losses, including investment contract receipts credited to a liability account 2.1 Contract fees for variable contracts with guarantees 2.2 Any other premiums, considerations and deposits not reported in Schedule T or Exhibit of Premiums and Losses Amounts, if applicable, that were deducted prior to determining amounts included in Lines 1 or 2 which are in the following categories: 3.1 Transfers to guaranteed Separate Accounts 3.2 Roll over of GICs or annuities into other companies 3.3 Surrenders or other benefits paid out 3.4 Excess interest credited to accounts 3.5 Aggregate write-ins for other amounts deducted prior to determining amounts included in Lines 1 or 2 3.99 Total (Lines 3.1 through 3.5) Transfers: 4.1 Enter in Column 2, as a negative number, and Column 4, as a positive number, the total of all amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, that are included in Column 2, Lines 1, 2 and 3.99 4.2 Enter in Column 2, as a positive number, and Column 4, as a negative number, any amounts reported in Column 4, Lines 1, 2 and 3.99 that are allocated. (Note: amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, should not be included in line 4.2) 4.3 Enter in Column 4, as a positive number, and Column 2, as a negative number, any amounts reported in Column 2, Lines 1, 2 and 3.99 that are unallocated 4.99 Total (Lines 4.1 + 4.2 + 4.3) Total (Lines 1 + 2 + 3.99 + 4.99) 1 2 3 Life Insurance Premiums Annuity Considerations A & H Premiums 4 Deposit-Type Contract Funds and Other Considerations 230,592 0 386,877,304 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 230,592 0 386,877,304 DEVELOPMENT OF AMOUNTS INCLUDED IN LINES 1 THROUGH 5 THAT SHOULD BE DEDUCTED IN DETERMINING THE BASE Do not include any amount more than once in Lines 6 through 9 Aggregate write-ins for amounts where the insurer is not subject to risk. Premiums for portions of policies or contracts NOT guaranteed or under which the entire investment risk is borne by the policyholder. (Please specify such deductions and indicate where such amounts were reported in the Annual Statement) Amounts NOT allocated to individuals or individual certificate holders or amounts received for such contracts in excess of limits: 7.1 Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans 7.2 Unallocated funding obligations that fund any employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation 7.3 Unallocated funding obligations that fund governmental lotteries or employee, union, or association of natural persons benefit plans in excess of $5 million per contract which are NOT: (a) government retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation 7.4 Total (Lines 7.1 + 7.2 + 7.3) Dividends/Experience rating credits paid or credited, but only if NOT guaranteed in advance (include only amounts NOT already deducted in determining Lines 1 and 2) Aggregate write-ins for Other Deductions Total (Lines 6 + 7.4 + 8 + 9) Current Year DETAILS OF WRITE-INS 0 0 0 0 0 0 0 XXX XXX XXX 0 XXX XXX XXX 0 XXX XXX XXX XXX XXX XXX 0 0 0 0 0 0 179,747,036 179,747,036 0 0 0 0 207,130,268 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 230,592 Summary of remaining write-ins for Line 3.5 from overflow page Totals (Lines 3.501 thru 3.503 plus 3.598)(Line 3.5 above) 0 0 0 0 0 0 0 0 Summary of remaining write-ins for Line 6 from overflow page Totals (Lines 0601 thru 0603 plus 0698)(Line 6 above) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 175,111,520 4,635,516 0 0 179,747,036 0 0 0 0 0 0 0 Medicare Part C & D Stop Loss Medicaid Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.DC *79413201830009100* ADJUSTMENTS TO THE LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: District of Columbia 1 2 Allocated Annuity and Other Allocated Fund Deposits Life Insurance Premiums 4 Unallocated Annuity & Other Unallocated Fund Deposits Accident & Health Premium 230,592 0 207,130,268 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. MODEL ACT BASE ( Line 11 of the Reconciliation Exhibit) 2. Enter in Column 2, as a positive number, and Column 4, as a negative number, the total of all amounts received to fund allocated contracts established under Section 403(b) of the U.S. Internal Revenue Code that are included in Column 4, Line 1 above 3. Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans: 4. 3 0 XXX 0 XXX 0 3.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 3.2 All amounts XXX XXX XXX 0 0 4.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 0 4.2 Amounts in excess of $1 million but NOT in excess of $5 million per contract XXX XXX XXX 4.3 Amounts in excess of $5 million per contract XXX XXX XXX 4.4 Total (Lines 4.1 + 4.2 + 4.3) XXX XXX XXX 4.5 Amounts up to $7.5 million, per contract (Minnesota only) XXX XXX XXX 0 0 0 0 5.1 Amounts in excess of $1 million per contract XXX XXX XXX 5.2 All amounts XXX XXX XXX 5.3 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 5.4 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 6.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 6.2 Amounts in excess of $1 million per contract XXX XXX XXX 6.3 Total (Lines 6.1 + 6.2) XXX XXX XXX 6.4 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 6.5 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 7.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 7.2 All amounts XXX XXX XXX Unallocated funding obligations issued to fund government lotteries or employee, union, or association of natural persons benefit plans which are NOT: (a) governmental retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation: 5. 6. 7. Unallocated funding obligations issued to fund governmental retirement plans established under Sections 401 and 457 of the U.S. Internal Revenue Code: 0 0 0 0 Unallocated funding obligations issued to fund governmental retirement plans established under Sections 403(b) of the U.S. Internal Revenue Code: 0 0 0 0 0 Unallocated funding obligations that fund employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation: 7.3 Amounts NOT in excess of $2 million per contract (New Jersey only) XXX XXX XXX 0 0 0 8. Unallocated funding obligations issued to fund government lotteries NOT in excess of $5 million per contractholder (New Jersey Only) XXX XXX XXX 0 9. Unallocated funding obligations that fund employee or association of natural persons benefit plans in excess of $2 million but NOT in excess of $5 million per contract (New Jersey Only) XXX 10. Aggregate write-ins for other deductions 0 0 0 0 0 230,592 0 207,130,268 0 0 0 0 0 0 0 0 0 XXX XXX BASE 11. Current Year (2018) DETAILS OF WRITE-INS 1001. 1002. 1003. 1098. Summary of remaining write-ins for Line 10 from overflow page 1099. Totals (Lines 1001 thru 1003 plus 1098)(Line 10 above) 300.DC *79413201829010100* LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Florida 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 3.501. 3.502. 3.503. 3.598. 3.599. 0601. 0602. 0603. 0698. 0699. 0901. 0902. 0903. 0998. 0999. PREMIUMS, CONSIDERATIONS AND DEPOSITS Premiums, considerations and deposits from Schedule T or Exhibit of Premiums and Losses Premiums, considerations and deposits NOT reported in Schedule T or Exhibit of Premiums and Losses, including investment contract receipts credited to a liability account 2.1 Contract fees for variable contracts with guarantees 2.2 Any other premiums, considerations and deposits not reported in Schedule T or Exhibit of Premiums and Losses Amounts, if applicable, that were deducted prior to determining amounts included in Lines 1 or 2 which are in the following categories: 3.1 Transfers to guaranteed Separate Accounts 3.2 Roll over of GICs or annuities into other companies 3.3 Surrenders or other benefits paid out 3.4 Excess interest credited to accounts 3.5 Aggregate write-ins for other amounts deducted prior to determining amounts included in Lines 1 or 2 3.99 Total (Lines 3.1 through 3.5) Transfers: 4.1 Enter in Column 2, as a negative number, and Column 4, as a positive number, the total of all amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, that are included in Column 2, Lines 1, 2 and 3.99 4.2 Enter in Column 2, as a positive number, and Column 4, as a negative number, any amounts reported in Column 4, Lines 1, 2 and 3.99 that are allocated. (Note: amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, should not be included in line 4.2) 4.3 Enter in Column 4, as a positive number, and Column 2, as a negative number, any amounts reported in Column 2, Lines 1, 2 and 3.99 that are unallocated 4.99 Total (Lines 4.1 + 4.2 + 4.3) Total (Lines 1 + 2 + 3.99 + 4.99) 1 2 3 Life Insurance Premiums Annuity Considerations A & H Premiums 4 Deposit-Type Contract Funds and Other Considerations 11,497,596 0 6,564,655,287 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 11,497,596 0 6,564,655,287 DEVELOPMENT OF AMOUNTS INCLUDED IN LINES 1 THROUGH 5 THAT SHOULD BE DEDUCTED IN DETERMINING THE BASE Do not include any amount more than once in Lines 6 through 9 Aggregate write-ins for amounts where the insurer is not subject to risk. Premiums for portions of policies or contracts NOT guaranteed or under which the entire investment risk is borne by the policyholder. (Please specify such deductions and indicate where such amounts were reported in the Annual Statement) Amounts NOT allocated to individuals or individual certificate holders or amounts received for such contracts in excess of limits: 7.1 Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans 7.2 Unallocated funding obligations that fund any employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation 7.3 Unallocated funding obligations that fund governmental lotteries or employee, union, or association of natural persons benefit plans in excess of $5 million per contract which are NOT: (a) government retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation 7.4 Total (Lines 7.1 + 7.2 + 7.3) Dividends/Experience rating credits paid or credited, but only if NOT guaranteed in advance (include only amounts NOT already deducted in determining Lines 1 and 2) Aggregate write-ins for Other Deductions Total (Lines 6 + 7.4 + 8 + 9) Current Year DETAILS OF WRITE-INS 0 0 0 0 0 0 0 XXX XXX XXX 0 XXX XXX XXX 0 XXX XXX XXX XXX XXX XXX 0 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 11,497,596 0 0 0 0 3,302,320,476 3,302,320,476 0 0 0 0 3,262,334,811 0 Summary of remaining write-ins for Line 3.5 from overflow page Totals (Lines 3.501 thru 3.503 plus 3.598)(Line 3.5 above) 0 0 0 0 0 0 0 0 Summary of remaining write-ins for Line 6 from overflow page Totals (Lines 0601 thru 0603 plus 0698)(Line 6 above) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3,260,078,190 42,242,286 0 0 3,302,320,476 0 0 0 0 0 0 0 Medicare Part C & D Stop Loss Medicaid Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.FL *79413201830010100* ADJUSTMENTS TO THE LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Florida 1 2 Allocated Annuity and Other Allocated Fund Deposits Life Insurance Premiums 4 Unallocated Annuity & Other Unallocated Fund Deposits Accident & Health Premium 11,497,596 0 3,262,334,811 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. MODEL ACT BASE ( Line 11 of the Reconciliation Exhibit) 2. Enter in Column 2, as a positive number, and Column 4, as a negative number, the total of all amounts received to fund allocated contracts established under Section 403(b) of the U.S. Internal Revenue Code that are included in Column 4, Line 1 above 3. Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans: 4. 3 0 XXX 0 XXX 0 3.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 3.2 All amounts XXX XXX XXX 0 0 4.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 0 4.2 Amounts in excess of $1 million but NOT in excess of $5 million per contract XXX XXX XXX 4.3 Amounts in excess of $5 million per contract XXX XXX XXX 4.4 Total (Lines 4.1 + 4.2 + 4.3) XXX XXX XXX 4.5 Amounts up to $7.5 million, per contract (Minnesota only) XXX XXX XXX 0 0 0 0 5.1 Amounts in excess of $1 million per contract XXX XXX XXX 5.2 All amounts XXX XXX XXX 5.3 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 5.4 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 6.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 6.2 Amounts in excess of $1 million per contract XXX XXX XXX 6.3 Total (Lines 6.1 + 6.2) XXX XXX XXX 6.4 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 6.5 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 7.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 7.2 All amounts XXX XXX XXX Unallocated funding obligations issued to fund government lotteries or employee, union, or association of natural persons benefit plans which are NOT: (a) governmental retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation: 5. 6. 7. Unallocated funding obligations issued to fund governmental retirement plans established under Sections 401 and 457 of the U.S. Internal Revenue Code: 0 0 0 0 Unallocated funding obligations issued to fund governmental retirement plans established under Sections 403(b) of the U.S. Internal Revenue Code: 0 0 0 0 0 Unallocated funding obligations that fund employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation: 7.3 Amounts NOT in excess of $2 million per contract (New Jersey only) XXX XXX XXX 0 0 0 8. Unallocated funding obligations issued to fund government lotteries NOT in excess of $5 million per contractholder (New Jersey Only) XXX XXX XXX 0 9. Unallocated funding obligations that fund employee or association of natural persons benefit plans in excess of $2 million but NOT in excess of $5 million per contract (New Jersey Only) XXX 10. Aggregate write-ins for other deductions 0 0 0 0 0 11,497,596 0 3,262,334,811 0 0 0 0 0 0 0 0 0 XXX XXX BASE 11. Current Year (2018) DETAILS OF WRITE-INS 1001. 1002. 1003. 1098. Summary of remaining write-ins for Line 10 from overflow page 1099. Totals (Lines 1001 thru 1003 plus 1098)(Line 10 above) 300.FL *79413201829011100* LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Georgia 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 3.501. 3.502. 3.503. 3.598. 3.599. 0601. 0602. 0603. 0698. 0699. 0901. 0902. 0903. 0998. 0999. PREMIUMS, CONSIDERATIONS AND DEPOSITS Premiums, considerations and deposits from Schedule T or Exhibit of Premiums and Losses Premiums, considerations and deposits NOT reported in Schedule T or Exhibit of Premiums and Losses, including investment contract receipts credited to a liability account 2.1 Contract fees for variable contracts with guarantees 2.2 Any other premiums, considerations and deposits not reported in Schedule T or Exhibit of Premiums and Losses Amounts, if applicable, that were deducted prior to determining amounts included in Lines 1 or 2 which are in the following categories: 3.1 Transfers to guaranteed Separate Accounts 3.2 Roll over of GICs or annuities into other companies 3.3 Surrenders or other benefits paid out 3.4 Excess interest credited to accounts 3.5 Aggregate write-ins for other amounts deducted prior to determining amounts included in Lines 1 or 2 3.99 Total (Lines 3.1 through 3.5) Transfers: 4.1 Enter in Column 2, as a negative number, and Column 4, as a positive number, the total of all amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, that are included in Column 2, Lines 1, 2 and 3.99 4.2 Enter in Column 2, as a positive number, and Column 4, as a negative number, any amounts reported in Column 4, Lines 1, 2 and 3.99 that are allocated. (Note: amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, should not be included in line 4.2) 4.3 Enter in Column 4, as a positive number, and Column 2, as a negative number, any amounts reported in Column 2, Lines 1, 2 and 3.99 that are unallocated 4.99 Total (Lines 4.1 + 4.2 + 4.3) Total (Lines 1 + 2 + 3.99 + 4.99) 1 2 3 Life Insurance Premiums Annuity Considerations A & H Premiums 4 Deposit-Type Contract Funds and Other Considerations 3,718,189 0 3,362,418,362 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3,718,189 0 3,362,418,362 DEVELOPMENT OF AMOUNTS INCLUDED IN LINES 1 THROUGH 5 THAT SHOULD BE DEDUCTED IN DETERMINING THE BASE Do not include any amount more than once in Lines 6 through 9 Aggregate write-ins for amounts where the insurer is not subject to risk. Premiums for portions of policies or contracts NOT guaranteed or under which the entire investment risk is borne by the policyholder. (Please specify such deductions and indicate where such amounts were reported in the Annual Statement) Amounts NOT allocated to individuals or individual certificate holders or amounts received for such contracts in excess of limits: 7.1 Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans 7.2 Unallocated funding obligations that fund any employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation 7.3 Unallocated funding obligations that fund governmental lotteries or employee, union, or association of natural persons benefit plans in excess of $5 million per contract which are NOT: (a) government retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation 7.4 Total (Lines 7.1 + 7.2 + 7.3) Dividends/Experience rating credits paid or credited, but only if NOT guaranteed in advance (include only amounts NOT already deducted in determining Lines 1 and 2) Aggregate write-ins for Other Deductions Total (Lines 6 + 7.4 + 8 + 9) Current Year DETAILS OF WRITE-INS 0 0 0 0 0 0 0 XXX XXX XXX 0 XXX XXX XXX 0 XXX XXX XXX XXX XXX XXX 0 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 3,718,189 0 0 0 0 2,245,282,161 2,245,282,161 0 0 0 0 1,117,136,201 0 Summary of remaining write-ins for Line 3.5 from overflow page Totals (Lines 3.501 thru 3.503 plus 3.598)(Line 3.5 above) 0 0 0 0 0 0 0 0 Summary of remaining write-ins for Line 6 from overflow page Totals (Lines 0601 thru 0603 plus 0698)(Line 6 above) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,223,615,429 21,666,732 0 0 2,245,282,161 0 0 0 0 0 0 0 Medicare Part C & D Stop Loss Medicaid Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.GA *79413201829012100* LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Hawaii 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 3.501. 3.502. 3.503. 3.598. 3.599. 0601. 0602. 0603. 0698. 0699. 0901. 0902. 0903. 0998. 0999. PREMIUMS, CONSIDERATIONS AND DEPOSITS Premiums, considerations and deposits from Schedule T or Exhibit of Premiums and Losses Premiums, considerations and deposits NOT reported in Schedule T or Exhibit of Premiums and Losses, including investment contract receipts credited to a liability account 2.1 Contract fees for variable contracts with guarantees 2.2 Any other premiums, considerations and deposits not reported in Schedule T or Exhibit of Premiums and Losses Amounts, if applicable, that were deducted prior to determining amounts included in Lines 1 or 2 which are in the following categories: 3.1 Transfers to guaranteed Separate Accounts 3.2 Roll over of GICs or annuities into other companies 3.3 Surrenders or other benefits paid out 3.4 Excess interest credited to accounts 3.5 Aggregate write-ins for other amounts deducted prior to determining amounts included in Lines 1 or 2 3.99 Total (Lines 3.1 through 3.5) Transfers: 4.1 Enter in Column 2, as a negative number, and Column 4, as a positive number, the total of all amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, that are included in Column 2, Lines 1, 2 and 3.99 4.2 Enter in Column 2, as a positive number, and Column 4, as a negative number, any amounts reported in Column 4, Lines 1, 2 and 3.99 that are allocated. (Note: amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, should not be included in line 4.2) 4.3 Enter in Column 4, as a positive number, and Column 2, as a negative number, any amounts reported in Column 2, Lines 1, 2 and 3.99 that are unallocated 4.99 Total (Lines 4.1 + 4.2 + 4.3) Total (Lines 1 + 2 + 3.99 + 4.99) 1 2 3 Life Insurance Premiums Annuity Considerations A & H Premiums 4 Deposit-Type Contract Funds and Other Considerations 251,748 0 854,263,186 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 251,748 0 854,263,186 DEVELOPMENT OF AMOUNTS INCLUDED IN LINES 1 THROUGH 5 THAT SHOULD BE DEDUCTED IN DETERMINING THE BASE Do not include any amount more than once in Lines 6 through 9 Aggregate write-ins for amounts where the insurer is not subject to risk. Premiums for portions of policies or contracts NOT guaranteed or under which the entire investment risk is borne by the policyholder. (Please specify such deductions and indicate where such amounts were reported in the Annual Statement) Amounts NOT allocated to individuals or individual certificate holders or amounts received for such contracts in excess of limits: 7.1 Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans 7.2 Unallocated funding obligations that fund any employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation 7.3 Unallocated funding obligations that fund governmental lotteries or employee, union, or association of natural persons benefit plans in excess of $5 million per contract which are NOT: (a) government retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation 7.4 Total (Lines 7.1 + 7.2 + 7.3) Dividends/Experience rating credits paid or credited, but only if NOT guaranteed in advance (include only amounts NOT already deducted in determining Lines 1 and 2) Aggregate write-ins for Other Deductions Total (Lines 6 + 7.4 + 8 + 9) Current Year DETAILS OF WRITE-INS 0 0 0 0 0 0 0 XXX XXX XXX 0 XXX XXX XXX 0 XXX XXX XXX XXX XXX XXX 0 0 0 0 0 0 368,829,220 368,829,220 0 0 0 0 485,433,966 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 251,748 Summary of remaining write-ins for Line 3.5 from overflow page Totals (Lines 3.501 thru 3.503 plus 3.598)(Line 3.5 above) 0 0 0 0 0 0 0 0 Summary of remaining write-ins for Line 6 from overflow page Totals (Lines 0601 thru 0603 plus 0698)(Line 6 above) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 368,788,675 40,545 0 0 368,829,220 0 0 0 0 0 0 0 Medicare Part C & D Stop Loss Medicaid Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.HI *79413201830012100* ADJUSTMENTS TO THE LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Hawaii 1 2 Allocated Annuity and Other Allocated Fund Deposits Life Insurance Premiums 4 Unallocated Annuity & Other Unallocated Fund Deposits Accident & Health Premium 251,748 0 485,433,966 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. MODEL ACT BASE ( Line 11 of the Reconciliation Exhibit) 2. Enter in Column 2, as a positive number, and Column 4, as a negative number, the total of all amounts received to fund allocated contracts established under Section 403(b) of the U.S. Internal Revenue Code that are included in Column 4, Line 1 above 3. Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans: 4. 3 0 XXX 0 XXX 0 3.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 3.2 All amounts XXX XXX XXX 0 0 4.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 0 4.2 Amounts in excess of $1 million but NOT in excess of $5 million per contract XXX XXX XXX 4.3 Amounts in excess of $5 million per contract XXX XXX XXX 4.4 Total (Lines 4.1 + 4.2 + 4.3) XXX XXX XXX 4.5 Amounts up to $7.5 million, per contract (Minnesota only) XXX XXX XXX 0 0 0 0 5.1 Amounts in excess of $1 million per contract XXX XXX XXX 5.2 All amounts XXX XXX XXX 5.3 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 5.4 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 6.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 6.2 Amounts in excess of $1 million per contract XXX XXX XXX 6.3 Total (Lines 6.1 + 6.2) XXX XXX XXX 6.4 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 6.5 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 7.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 7.2 All amounts XXX XXX XXX Unallocated funding obligations issued to fund government lotteries or employee, union, or association of natural persons benefit plans which are NOT: (a) governmental retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation: 5. 6. 7. Unallocated funding obligations issued to fund governmental retirement plans established under Sections 401 and 457 of the U.S. Internal Revenue Code: 0 0 0 0 Unallocated funding obligations issued to fund governmental retirement plans established under Sections 403(b) of the U.S. Internal Revenue Code: 0 0 0 0 0 Unallocated funding obligations that fund employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation: 7.3 Amounts NOT in excess of $2 million per contract (New Jersey only) XXX XXX XXX 0 0 0 8. Unallocated funding obligations issued to fund government lotteries NOT in excess of $5 million per contractholder (New Jersey Only) XXX XXX XXX 0 9. Unallocated funding obligations that fund employee or association of natural persons benefit plans in excess of $2 million but NOT in excess of $5 million per contract (New Jersey Only) XXX 10. Aggregate write-ins for other deductions 0 0 0 0 0 251,748 0 485,433,966 0 0 0 0 0 0 0 0 0 XXX XXX BASE 11. Current Year (2018) DETAILS OF WRITE-INS 1001. 1002. 1003. 1098. Summary of remaining write-ins for Line 10 from overflow page 1099. Totals (Lines 1001 thru 1003 plus 1098)(Line 10 above) 300.HI *79413201829013100* LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Idaho 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 3.501. 3.502. 3.503. 3.598. 3.599. 0601. 0602. 0603. 0698. 0699. 0901. 0902. 0903. 0998. 0999. PREMIUMS, CONSIDERATIONS AND DEPOSITS Premiums, considerations and deposits from Schedule T or Exhibit of Premiums and Losses Premiums, considerations and deposits NOT reported in Schedule T or Exhibit of Premiums and Losses, including investment contract receipts credited to a liability account 2.1 Contract fees for variable contracts with guarantees 2.2 Any other premiums, considerations and deposits not reported in Schedule T or Exhibit of Premiums and Losses Amounts, if applicable, that were deducted prior to determining amounts included in Lines 1 or 2 which are in the following categories: 3.1 Transfers to guaranteed Separate Accounts 3.2 Roll over of GICs or annuities into other companies 3.3 Surrenders or other benefits paid out 3.4 Excess interest credited to accounts 3.5 Aggregate write-ins for other amounts deducted prior to determining amounts included in Lines 1 or 2 3.99 Total (Lines 3.1 through 3.5) Transfers: 4.1 Enter in Column 2, as a negative number, and Column 4, as a positive number, the total of all amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, that are included in Column 2, Lines 1, 2 and 3.99 4.2 Enter in Column 2, as a positive number, and Column 4, as a negative number, any amounts reported in Column 4, Lines 1, 2 and 3.99 that are allocated. (Note: amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, should not be included in line 4.2) 4.3 Enter in Column 4, as a positive number, and Column 2, as a negative number, any amounts reported in Column 2, Lines 1, 2 and 3.99 that are unallocated 4.99 Total (Lines 4.1 + 4.2 + 4.3) Total (Lines 1 + 2 + 3.99 + 4.99) 1 2 3 Life Insurance Premiums Annuity Considerations A & H Premiums 4 Deposit-Type Contract Funds and Other Considerations 169,428 0 327,084,250 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 169,428 0 327,084,250 DEVELOPMENT OF AMOUNTS INCLUDED IN LINES 1 THROUGH 5 THAT SHOULD BE DEDUCTED IN DETERMINING THE BASE Do not include any amount more than once in Lines 6 through 9 Aggregate write-ins for amounts where the insurer is not subject to risk. Premiums for portions of policies or contracts NOT guaranteed or under which the entire investment risk is borne by the policyholder. (Please specify such deductions and indicate where such amounts were reported in the Annual Statement) Amounts NOT allocated to individuals or individual certificate holders or amounts received for such contracts in excess of limits: 7.1 Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans 7.2 Unallocated funding obligations that fund any employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation 7.3 Unallocated funding obligations that fund governmental lotteries or employee, union, or association of natural persons benefit plans in excess of $5 million per contract which are NOT: (a) government retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation 7.4 Total (Lines 7.1 + 7.2 + 7.3) Dividends/Experience rating credits paid or credited, but only if NOT guaranteed in advance (include only amounts NOT already deducted in determining Lines 1 and 2) Aggregate write-ins for Other Deductions Total (Lines 6 + 7.4 + 8 + 9) Current Year DETAILS OF WRITE-INS 0 0 0 0 0 0 0 XXX XXX XXX 0 XXX XXX XXX 0 XXX XXX XXX XXX XXX XXX 0 0 0 0 0 0 243,608,440 243,608,440 0 0 0 0 83,475,810 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 169,428 Summary of remaining write-ins for Line 3.5 from overflow page Totals (Lines 3.501 thru 3.503 plus 3.598)(Line 3.5 above) 0 0 0 0 0 0 0 0 Summary of remaining write-ins for Line 6 from overflow page Totals (Lines 0601 thru 0603 plus 0698)(Line 6 above) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 241,875,751 1,732,689 0 0 243,608,440 0 0 0 0 0 0 0 Medicare Part C & D Stop Loss Medicaid Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.ID *79413201830013100* ADJUSTMENTS TO THE LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Idaho 1 2 Allocated Annuity and Other Allocated Fund Deposits Life Insurance Premiums MODEL ACT BASE ( Line 11 of the Reconciliation Exhibit) 2. Enter in Column 2, as a positive number, and Column 4, as a negative number, the total of all amounts received to fund allocated contracts established under Section 403(b) of the U.S. Internal Revenue Code that are included in Column 4, Line 1 above 3. Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans: 0 XXX 4 Unallocated Annuity & Other Unallocated Fund Deposits Accident & Health Premium 169,428 0 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. 4. 3 83,475,810 0 XXX 0 3.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 3.2 All amounts XXX XXX XXX 0 0 4.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 0 4.2 Amounts in excess of $1 million but NOT in excess of $5 million per contract XXX XXX XXX 4.3 Amounts in excess of $5 million per contract XXX XXX XXX 4.4 Total (Lines 4.1 + 4.2 + 4.3) XXX XXX XXX 4.5 Amounts up to $7.5 million, per contract (Minnesota only) XXX XXX XXX 0 0 0 0 5.1 Amounts in excess of $1 million per contract XXX XXX XXX 5.2 All amounts XXX XXX XXX 5.3 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 5.4 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 6.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 6.2 Amounts in excess of $1 million per contract XXX XXX XXX 6.3 Total (Lines 6.1 + 6.2) XXX XXX XXX 6.4 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 6.5 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 7.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 7.2 All amounts XXX XXX XXX Unallocated funding obligations issued to fund government lotteries or employee, union, or association of natural persons benefit plans which are NOT: (a) governmental retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation: 5. 6. 7. Unallocated funding obligations issued to fund governmental retirement plans established under Sections 401 and 457 of the U.S. Internal Revenue Code: 0 0 0 0 Unallocated funding obligations issued to fund governmental retirement plans established under Sections 403(b) of the U.S. Internal Revenue Code: 0 0 0 0 0 Unallocated funding obligations that fund employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation: 7.3 Amounts NOT in excess of $2 million per contract (New Jersey only) XXX XXX XXX 0 0 0 8. Unallocated funding obligations issued to fund government lotteries NOT in excess of $5 million per contractholder (New Jersey Only) XXX XXX XXX 0 9. Unallocated funding obligations that fund employee or association of natural persons benefit plans in excess of $2 million but NOT in excess of $5 million per contract (New Jersey Only) XXX 10. Aggregate write-ins for other deductions 0 0 0 0 0 169,428 0 83,475,810 0 0 0 0 0 0 0 0 0 XXX XXX BASE 11. Current Year (2018) DETAILS OF WRITE-INS 1001. 1002. 1003. 1098. Summary of remaining write-ins for Line 10 from overflow page 1099. Totals (Lines 1001 thru 1003 plus 1098)(Line 10 above) 300.ID *79413201829014100* LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Illinois 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 3.501. 3.502. 3.503. 3.598. 3.599. 0601. 0602. 0603. 0698. 0699. 0901. 0902. 0903. 0998. 0999. PREMIUMS, CONSIDERATIONS AND DEPOSITS Premiums, considerations and deposits from Schedule T or Exhibit of Premiums and Losses Premiums, considerations and deposits NOT reported in Schedule T or Exhibit of Premiums and Losses, including investment contract receipts credited to a liability account 2.1 Contract fees for variable contracts with guarantees 2.2 Any other premiums, considerations and deposits not reported in Schedule T or Exhibit of Premiums and Losses Amounts, if applicable, that were deducted prior to determining amounts included in Lines 1 or 2 which are in the following categories: 3.1 Transfers to guaranteed Separate Accounts 3.2 Roll over of GICs or annuities into other companies 3.3 Surrenders or other benefits paid out 3.4 Excess interest credited to accounts 3.5 Aggregate write-ins for other amounts deducted prior to determining amounts included in Lines 1 or 2 3.99 Total (Lines 3.1 through 3.5) Transfers: 4.1 Enter in Column 2, as a negative number, and Column 4, as a positive number, the total of all amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, that are included in Column 2, Lines 1, 2 and 3.99 4.2 Enter in Column 2, as a positive number, and Column 4, as a negative number, any amounts reported in Column 4, Lines 1, 2 and 3.99 that are allocated. (Note: amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, should not be included in line 4.2) 4.3 Enter in Column 4, as a positive number, and Column 2, as a negative number, any amounts reported in Column 2, Lines 1, 2 and 3.99 that are unallocated 4.99 Total (Lines 4.1 + 4.2 + 4.3) Total (Lines 1 + 2 + 3.99 + 4.99) 1 2 3 Life Insurance Premiums Annuity Considerations A & H Premiums 4 Deposit-Type Contract Funds and Other Considerations 5,743,942 0 1,028,343,519 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5,743,942 0 1,028,343,519 DEVELOPMENT OF AMOUNTS INCLUDED IN LINES 1 THROUGH 5 THAT SHOULD BE DEDUCTED IN DETERMINING THE BASE Do not include any amount more than once in Lines 6 through 9 Aggregate write-ins for amounts where the insurer is not subject to risk. Premiums for portions of policies or contracts NOT guaranteed or under which the entire investment risk is borne by the policyholder. (Please specify such deductions and indicate where such amounts were reported in the Annual Statement) Amounts NOT allocated to individuals or individual certificate holders or amounts received for such contracts in excess of limits: 7.1 Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans 7.2 Unallocated funding obligations that fund any employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation 7.3 Unallocated funding obligations that fund governmental lotteries or employee, union, or association of natural persons benefit plans in excess of $5 million per contract which are NOT: (a) government retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation 7.4 Total (Lines 7.1 + 7.2 + 7.3) Dividends/Experience rating credits paid or credited, but only if NOT guaranteed in advance (include only amounts NOT already deducted in determining Lines 1 and 2) Aggregate write-ins for Other Deductions Total (Lines 6 + 7.4 + 8 + 9) Current Year DETAILS OF WRITE-INS 0 0 0 0 0 0 0 XXX XXX XXX 0 XXX XXX XXX 0 XXX XXX XXX XXX XXX XXX 0 0 0 0 0 0 244,491,939 244,491,939 0 0 0 0 783,851,580 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 5,743,942 Summary of remaining write-ins for Line 3.5 from overflow page Totals (Lines 3.501 thru 3.503 plus 3.598)(Line 3.5 above) 0 0 0 0 0 0 0 0 Summary of remaining write-ins for Line 6 from overflow page Totals (Lines 0601 thru 0603 plus 0698)(Line 6 above) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 215,558,642 28,933,297 0 0 244,491,939 0 0 0 0 0 0 0 Medicare Part C & D Stop Loss Medicaid Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.IL *79413201830014100* ADJUSTMENTS TO THE LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Illinois 1 2 Allocated Annuity and Other Allocated Fund Deposits Life Insurance Premiums 4 Unallocated Annuity & Other Unallocated Fund Deposits Accident & Health Premium 5,743,942 0 783,851,580 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. MODEL ACT BASE ( Line 11 of the Reconciliation Exhibit) 2. Enter in Column 2, as a positive number, and Column 4, as a negative number, the total of all amounts received to fund allocated contracts established under Section 403(b) of the U.S. Internal Revenue Code that are included in Column 4, Line 1 above 3. Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans: 4. 3 0 XXX 0 XXX 0 3.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 3.2 All amounts XXX XXX XXX 0 0 4.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 0 4.2 Amounts in excess of $1 million but NOT in excess of $5 million per contract XXX XXX XXX 4.3 Amounts in excess of $5 million per contract XXX XXX XXX 4.4 Total (Lines 4.1 + 4.2 + 4.3) XXX XXX XXX 4.5 Amounts up to $7.5 million, per contract (Minnesota only) XXX XXX XXX 0 0 0 0 5.1 Amounts in excess of $1 million per contract XXX XXX XXX 5.2 All amounts XXX XXX XXX 5.3 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 5.4 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 6.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 6.2 Amounts in excess of $1 million per contract XXX XXX XXX 6.3 Total (Lines 6.1 + 6.2) XXX XXX XXX 6.4 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 6.5 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 7.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 7.2 All amounts XXX XXX XXX Unallocated funding obligations issued to fund government lotteries or employee, union, or association of natural persons benefit plans which are NOT: (a) governmental retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation: 5. 6. 7. Unallocated funding obligations issued to fund governmental retirement plans established under Sections 401 and 457 of the U.S. Internal Revenue Code: 0 0 0 0 Unallocated funding obligations issued to fund governmental retirement plans established under Sections 403(b) of the U.S. Internal Revenue Code: 0 0 0 0 0 Unallocated funding obligations that fund employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation: 7.3 Amounts NOT in excess of $2 million per contract (New Jersey only) XXX XXX XXX 0 0 0 8. Unallocated funding obligations issued to fund government lotteries NOT in excess of $5 million per contractholder (New Jersey Only) XXX XXX XXX 0 9. Unallocated funding obligations that fund employee or association of natural persons benefit plans in excess of $2 million but NOT in excess of $5 million per contract (New Jersey Only) XXX 10. Aggregate write-ins for other deductions 0 0 0 0 0 5,743,942 0 783,851,580 0 0 0 0 0 0 0 0 0 XXX XXX BASE 11. Current Year (2018) DETAILS OF WRITE-INS 1001. 1002. 1003. 1098. Summary of remaining write-ins for Line 10 from overflow page 1099. Totals (Lines 1001 thru 1003 plus 1098)(Line 10 above) 300.IL *79413201829015100* LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Indiana 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 3.501. 3.502. 3.503. 3.598. 3.599. 0601. 0602. 0603. 0698. 0699. 0901. 0902. 0903. 0998. 0999. PREMIUMS, CONSIDERATIONS AND DEPOSITS Premiums, considerations and deposits from Schedule T or Exhibit of Premiums and Losses Premiums, considerations and deposits NOT reported in Schedule T or Exhibit of Premiums and Losses, including investment contract receipts credited to a liability account 2.1 Contract fees for variable contracts with guarantees 2.2 Any other premiums, considerations and deposits not reported in Schedule T or Exhibit of Premiums and Losses Amounts, if applicable, that were deducted prior to determining amounts included in Lines 1 or 2 which are in the following categories: 3.1 Transfers to guaranteed Separate Accounts 3.2 Roll over of GICs or annuities into other companies 3.3 Surrenders or other benefits paid out 3.4 Excess interest credited to accounts 3.5 Aggregate write-ins for other amounts deducted prior to determining amounts included in Lines 1 or 2 3.99 Total (Lines 3.1 through 3.5) Transfers: 4.1 Enter in Column 2, as a negative number, and Column 4, as a positive number, the total of all amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, that are included in Column 2, Lines 1, 2 and 3.99 4.2 Enter in Column 2, as a positive number, and Column 4, as a negative number, any amounts reported in Column 4, Lines 1, 2 and 3.99 that are allocated. (Note: amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, should not be included in line 4.2) 4.3 Enter in Column 4, as a positive number, and Column 2, as a negative number, any amounts reported in Column 2, Lines 1, 2 and 3.99 that are unallocated 4.99 Total (Lines 4.1 + 4.2 + 4.3) Total (Lines 1 + 2 + 3.99 + 4.99) 1 2 3 Life Insurance Premiums Annuity Considerations A & H Premiums 4 Deposit-Type Contract Funds and Other Considerations 5,374,132 0 1,947,993,830 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5,374,132 0 1,947,993,830 DEVELOPMENT OF AMOUNTS INCLUDED IN LINES 1 THROUGH 5 THAT SHOULD BE DEDUCTED IN DETERMINING THE BASE Do not include any amount more than once in Lines 6 through 9 Aggregate write-ins for amounts where the insurer is not subject to risk. Premiums for portions of policies or contracts NOT guaranteed or under which the entire investment risk is borne by the policyholder. (Please specify such deductions and indicate where such amounts were reported in the Annual Statement) Amounts NOT allocated to individuals or individual certificate holders or amounts received for such contracts in excess of limits: 7.1 Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans 7.2 Unallocated funding obligations that fund any employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation 7.3 Unallocated funding obligations that fund governmental lotteries or employee, union, or association of natural persons benefit plans in excess of $5 million per contract which are NOT: (a) government retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation 7.4 Total (Lines 7.1 + 7.2 + 7.3) Dividends/Experience rating credits paid or credited, but only if NOT guaranteed in advance (include only amounts NOT already deducted in determining Lines 1 and 2) Aggregate write-ins for Other Deductions Total (Lines 6 + 7.4 + 8 + 9) Current Year DETAILS OF WRITE-INS 0 0 0 0 0 0 0 XXX XXX XXX 0 XXX XXX XXX 0 XXX XXX XXX XXX XXX XXX 0 0 0 0 0 0 862,267,991 862,267,991 0 0 0 0 1,085,725,839 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 5,374,132 Summary of remaining write-ins for Line 3.5 from overflow page Totals (Lines 3.501 thru 3.503 plus 3.598)(Line 3.5 above) 0 0 0 0 0 0 0 0 Summary of remaining write-ins for Line 6 from overflow page Totals (Lines 0601 thru 0603 plus 0698)(Line 6 above) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 843,307,607 18,960,384 0 0 862,267,991 0 0 0 0 0 0 0 Medicare Part C & D Stop Loss Medicaid Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.IN *79413201830015100* ADJUSTMENTS TO THE LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Indiana 1 2 Allocated Annuity and Other Allocated Fund Deposits Life Insurance Premiums 4 Unallocated Annuity & Other Unallocated Fund Deposits Accident & Health Premium 5,374,132 0 1,085,725,839 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. MODEL ACT BASE ( Line 11 of the Reconciliation Exhibit) 2. Enter in Column 2, as a positive number, and Column 4, as a negative number, the total of all amounts received to fund allocated contracts established under Section 403(b) of the U.S. Internal Revenue Code that are included in Column 4, Line 1 above 3. Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans: 4. 3 0 XXX 0 XXX 0 3.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 3.2 All amounts XXX XXX XXX 0 0 4.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 0 4.2 Amounts in excess of $1 million but NOT in excess of $5 million per contract XXX XXX XXX 4.3 Amounts in excess of $5 million per contract XXX XXX XXX 4.4 Total (Lines 4.1 + 4.2 + 4.3) XXX XXX XXX 4.5 Amounts up to $7.5 million, per contract (Minnesota only) XXX XXX XXX 0 0 0 0 5.1 Amounts in excess of $1 million per contract XXX XXX XXX 5.2 All amounts XXX XXX XXX 5.3 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 5.4 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 6.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 6.2 Amounts in excess of $1 million per contract XXX XXX XXX 6.3 Total (Lines 6.1 + 6.2) XXX XXX XXX 6.4 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 6.5 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 7.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 7.2 All amounts XXX XXX XXX Unallocated funding obligations issued to fund government lotteries or employee, union, or association of natural persons benefit plans which are NOT: (a) governmental retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation: 5. 6. 7. Unallocated funding obligations issued to fund governmental retirement plans established under Sections 401 and 457 of the U.S. Internal Revenue Code: 0 0 0 0 Unallocated funding obligations issued to fund governmental retirement plans established under Sections 403(b) of the U.S. Internal Revenue Code: 0 0 0 0 0 Unallocated funding obligations that fund employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation: 7.3 Amounts NOT in excess of $2 million per contract (New Jersey only) XXX XXX XXX 0 0 0 8. Unallocated funding obligations issued to fund government lotteries NOT in excess of $5 million per contractholder (New Jersey Only) XXX XXX XXX 0 9. Unallocated funding obligations that fund employee or association of natural persons benefit plans in excess of $2 million but NOT in excess of $5 million per contract (New Jersey Only) XXX 10. Aggregate write-ins for other deductions 0 0 0 0 0 5,374,132 0 1,085,725,839 0 0 0 0 0 0 0 0 0 XXX XXX BASE 11. Current Year (2018) DETAILS OF WRITE-INS 1001. 1002. 1003. 1098. Summary of remaining write-ins for Line 10 from overflow page 1099. Totals (Lines 1001 thru 1003 plus 1098)(Line 10 above) 300.IN *79413201829016100* LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Iowa 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 3.501. 3.502. 3.503. 3.598. 3.599. 0601. 0602. 0603. 0698. 0699. 0901. 0902. 0903. 0998. 0999. PREMIUMS, CONSIDERATIONS AND DEPOSITS Premiums, considerations and deposits from Schedule T or Exhibit of Premiums and Losses Premiums, considerations and deposits NOT reported in Schedule T or Exhibit of Premiums and Losses, including investment contract receipts credited to a liability account 2.1 Contract fees for variable contracts with guarantees 2.2 Any other premiums, considerations and deposits not reported in Schedule T or Exhibit of Premiums and Losses Amounts, if applicable, that were deducted prior to determining amounts included in Lines 1 or 2 which are in the following categories: 3.1 Transfers to guaranteed Separate Accounts 3.2 Roll over of GICs or annuities into other companies 3.3 Surrenders or other benefits paid out 3.4 Excess interest credited to accounts 3.5 Aggregate write-ins for other amounts deducted prior to determining amounts included in Lines 1 or 2 3.99 Total (Lines 3.1 through 3.5) Transfers: 4.1 Enter in Column 2, as a negative number, and Column 4, as a positive number, the total of all amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, that are included in Column 2, Lines 1, 2 and 3.99 4.2 Enter in Column 2, as a positive number, and Column 4, as a negative number, any amounts reported in Column 4, Lines 1, 2 and 3.99 that are allocated. (Note: amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, should not be included in line 4.2) 4.3 Enter in Column 4, as a positive number, and Column 2, as a negative number, any amounts reported in Column 2, Lines 1, 2 and 3.99 that are unallocated 4.99 Total (Lines 4.1 + 4.2 + 4.3) Total (Lines 1 + 2 + 3.99 + 4.99) 1 2 3 Life Insurance Premiums Annuity Considerations A & H Premiums 4 Deposit-Type Contract Funds and Other Considerations 1,378,775 0 307,217,602 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,378,775 0 307,217,602 DEVELOPMENT OF AMOUNTS INCLUDED IN LINES 1 THROUGH 5 THAT SHOULD BE DEDUCTED IN DETERMINING THE BASE Do not include any amount more than once in Lines 6 through 9 Aggregate write-ins for amounts where the insurer is not subject to risk. Premiums for portions of policies or contracts NOT guaranteed or under which the entire investment risk is borne by the policyholder. (Please specify such deductions and indicate where such amounts were reported in the Annual Statement) Amounts NOT allocated to individuals or individual certificate holders or amounts received for such contracts in excess of limits: 7.1 Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans 7.2 Unallocated funding obligations that fund any employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation 7.3 Unallocated funding obligations that fund governmental lotteries or employee, union, or association of natural persons benefit plans in excess of $5 million per contract which are NOT: (a) government retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation 7.4 Total (Lines 7.1 + 7.2 + 7.3) Dividends/Experience rating credits paid or credited, but only if NOT guaranteed in advance (include only amounts NOT already deducted in determining Lines 1 and 2) Aggregate write-ins for Other Deductions Total (Lines 6 + 7.4 + 8 + 9) Current Year DETAILS OF WRITE-INS 0 0 0 0 0 0 0 XXX XXX XXX 0 XXX XXX XXX 0 XXX XXX XXX XXX XXX XXX 0 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 1,378,775 0 0 0 0 31,499,761 31,499,761 0 0 0 0 275,717,841 0 Summary of remaining write-ins for Line 3.5 from overflow page Totals (Lines 3.501 thru 3.503 plus 3.598)(Line 3.5 above) 0 0 0 0 0 0 0 0 Summary of remaining write-ins for Line 6 from overflow page Totals (Lines 0601 thru 0603 plus 0698)(Line 6 above) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 26,502,933 4,996,828 0 0 31,499,761 0 0 0 0 0 0 0 Medicare Part C & D Stop Loss Medicaid Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.IA *79413201830016100* ADJUSTMENTS TO THE LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Iowa 1 2 Allocated Annuity and Other Allocated Fund Deposits Life Insurance Premiums 4 Unallocated Annuity & Other Unallocated Fund Deposits Accident & Health Premium 1,378,775 0 275,717,841 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. MODEL ACT BASE ( Line 11 of the Reconciliation Exhibit) 2. Enter in Column 2, as a positive number, and Column 4, as a negative number, the total of all amounts received to fund allocated contracts established under Section 403(b) of the U.S. Internal Revenue Code that are included in Column 4, Line 1 above 3. Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans: 4. 3 0 XXX 0 XXX 0 3.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 3.2 All amounts XXX XXX XXX 0 0 4.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 0 4.2 Amounts in excess of $1 million but NOT in excess of $5 million per contract XXX XXX XXX 4.3 Amounts in excess of $5 million per contract XXX XXX XXX 4.4 Total (Lines 4.1 + 4.2 + 4.3) XXX XXX XXX 4.5 Amounts up to $7.5 million, per contract (Minnesota only) XXX XXX XXX 0 0 0 0 5.1 Amounts in excess of $1 million per contract XXX XXX XXX 5.2 All amounts XXX XXX XXX 5.3 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 5.4 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 6.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 6.2 Amounts in excess of $1 million per contract XXX XXX XXX 6.3 Total (Lines 6.1 + 6.2) XXX XXX XXX 6.4 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 6.5 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 7.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 7.2 All amounts XXX XXX XXX Unallocated funding obligations issued to fund government lotteries or employee, union, or association of natural persons benefit plans which are NOT: (a) governmental retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation: 5. 6. 7. Unallocated funding obligations issued to fund governmental retirement plans established under Sections 401 and 457 of the U.S. Internal Revenue Code: 0 0 0 0 Unallocated funding obligations issued to fund governmental retirement plans established under Sections 403(b) of the U.S. Internal Revenue Code: 0 0 0 0 0 Unallocated funding obligations that fund employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation: 7.3 Amounts NOT in excess of $2 million per contract (New Jersey only) XXX XXX XXX 0 0 0 8. Unallocated funding obligations issued to fund government lotteries NOT in excess of $5 million per contractholder (New Jersey Only) XXX XXX XXX 0 9. Unallocated funding obligations that fund employee or association of natural persons benefit plans in excess of $2 million but NOT in excess of $5 million per contract (New Jersey Only) XXX 10. Aggregate write-ins for other deductions 0 0 0 0 0 1,378,775 0 275,717,841 0 0 0 0 0 0 0 0 0 XXX XXX BASE 11. Current Year (2018) DETAILS OF WRITE-INS 1001. 1002. 1003. 1098. Summary of remaining write-ins for Line 10 from overflow page 1099. Totals (Lines 1001 thru 1003 plus 1098)(Line 10 above) 300.IA *79413201829017100* LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Kansas 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 3.501. 3.502. 3.503. 3.598. 3.599. 0601. 0602. 0603. 0698. 0699. 0901. 0902. 0903. 0998. 0999. PREMIUMS, CONSIDERATIONS AND DEPOSITS Premiums, considerations and deposits from Schedule T or Exhibit of Premiums and Losses Premiums, considerations and deposits NOT reported in Schedule T or Exhibit of Premiums and Losses, including investment contract receipts credited to a liability account 2.1 Contract fees for variable contracts with guarantees 2.2 Any other premiums, considerations and deposits not reported in Schedule T or Exhibit of Premiums and Losses Amounts, if applicable, that were deducted prior to determining amounts included in Lines 1 or 2 which are in the following categories: 3.1 Transfers to guaranteed Separate Accounts 3.2 Roll over of GICs or annuities into other companies 3.3 Surrenders or other benefits paid out 3.4 Excess interest credited to accounts 3.5 Aggregate write-ins for other amounts deducted prior to determining amounts included in Lines 1 or 2 3.99 Total (Lines 3.1 through 3.5) Transfers: 4.1 Enter in Column 2, as a negative number, and Column 4, as a positive number, the total of all amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, that are included in Column 2, Lines 1, 2 and 3.99 4.2 Enter in Column 2, as a positive number, and Column 4, as a negative number, any amounts reported in Column 4, Lines 1, 2 and 3.99 that are allocated. (Note: amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, should not be included in line 4.2) 4.3 Enter in Column 4, as a positive number, and Column 2, as a negative number, any amounts reported in Column 2, Lines 1, 2 and 3.99 that are unallocated 4.99 Total (Lines 4.1 + 4.2 + 4.3) Total (Lines 1 + 2 + 3.99 + 4.99) 1 2 3 Life Insurance Premiums Annuity Considerations A & H Premiums 4 Deposit-Type Contract Funds and Other Considerations 1,377,400 0 414,652,099 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,377,400 0 414,652,099 DEVELOPMENT OF AMOUNTS INCLUDED IN LINES 1 THROUGH 5 THAT SHOULD BE DEDUCTED IN DETERMINING THE BASE Do not include any amount more than once in Lines 6 through 9 Aggregate write-ins for amounts where the insurer is not subject to risk. Premiums for portions of policies or contracts NOT guaranteed or under which the entire investment risk is borne by the policyholder. (Please specify such deductions and indicate where such amounts were reported in the Annual Statement) Amounts NOT allocated to individuals or individual certificate holders or amounts received for such contracts in excess of limits: 7.1 Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans 7.2 Unallocated funding obligations that fund any employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation 7.3 Unallocated funding obligations that fund governmental lotteries or employee, union, or association of natural persons benefit plans in excess of $5 million per contract which are NOT: (a) government retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation 7.4 Total (Lines 7.1 + 7.2 + 7.3) Dividends/Experience rating credits paid or credited, but only if NOT guaranteed in advance (include only amounts NOT already deducted in determining Lines 1 and 2) Aggregate write-ins for Other Deductions Total (Lines 6 + 7.4 + 8 + 9) Current Year DETAILS OF WRITE-INS 0 0 0 0 0 0 0 XXX XXX XXX 0 XXX XXX XXX 0 XXX XXX XXX XXX XXX XXX 0 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 1,377,400 0 0 0 0 54,664,261 54,664,261 0 0 0 0 359,987,838 0 Summary of remaining write-ins for Line 3.5 from overflow page Totals (Lines 3.501 thru 3.503 plus 3.598)(Line 3.5 above) 0 0 0 0 0 0 0 0 Summary of remaining write-ins for Line 6 from overflow page Totals (Lines 0601 thru 0603 plus 0698)(Line 6 above) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 48,634,676 6,029,585 0 0 54,664,261 0 0 0 0 0 0 0 Medicare Part C & D Stop Loss Medicaid Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.KS *79413201830017100* ADJUSTMENTS TO THE LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Kansas 1 2 Allocated Annuity and Other Allocated Fund Deposits Life Insurance Premiums 4 Unallocated Annuity & Other Unallocated Fund Deposits Accident & Health Premium 1,377,400 0 359,987,838 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. MODEL ACT BASE ( Line 11 of the Reconciliation Exhibit) 2. Enter in Column 2, as a positive number, and Column 4, as a negative number, the total of all amounts received to fund allocated contracts established under Section 403(b) of the U.S. Internal Revenue Code that are included in Column 4, Line 1 above 3. Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans: 4. 3 0 XXX 0 XXX 0 3.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 3.2 All amounts XXX XXX XXX 0 0 4.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 0 4.2 Amounts in excess of $1 million but NOT in excess of $5 million per contract XXX XXX XXX 4.3 Amounts in excess of $5 million per contract XXX XXX XXX 4.4 Total (Lines 4.1 + 4.2 + 4.3) XXX XXX XXX 4.5 Amounts up to $7.5 million, per contract (Minnesota only) XXX XXX XXX 0 0 0 0 5.1 Amounts in excess of $1 million per contract XXX XXX XXX 5.2 All amounts XXX XXX XXX 5.3 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 5.4 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 6.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 6.2 Amounts in excess of $1 million per contract XXX XXX XXX 6.3 Total (Lines 6.1 + 6.2) XXX XXX XXX 6.4 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 6.5 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 7.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 7.2 All amounts XXX XXX XXX Unallocated funding obligations issued to fund government lotteries or employee, union, or association of natural persons benefit plans which are NOT: (a) governmental retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation: 5. 6. 7. Unallocated funding obligations issued to fund governmental retirement plans established under Sections 401 and 457 of the U.S. Internal Revenue Code: 0 0 0 0 Unallocated funding obligations issued to fund governmental retirement plans established under Sections 403(b) of the U.S. Internal Revenue Code: 0 0 0 0 0 Unallocated funding obligations that fund employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation: 7.3 Amounts NOT in excess of $2 million per contract (New Jersey only) XXX XXX XXX 0 0 0 8. Unallocated funding obligations issued to fund government lotteries NOT in excess of $5 million per contractholder (New Jersey Only) XXX XXX XXX 0 9. Unallocated funding obligations that fund employee or association of natural persons benefit plans in excess of $2 million but NOT in excess of $5 million per contract (New Jersey Only) XXX 10. Aggregate write-ins for other deductions 0 0 0 0 0 1,377,400 0 359,987,838 0 0 0 0 0 0 0 0 0 XXX XXX BASE 11. Current Year (2018) DETAILS OF WRITE-INS 1001. 1002. 1003. 1098. Summary of remaining write-ins for Line 10 from overflow page 1099. Totals (Lines 1001 thru 1003 plus 1098)(Line 10 above) 300.KS *79413201829018100* LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Kentucky 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 3.501. 3.502. 3.503. 3.598. 3.599. 0601. 0602. 0603. 0698. 0699. 0901. 0902. 0903. 0998. 0999. PREMIUMS, CONSIDERATIONS AND DEPOSITS Premiums, considerations and deposits from Schedule T or Exhibit of Premiums and Losses Premiums, considerations and deposits NOT reported in Schedule T or Exhibit of Premiums and Losses, including investment contract receipts credited to a liability account 2.1 Contract fees for variable contracts with guarantees 2.2 Any other premiums, considerations and deposits not reported in Schedule T or Exhibit of Premiums and Losses Amounts, if applicable, that were deducted prior to determining amounts included in Lines 1 or 2 which are in the following categories: 3.1 Transfers to guaranteed Separate Accounts 3.2 Roll over of GICs or annuities into other companies 3.3 Surrenders or other benefits paid out 3.4 Excess interest credited to accounts 3.5 Aggregate write-ins for other amounts deducted prior to determining amounts included in Lines 1 or 2 3.99 Total (Lines 3.1 through 3.5) Transfers: 4.1 Enter in Column 2, as a negative number, and Column 4, as a positive number, the total of all amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, that are included in Column 2, Lines 1, 2 and 3.99 4.2 Enter in Column 2, as a positive number, and Column 4, as a negative number, any amounts reported in Column 4, Lines 1, 2 and 3.99 that are allocated. (Note: amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, should not be included in line 4.2) 4.3 Enter in Column 4, as a positive number, and Column 2, as a negative number, any amounts reported in Column 2, Lines 1, 2 and 3.99 that are unallocated 4.99 Total (Lines 4.1 + 4.2 + 4.3) Total (Lines 1 + 2 + 3.99 + 4.99) 1 2 3 Life Insurance Premiums Annuity Considerations A & H Premiums 4 Deposit-Type Contract Funds and Other Considerations 935,375 0 368,362,448 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 935,375 0 368,362,448 DEVELOPMENT OF AMOUNTS INCLUDED IN LINES 1 THROUGH 5 THAT SHOULD BE DEDUCTED IN DETERMINING THE BASE Do not include any amount more than once in Lines 6 through 9 Aggregate write-ins for amounts where the insurer is not subject to risk. Premiums for portions of policies or contracts NOT guaranteed or under which the entire investment risk is borne by the policyholder. (Please specify such deductions and indicate where such amounts were reported in the Annual Statement) Amounts NOT allocated to individuals or individual certificate holders or amounts received for such contracts in excess of limits: 7.1 Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans 7.2 Unallocated funding obligations that fund any employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation 7.3 Unallocated funding obligations that fund governmental lotteries or employee, union, or association of natural persons benefit plans in excess of $5 million per contract which are NOT: (a) government retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation 7.4 Total (Lines 7.1 + 7.2 + 7.3) Dividends/Experience rating credits paid or credited, but only if NOT guaranteed in advance (include only amounts NOT already deducted in determining Lines 1 and 2) Aggregate write-ins for Other Deductions Total (Lines 6 + 7.4 + 8 + 9) Current Year DETAILS OF WRITE-INS 0 0 0 0 0 0 0 XXX XXX XXX 0 XXX XXX XXX 0 XXX XXX XXX XXX XXX XXX 0 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 935,375 0 0 0 0 90,673,589 90,673,589 0 0 0 0 277,688,859 0 Summary of remaining write-ins for Line 3.5 from overflow page Totals (Lines 3.501 thru 3.503 plus 3.598)(Line 3.5 above) 0 0 0 0 0 0 0 0 Summary of remaining write-ins for Line 6 from overflow page Totals (Lines 0601 thru 0603 plus 0698)(Line 6 above) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 82,388,735 8,284,854 0 0 90,673,589 0 0 0 0 0 0 0 Medicare Part C & D Stop Loss Medicaid Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.KY *79413201830018100* ADJUSTMENTS TO THE LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Kentucky 1 2 Allocated Annuity and Other Allocated Fund Deposits Life Insurance Premiums 4 Unallocated Annuity & Other Unallocated Fund Deposits Accident & Health Premium 935,375 0 277,688,859 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. MODEL ACT BASE ( Line 11 of the Reconciliation Exhibit) 2. Enter in Column 2, as a positive number, and Column 4, as a negative number, the total of all amounts received to fund allocated contracts established under Section 403(b) of the U.S. Internal Revenue Code that are included in Column 4, Line 1 above 3. Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans: 4. 3 0 XXX 0 XXX 0 3.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 3.2 All amounts XXX XXX XXX 0 0 4.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 0 4.2 Amounts in excess of $1 million but NOT in excess of $5 million per contract XXX XXX XXX 4.3 Amounts in excess of $5 million per contract XXX XXX XXX 4.4 Total (Lines 4.1 + 4.2 + 4.3) XXX XXX XXX 4.5 Amounts up to $7.5 million, per contract (Minnesota only) XXX XXX XXX 0 0 0 0 5.1 Amounts in excess of $1 million per contract XXX XXX XXX 5.2 All amounts XXX XXX XXX 5.3 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 5.4 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 6.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 6.2 Amounts in excess of $1 million per contract XXX XXX XXX 6.3 Total (Lines 6.1 + 6.2) XXX XXX XXX 6.4 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 6.5 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 7.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 7.2 All amounts XXX XXX XXX Unallocated funding obligations issued to fund government lotteries or employee, union, or association of natural persons benefit plans which are NOT: (a) governmental retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation: 5. 6. 7. Unallocated funding obligations issued to fund governmental retirement plans established under Sections 401 and 457 of the U.S. Internal Revenue Code: 0 0 0 0 Unallocated funding obligations issued to fund governmental retirement plans established under Sections 403(b) of the U.S. Internal Revenue Code: 0 0 0 0 0 Unallocated funding obligations that fund employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation: 7.3 Amounts NOT in excess of $2 million per contract (New Jersey only) XXX XXX XXX 0 0 0 8. Unallocated funding obligations issued to fund government lotteries NOT in excess of $5 million per contractholder (New Jersey Only) XXX XXX XXX 0 9. Unallocated funding obligations that fund employee or association of natural persons benefit plans in excess of $2 million but NOT in excess of $5 million per contract (New Jersey Only) XXX 10. Aggregate write-ins for other deductions 0 0 0 0 0 935,375 0 277,688,859 0 0 0 0 0 0 0 0 0 XXX XXX BASE 11. Current Year (2018) DETAILS OF WRITE-INS 1001. 1002. 1003. 1098. Summary of remaining write-ins for Line 10 from overflow page 1099. Totals (Lines 1001 thru 1003 plus 1098)(Line 10 above) 300.KY *79413201829019100* LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Louisiana 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 3.501. 3.502. 3.503. 3.598. 3.599. 0601. 0602. 0603. 0698. 0699. 0901. 0902. 0903. 0998. 0999. PREMIUMS, CONSIDERATIONS AND DEPOSITS Premiums, considerations and deposits from Schedule T or Exhibit of Premiums and Losses Premiums, considerations and deposits NOT reported in Schedule T or Exhibit of Premiums and Losses, including investment contract receipts credited to a liability account 2.1 Contract fees for variable contracts with guarantees 2.2 Any other premiums, considerations and deposits not reported in Schedule T or Exhibit of Premiums and Losses Amounts, if applicable, that were deducted prior to determining amounts included in Lines 1 or 2 which are in the following categories: 3.1 Transfers to guaranteed Separate Accounts 3.2 Roll over of GICs or annuities into other companies 3.3 Surrenders or other benefits paid out 3.4 Excess interest credited to accounts 3.5 Aggregate write-ins for other amounts deducted prior to determining amounts included in Lines 1 or 2 3.99 Total (Lines 3.1 through 3.5) Transfers: 4.1 Enter in Column 2, as a negative number, and Column 4, as a positive number, the total of all amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, that are included in Column 2, Lines 1, 2 and 3.99 4.2 Enter in Column 2, as a positive number, and Column 4, as a negative number, any amounts reported in Column 4, Lines 1, 2 and 3.99 that are allocated. (Note: amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, should not be included in line 4.2) 4.3 Enter in Column 4, as a positive number, and Column 2, as a negative number, any amounts reported in Column 2, Lines 1, 2 and 3.99 that are unallocated 4.99 Total (Lines 4.1 + 4.2 + 4.3) Total (Lines 1 + 2 + 3.99 + 4.99) 1 2 3 Life Insurance Premiums Annuity Considerations A & H Premiums 4 Deposit-Type Contract Funds and Other Considerations 1,671,398 0 634,473,430 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,671,398 0 634,473,430 DEVELOPMENT OF AMOUNTS INCLUDED IN LINES 1 THROUGH 5 THAT SHOULD BE DEDUCTED IN DETERMINING THE BASE Do not include any amount more than once in Lines 6 through 9 Aggregate write-ins for amounts where the insurer is not subject to risk. Premiums for portions of policies or contracts NOT guaranteed or under which the entire investment risk is borne by the policyholder. (Please specify such deductions and indicate where such amounts were reported in the Annual Statement) Amounts NOT allocated to individuals or individual certificate holders or amounts received for such contracts in excess of limits: 7.1 Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans 7.2 Unallocated funding obligations that fund any employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation 7.3 Unallocated funding obligations that fund governmental lotteries or employee, union, or association of natural persons benefit plans in excess of $5 million per contract which are NOT: (a) government retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation 7.4 Total (Lines 7.1 + 7.2 + 7.3) Dividends/Experience rating credits paid or credited, but only if NOT guaranteed in advance (include only amounts NOT already deducted in determining Lines 1 and 2) Aggregate write-ins for Other Deductions Total (Lines 6 + 7.4 + 8 + 9) Current Year DETAILS OF WRITE-INS 0 0 0 0 0 0 0 XXX XXX XXX 0 XXX XXX XXX 0 XXX XXX XXX XXX XXX XXX 0 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 1,671,398 0 0 0 0 97,218,780 97,218,780 0 0 0 0 537,254,650 0 Summary of remaining write-ins for Line 3.5 from overflow page Totals (Lines 3.501 thru 3.503 plus 3.598)(Line 3.5 above) 0 0 0 0 0 0 0 0 Summary of remaining write-ins for Line 6 from overflow page Totals (Lines 0601 thru 0603 plus 0698)(Line 6 above) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 84,736,771 12,482,009 0 0 97,218,780 0 0 0 0 0 0 0 Medicare Part C & D Stop Loss Medicaid Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.LA *79413201830019100* ADJUSTMENTS TO THE LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Louisiana 1 2 Allocated Annuity and Other Allocated Fund Deposits Life Insurance Premiums 4 Unallocated Annuity & Other Unallocated Fund Deposits Accident & Health Premium 1,671,398 0 537,254,650 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. MODEL ACT BASE ( Line 11 of the Reconciliation Exhibit) 2. Enter in Column 2, as a positive number, and Column 4, as a negative number, the total of all amounts received to fund allocated contracts established under Section 403(b) of the U.S. Internal Revenue Code that are included in Column 4, Line 1 above 3. Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans: 4. 3 0 XXX 0 XXX 0 3.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 3.2 All amounts XXX XXX XXX 0 0 4.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 0 4.2 Amounts in excess of $1 million but NOT in excess of $5 million per contract XXX XXX XXX 4.3 Amounts in excess of $5 million per contract XXX XXX XXX 4.4 Total (Lines 4.1 + 4.2 + 4.3) XXX XXX XXX 4.5 Amounts up to $7.5 million, per contract (Minnesota only) XXX XXX XXX 0 0 0 0 5.1 Amounts in excess of $1 million per contract XXX XXX XXX 5.2 All amounts XXX XXX XXX 5.3 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 5.4 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 6.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 6.2 Amounts in excess of $1 million per contract XXX XXX XXX 6.3 Total (Lines 6.1 + 6.2) XXX XXX XXX 6.4 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 6.5 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 7.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 7.2 All amounts XXX XXX XXX Unallocated funding obligations issued to fund government lotteries or employee, union, or association of natural persons benefit plans which are NOT: (a) governmental retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation: 5. 6. 7. Unallocated funding obligations issued to fund governmental retirement plans established under Sections 401 and 457 of the U.S. Internal Revenue Code: 0 0 0 0 Unallocated funding obligations issued to fund governmental retirement plans established under Sections 403(b) of the U.S. Internal Revenue Code: 0 0 0 0 0 Unallocated funding obligations that fund employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation: 7.3 Amounts NOT in excess of $2 million per contract (New Jersey only) XXX XXX XXX 0 0 0 8. Unallocated funding obligations issued to fund government lotteries NOT in excess of $5 million per contractholder (New Jersey Only) XXX XXX XXX 0 9. Unallocated funding obligations that fund employee or association of natural persons benefit plans in excess of $2 million but NOT in excess of $5 million per contract (New Jersey Only) XXX 10. Aggregate write-ins for other deductions 0 0 0 0 0 1,671,398 0 537,254,650 0 0 0 0 0 0 0 0 0 XXX XXX BASE 11. Current Year (2018) DETAILS OF WRITE-INS 1001. 1002. 1003. 1098. Summary of remaining write-ins for Line 10 from overflow page 1099. Totals (Lines 1001 thru 1003 plus 1098)(Line 10 above) 300.LA *79413201829020100* LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Maine 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 3.501. 3.502. 3.503. 3.598. 3.599. 0601. 0602. 0603. 0698. 0699. 0901. 0902. 0903. 0998. 0999. PREMIUMS, CONSIDERATIONS AND DEPOSITS Premiums, considerations and deposits from Schedule T or Exhibit of Premiums and Losses Premiums, considerations and deposits NOT reported in Schedule T or Exhibit of Premiums and Losses, including investment contract receipts credited to a liability account 2.1 Contract fees for variable contracts with guarantees 2.2 Any other premiums, considerations and deposits not reported in Schedule T or Exhibit of Premiums and Losses Amounts, if applicable, that were deducted prior to determining amounts included in Lines 1 or 2 which are in the following categories: 3.1 Transfers to guaranteed Separate Accounts 3.2 Roll over of GICs or annuities into other companies 3.3 Surrenders or other benefits paid out 3.4 Excess interest credited to accounts 3.5 Aggregate write-ins for other amounts deducted prior to determining amounts included in Lines 1 or 2 3.99 Total (Lines 3.1 through 3.5) Transfers: 4.1 Enter in Column 2, as a negative number, and Column 4, as a positive number, the total of all amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, that are included in Column 2, Lines 1, 2 and 3.99 4.2 Enter in Column 2, as a positive number, and Column 4, as a negative number, any amounts reported in Column 4, Lines 1, 2 and 3.99 that are allocated. (Note: amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, should not be included in line 4.2) 4.3 Enter in Column 4, as a positive number, and Column 2, as a negative number, any amounts reported in Column 2, Lines 1, 2 and 3.99 that are unallocated 4.99 Total (Lines 4.1 + 4.2 + 4.3) Total (Lines 1 + 2 + 3.99 + 4.99) 1 2 3 Life Insurance Premiums Annuity Considerations A & H Premiums 4 Deposit-Type Contract Funds and Other Considerations 138,502 0 169,571,848 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 138,502 0 169,571,848 DEVELOPMENT OF AMOUNTS INCLUDED IN LINES 1 THROUGH 5 THAT SHOULD BE DEDUCTED IN DETERMINING THE BASE Do not include any amount more than once in Lines 6 through 9 Aggregate write-ins for amounts where the insurer is not subject to risk. Premiums for portions of policies or contracts NOT guaranteed or under which the entire investment risk is borne by the policyholder. (Please specify such deductions and indicate where such amounts were reported in the Annual Statement) Amounts NOT allocated to individuals or individual certificate holders or amounts received for such contracts in excess of limits: 7.1 Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans 7.2 Unallocated funding obligations that fund any employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation 7.3 Unallocated funding obligations that fund governmental lotteries or employee, union, or association of natural persons benefit plans in excess of $5 million per contract which are NOT: (a) government retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation 7.4 Total (Lines 7.1 + 7.2 + 7.3) Dividends/Experience rating credits paid or credited, but only if NOT guaranteed in advance (include only amounts NOT already deducted in determining Lines 1 and 2) Aggregate write-ins for Other Deductions Total (Lines 6 + 7.4 + 8 + 9) Current Year DETAILS OF WRITE-INS 0 0 0 0 0 0 0 XXX XXX XXX 0 XXX XXX XXX 0 XXX XXX XXX XXX XXX XXX 0 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 138,502 0 0 0 0 52,902,218 52,902,218 0 0 0 0 116,669,630 0 Summary of remaining write-ins for Line 3.5 from overflow page Totals (Lines 3.501 thru 3.503 plus 3.598)(Line 3.5 above) 0 0 0 0 0 0 0 0 Summary of remaining write-ins for Line 6 from overflow page Totals (Lines 0601 thru 0603 plus 0698)(Line 6 above) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 51,334,131 1,568,087 0 0 52,902,218 0 0 0 0 0 0 0 Medicare Part C & D Stop Loss Medicaid Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.ME *79413201830020100* ADJUSTMENTS TO THE LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Maine 1 2 Allocated Annuity and Other Allocated Fund Deposits Life Insurance Premiums 4 Unallocated Annuity & Other Unallocated Fund Deposits Accident & Health Premium 138,502 0 116,669,630 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. MODEL ACT BASE ( Line 11 of the Reconciliation Exhibit) 2. Enter in Column 2, as a positive number, and Column 4, as a negative number, the total of all amounts received to fund allocated contracts established under Section 403(b) of the U.S. Internal Revenue Code that are included in Column 4, Line 1 above 3. Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans: 4. 3 0 XXX 0 XXX 0 3.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 3.2 All amounts XXX XXX XXX 0 0 4.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 0 4.2 Amounts in excess of $1 million but NOT in excess of $5 million per contract XXX XXX XXX 4.3 Amounts in excess of $5 million per contract XXX XXX XXX 4.4 Total (Lines 4.1 + 4.2 + 4.3) XXX XXX XXX 4.5 Amounts up to $7.5 million, per contract (Minnesota only) XXX XXX XXX 0 0 0 0 5.1 Amounts in excess of $1 million per contract XXX XXX XXX 5.2 All amounts XXX XXX XXX 5.3 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 5.4 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 6.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 6.2 Amounts in excess of $1 million per contract XXX XXX XXX 6.3 Total (Lines 6.1 + 6.2) XXX XXX XXX 6.4 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 6.5 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 7.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 7.2 All amounts XXX XXX XXX Unallocated funding obligations issued to fund government lotteries or employee, union, or association of natural persons benefit plans which are NOT: (a) governmental retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation: 5. 6. 7. Unallocated funding obligations issued to fund governmental retirement plans established under Sections 401 and 457 of the U.S. Internal Revenue Code: 0 0 0 0 Unallocated funding obligations issued to fund governmental retirement plans established under Sections 403(b) of the U.S. Internal Revenue Code: 0 0 0 0 0 Unallocated funding obligations that fund employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation: 7.3 Amounts NOT in excess of $2 million per contract (New Jersey only) XXX XXX XXX 0 0 0 8. Unallocated funding obligations issued to fund government lotteries NOT in excess of $5 million per contractholder (New Jersey Only) XXX XXX XXX 0 9. Unallocated funding obligations that fund employee or association of natural persons benefit plans in excess of $2 million but NOT in excess of $5 million per contract (New Jersey Only) XXX 10. Aggregate write-ins for other deductions 0 0 0 0 0 138,502 0 116,669,630 0 0 0 0 0 0 0 0 0 XXX XXX BASE 11. Current Year (2018) DETAILS OF WRITE-INS 1001. 1002. 1003. 1098. Summary of remaining write-ins for Line 10 from overflow page 1099. Totals (Lines 1001 thru 1003 plus 1098)(Line 10 above) 300.ME *79413201829021100* LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Maryland 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 3.501. 3.502. 3.503. 3.598. 3.599. 0601. 0602. 0603. 0698. 0699. 0901. 0902. 0903. 0998. 0999. PREMIUMS, CONSIDERATIONS AND DEPOSITS Premiums, considerations and deposits from Schedule T or Exhibit of Premiums and Losses Premiums, considerations and deposits NOT reported in Schedule T or Exhibit of Premiums and Losses, including investment contract receipts credited to a liability account 2.1 Contract fees for variable contracts with guarantees 2.2 Any other premiums, considerations and deposits not reported in Schedule T or Exhibit of Premiums and Losses Amounts, if applicable, that were deducted prior to determining amounts included in Lines 1 or 2 which are in the following categories: 3.1 Transfers to guaranteed Separate Accounts 3.2 Roll over of GICs or annuities into other companies 3.3 Surrenders or other benefits paid out 3.4 Excess interest credited to accounts 3.5 Aggregate write-ins for other amounts deducted prior to determining amounts included in Lines 1 or 2 3.99 Total (Lines 3.1 through 3.5) Transfers: 4.1 Enter in Column 2, as a negative number, and Column 4, as a positive number, the total of all amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, that are included in Column 2, Lines 1, 2 and 3.99 4.2 Enter in Column 2, as a positive number, and Column 4, as a negative number, any amounts reported in Column 4, Lines 1, 2 and 3.99 that are allocated. (Note: amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, should not be included in line 4.2) 4.3 Enter in Column 4, as a positive number, and Column 2, as a negative number, any amounts reported in Column 2, Lines 1, 2 and 3.99 that are unallocated 4.99 Total (Lines 4.1 + 4.2 + 4.3) Total (Lines 1 + 2 + 3.99 + 4.99) 1 2 3 Life Insurance Premiums Annuity Considerations A & H Premiums 4 Deposit-Type Contract Funds and Other Considerations 2,828,888 0 1,151,118,122 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,828,888 0 1,151,118,122 DEVELOPMENT OF AMOUNTS INCLUDED IN LINES 1 THROUGH 5 THAT SHOULD BE DEDUCTED IN DETERMINING THE BASE Do not include any amount more than once in Lines 6 through 9 Aggregate write-ins for amounts where the insurer is not subject to risk. Premiums for portions of policies or contracts NOT guaranteed or under which the entire investment risk is borne by the policyholder. (Please specify such deductions and indicate where such amounts were reported in the Annual Statement) Amounts NOT allocated to individuals or individual certificate holders or amounts received for such contracts in excess of limits: 7.1 Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans 7.2 Unallocated funding obligations that fund any employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation 7.3 Unallocated funding obligations that fund governmental lotteries or employee, union, or association of natural persons benefit plans in excess of $5 million per contract which are NOT: (a) government retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation 7.4 Total (Lines 7.1 + 7.2 + 7.3) Dividends/Experience rating credits paid or credited, but only if NOT guaranteed in advance (include only amounts NOT already deducted in determining Lines 1 and 2) Aggregate write-ins for Other Deductions Total (Lines 6 + 7.4 + 8 + 9) Current Year DETAILS OF WRITE-INS 0 0 0 0 0 0 0 XXX XXX XXX 0 XXX XXX XXX 0 XXX XXX XXX XXX XXX XXX 0 0 0 0 0 0 187,566,126 187,566,126 0 0 0 0 963,551,996 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 2,828,888 Summary of remaining write-ins for Line 3.5 from overflow page Totals (Lines 3.501 thru 3.503 plus 3.598)(Line 3.5 above) 0 0 0 0 0 0 0 0 Summary of remaining write-ins for Line 6 from overflow page Totals (Lines 0601 thru 0603 plus 0698)(Line 6 above) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 170,913,842 16,652,284 0 0 187,566,126 0 0 0 0 0 0 0 Medicare Part C & D Stop Loss Medicaid Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.MD *79413201830021100* ADJUSTMENTS TO THE LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Maryland 1 2 Allocated Annuity and Other Allocated Fund Deposits Life Insurance Premiums 4 Unallocated Annuity & Other Unallocated Fund Deposits Accident & Health Premium 2,828,888 0 963,551,996 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. MODEL ACT BASE ( Line 11 of the Reconciliation Exhibit) 2. Enter in Column 2, as a positive number, and Column 4, as a negative number, the total of all amounts received to fund allocated contracts established under Section 403(b) of the U.S. Internal Revenue Code that are included in Column 4, Line 1 above 3. Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans: 4. 3 0 XXX 0 XXX 0 3.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 3.2 All amounts XXX XXX XXX 0 0 4.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 0 4.2 Amounts in excess of $1 million but NOT in excess of $5 million per contract XXX XXX XXX 4.3 Amounts in excess of $5 million per contract XXX XXX XXX 4.4 Total (Lines 4.1 + 4.2 + 4.3) XXX XXX XXX 4.5 Amounts up to $7.5 million, per contract (Minnesota only) XXX XXX XXX 0 0 0 0 5.1 Amounts in excess of $1 million per contract XXX XXX XXX 5.2 All amounts XXX XXX XXX 5.3 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 5.4 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 6.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 6.2 Amounts in excess of $1 million per contract XXX XXX XXX 6.3 Total (Lines 6.1 + 6.2) XXX XXX XXX 6.4 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 6.5 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 7.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 7.2 All amounts XXX XXX XXX Unallocated funding obligations issued to fund government lotteries or employee, union, or association of natural persons benefit plans which are NOT: (a) governmental retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation: 5. 6. 7. Unallocated funding obligations issued to fund governmental retirement plans established under Sections 401 and 457 of the U.S. Internal Revenue Code: 0 0 0 0 Unallocated funding obligations issued to fund governmental retirement plans established under Sections 403(b) of the U.S. Internal Revenue Code: 0 0 0 0 0 Unallocated funding obligations that fund employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation: 7.3 Amounts NOT in excess of $2 million per contract (New Jersey only) XXX XXX XXX 0 0 0 8. Unallocated funding obligations issued to fund government lotteries NOT in excess of $5 million per contractholder (New Jersey Only) XXX XXX XXX 0 9. Unallocated funding obligations that fund employee or association of natural persons benefit plans in excess of $2 million but NOT in excess of $5 million per contract (New Jersey Only) XXX 10. Aggregate write-ins for other deductions 0 0 0 0 0 2,828,888 0 963,551,996 0 0 0 0 0 0 0 0 0 XXX XXX BASE 11. Current Year (2018) DETAILS OF WRITE-INS 1001. 1002. 1003. 1098. Summary of remaining write-ins for Line 10 from overflow page 1099. Totals (Lines 1001 thru 1003 plus 1098)(Line 10 above) 300.MD *79413201829022100* LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Massachusetts 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 3.501. 3.502. 3.503. 3.598. 3.599. 0601. 0602. 0603. 0698. 0699. 0901. 0902. 0903. 0998. 0999. PREMIUMS, CONSIDERATIONS AND DEPOSITS Premiums, considerations and deposits from Schedule T or Exhibit of Premiums and Losses Premiums, considerations and deposits NOT reported in Schedule T or Exhibit of Premiums and Losses, including investment contract receipts credited to a liability account 2.1 Contract fees for variable contracts with guarantees 2.2 Any other premiums, considerations and deposits not reported in Schedule T or Exhibit of Premiums and Losses Amounts, if applicable, that were deducted prior to determining amounts included in Lines 1 or 2 which are in the following categories: 3.1 Transfers to guaranteed Separate Accounts 3.2 Roll over of GICs or annuities into other companies 3.3 Surrenders or other benefits paid out 3.4 Excess interest credited to accounts 3.5 Aggregate write-ins for other amounts deducted prior to determining amounts included in Lines 1 or 2 3.99 Total (Lines 3.1 through 3.5) Transfers: 4.1 Enter in Column 2, as a negative number, and Column 4, as a positive number, the total of all amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, that are included in Column 2, Lines 1, 2 and 3.99 4.2 Enter in Column 2, as a positive number, and Column 4, as a negative number, any amounts reported in Column 4, Lines 1, 2 and 3.99 that are allocated. (Note: amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, should not be included in line 4.2) 4.3 Enter in Column 4, as a positive number, and Column 2, as a negative number, any amounts reported in Column 2, Lines 1, 2 and 3.99 that are unallocated 4.99 Total (Lines 4.1 + 4.2 + 4.3) Total (Lines 1 + 2 + 3.99 + 4.99) 1 2 3 Life Insurance Premiums Annuity Considerations A & H Premiums 4 Deposit-Type Contract Funds and Other Considerations 1,081,378 0 1,216,728,541 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,081,378 0 1,216,728,541 DEVELOPMENT OF AMOUNTS INCLUDED IN LINES 1 THROUGH 5 THAT SHOULD BE DEDUCTED IN DETERMINING THE BASE Do not include any amount more than once in Lines 6 through 9 Aggregate write-ins for amounts where the insurer is not subject to risk. Premiums for portions of policies or contracts NOT guaranteed or under which the entire investment risk is borne by the policyholder. (Please specify such deductions and indicate where such amounts were reported in the Annual Statement) Amounts NOT allocated to individuals or individual certificate holders or amounts received for such contracts in excess of limits: 7.1 Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans 7.2 Unallocated funding obligations that fund any employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation 7.3 Unallocated funding obligations that fund governmental lotteries or employee, union, or association of natural persons benefit plans in excess of $5 million per contract which are NOT: (a) government retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation 7.4 Total (Lines 7.1 + 7.2 + 7.3) Dividends/Experience rating credits paid or credited, but only if NOT guaranteed in advance (include only amounts NOT already deducted in determining Lines 1 and 2) Aggregate write-ins for Other Deductions Total (Lines 6 + 7.4 + 8 + 9) Current Year DETAILS OF WRITE-INS 0 0 0 0 0 0 0 XXX XXX XXX 0 XXX XXX XXX 0 XXX XXX XXX XXX XXX XXX 0 0 0 0 0 0 182,929,180 182,929,180 0 0 0 0 1,033,799,361 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 1,081,378 Summary of remaining write-ins for Line 3.5 from overflow page Totals (Lines 3.501 thru 3.503 plus 3.598)(Line 3.5 above) 0 0 0 0 0 0 0 0 Summary of remaining write-ins for Line 6 from overflow page Totals (Lines 0601 thru 0603 plus 0698)(Line 6 above) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 169,807,434 13,121,746 0 0 182,929,180 0 0 0 0 0 0 0 Medicare Part C & D Stop Loss Medicaid Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.MA *79413201830022100* ADJUSTMENTS TO THE LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Massachusetts 1 2 Allocated Annuity and Other Allocated Fund Deposits Life Insurance Premiums 4 Unallocated Annuity & Other Unallocated Fund Deposits Accident & Health Premium 1,081,378 0 1,033,799,361 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. MODEL ACT BASE ( Line 11 of the Reconciliation Exhibit) 2. Enter in Column 2, as a positive number, and Column 4, as a negative number, the total of all amounts received to fund allocated contracts established under Section 403(b) of the U.S. Internal Revenue Code that are included in Column 4, Line 1 above 3. Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans: 4. 3 0 XXX 0 XXX 0 3.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 3.2 All amounts XXX XXX XXX 0 0 4.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 0 4.2 Amounts in excess of $1 million but NOT in excess of $5 million per contract XXX XXX XXX 4.3 Amounts in excess of $5 million per contract XXX XXX XXX 4.4 Total (Lines 4.1 + 4.2 + 4.3) XXX XXX XXX 4.5 Amounts up to $7.5 million, per contract (Minnesota only) XXX XXX XXX 0 0 0 0 5.1 Amounts in excess of $1 million per contract XXX XXX XXX 5.2 All amounts XXX XXX XXX 5.3 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 5.4 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 6.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 6.2 Amounts in excess of $1 million per contract XXX XXX XXX 6.3 Total (Lines 6.1 + 6.2) XXX XXX XXX 6.4 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 6.5 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 7.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 7.2 All amounts XXX XXX XXX Unallocated funding obligations issued to fund government lotteries or employee, union, or association of natural persons benefit plans which are NOT: (a) governmental retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation: 5. 6. 7. Unallocated funding obligations issued to fund governmental retirement plans established under Sections 401 and 457 of the U.S. Internal Revenue Code: 0 0 0 0 Unallocated funding obligations issued to fund governmental retirement plans established under Sections 403(b) of the U.S. Internal Revenue Code: 0 0 0 0 0 Unallocated funding obligations that fund employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation: 7.3 Amounts NOT in excess of $2 million per contract (New Jersey only) XXX XXX XXX 0 0 0 8. Unallocated funding obligations issued to fund government lotteries NOT in excess of $5 million per contractholder (New Jersey Only) XXX XXX XXX 0 9. Unallocated funding obligations that fund employee or association of natural persons benefit plans in excess of $2 million but NOT in excess of $5 million per contract (New Jersey Only) XXX 10. Aggregate write-ins for other deductions 0 0 0 0 0 1,081,378 0 1,033,799,361 0 0 0 0 0 0 0 0 0 XXX XXX BASE 11. Current Year (2018) DETAILS OF WRITE-INS 1001. 1002. 1003. 1098. Summary of remaining write-ins for Line 10 from overflow page 1099. Totals (Lines 1001 thru 1003 plus 1098)(Line 10 above) 300.MA *79413201829023100* LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Michigan 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 3.501. 3.502. 3.503. 3.598. 3.599. 0601. 0602. 0603. 0698. 0699. 0901. 0902. 0903. 0998. 0999. PREMIUMS, CONSIDERATIONS AND DEPOSITS Premiums, considerations and deposits from Schedule T or Exhibit of Premiums and Losses Premiums, considerations and deposits NOT reported in Schedule T or Exhibit of Premiums and Losses, including investment contract receipts credited to a liability account 2.1 Contract fees for variable contracts with guarantees 2.2 Any other premiums, considerations and deposits not reported in Schedule T or Exhibit of Premiums and Losses Amounts, if applicable, that were deducted prior to determining amounts included in Lines 1 or 2 which are in the following categories: 3.1 Transfers to guaranteed Separate Accounts 3.2 Roll over of GICs or annuities into other companies 3.3 Surrenders or other benefits paid out 3.4 Excess interest credited to accounts 3.5 Aggregate write-ins for other amounts deducted prior to determining amounts included in Lines 1 or 2 3.99 Total (Lines 3.1 through 3.5) Transfers: 4.1 Enter in Column 2, as a negative number, and Column 4, as a positive number, the total of all amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, that are included in Column 2, Lines 1, 2 and 3.99 4.2 Enter in Column 2, as a positive number, and Column 4, as a negative number, any amounts reported in Column 4, Lines 1, 2 and 3.99 that are allocated. (Note: amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, should not be included in line 4.2) 4.3 Enter in Column 4, as a positive number, and Column 2, as a negative number, any amounts reported in Column 2, Lines 1, 2 and 3.99 that are unallocated 4.99 Total (Lines 4.1 + 4.2 + 4.3) Total (Lines 1 + 2 + 3.99 + 4.99) 1 2 3 Life Insurance Premiums Annuity Considerations A & H Premiums 4 Deposit-Type Contract Funds and Other Considerations 1,910,695 0 813,122,803 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,910,695 0 813,122,803 DEVELOPMENT OF AMOUNTS INCLUDED IN LINES 1 THROUGH 5 THAT SHOULD BE DEDUCTED IN DETERMINING THE BASE Do not include any amount more than once in Lines 6 through 9 Aggregate write-ins for amounts where the insurer is not subject to risk. Premiums for portions of policies or contracts NOT guaranteed or under which the entire investment risk is borne by the policyholder. (Please specify such deductions and indicate where such amounts were reported in the Annual Statement) Amounts NOT allocated to individuals or individual certificate holders or amounts received for such contracts in excess of limits: 7.1 Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans 7.2 Unallocated funding obligations that fund any employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation 7.3 Unallocated funding obligations that fund governmental lotteries or employee, union, or association of natural persons benefit plans in excess of $5 million per contract which are NOT: (a) government retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation 7.4 Total (Lines 7.1 + 7.2 + 7.3) Dividends/Experience rating credits paid or credited, but only if NOT guaranteed in advance (include only amounts NOT already deducted in determining Lines 1 and 2) Aggregate write-ins for Other Deductions Total (Lines 6 + 7.4 + 8 + 9) Current Year DETAILS OF WRITE-INS 0 0 0 0 0 0 0 XXX XXX XXX 0 XXX XXX XXX 0 XXX XXX XXX XXX XXX XXX 0 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 1,910,695 0 0 0 0 99,482,730 99,482,730 0 0 0 0 713,640,073 0 Summary of remaining write-ins for Line 3.5 from overflow page Totals (Lines 3.501 thru 3.503 plus 3.598)(Line 3.5 above) 0 0 0 0 0 0 0 0 Summary of remaining write-ins for Line 6 from overflow page Totals (Lines 0601 thru 0603 plus 0698)(Line 6 above) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 99,482,730 0 0 0 99,482,730 0 0 0 0 0 0 0 Medicare Part C & D Stop Loss Medicaid Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.MI *79413201830023100* ADJUSTMENTS TO THE LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Michigan 1 2 Allocated Annuity and Other Allocated Fund Deposits Life Insurance Premiums 4 Unallocated Annuity & Other Unallocated Fund Deposits Accident & Health Premium 1,910,695 0 713,640,073 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. MODEL ACT BASE ( Line 11 of the Reconciliation Exhibit) 2. Enter in Column 2, as a positive number, and Column 4, as a negative number, the total of all amounts received to fund allocated contracts established under Section 403(b) of the U.S. Internal Revenue Code that are included in Column 4, Line 1 above 3. Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans: 4. 3 0 XXX 0 XXX 0 3.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 3.2 All amounts XXX XXX XXX 0 0 4.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 0 4.2 Amounts in excess of $1 million but NOT in excess of $5 million per contract XXX XXX XXX 4.3 Amounts in excess of $5 million per contract XXX XXX XXX 4.4 Total (Lines 4.1 + 4.2 + 4.3) XXX XXX XXX 4.5 Amounts up to $7.5 million, per contract (Minnesota only) XXX XXX XXX 0 0 0 0 5.1 Amounts in excess of $1 million per contract XXX XXX XXX 5.2 All amounts XXX XXX XXX 5.3 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 5.4 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 6.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 6.2 Amounts in excess of $1 million per contract XXX XXX XXX 6.3 Total (Lines 6.1 + 6.2) XXX XXX XXX 6.4 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 6.5 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 7.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 7.2 All amounts XXX XXX XXX Unallocated funding obligations issued to fund government lotteries or employee, union, or association of natural persons benefit plans which are NOT: (a) governmental retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation: 5. 6. 7. Unallocated funding obligations issued to fund governmental retirement plans established under Sections 401 and 457 of the U.S. Internal Revenue Code: 0 0 0 0 Unallocated funding obligations issued to fund governmental retirement plans established under Sections 403(b) of the U.S. Internal Revenue Code: 0 0 0 0 0 Unallocated funding obligations that fund employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation: 7.3 Amounts NOT in excess of $2 million per contract (New Jersey only) XXX XXX XXX 0 0 0 8. Unallocated funding obligations issued to fund government lotteries NOT in excess of $5 million per contractholder (New Jersey Only) XXX XXX XXX 0 9. Unallocated funding obligations that fund employee or association of natural persons benefit plans in excess of $2 million but NOT in excess of $5 million per contract (New Jersey Only) XXX 10. Aggregate write-ins for other deductions 0 0 0 0 0 1,910,695 0 713,640,073 0 0 0 0 0 0 0 0 0 XXX XXX BASE 11. Current Year (2018) DETAILS OF WRITE-INS 1001. 1002. 1003. 1098. Summary of remaining write-ins for Line 10 from overflow page 1099. Totals (Lines 1001 thru 1003 plus 1098)(Line 10 above) 300.MI *79413201829024100* LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Minnesota 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 3.501. 3.502. 3.503. 3.598. 3.599. 0601. 0602. 0603. 0698. 0699. 0901. 0902. 0903. 0998. 0999. PREMIUMS, CONSIDERATIONS AND DEPOSITS Premiums, considerations and deposits from Schedule T or Exhibit of Premiums and Losses Premiums, considerations and deposits NOT reported in Schedule T or Exhibit of Premiums and Losses, including investment contract receipts credited to a liability account 2.1 Contract fees for variable contracts with guarantees 2.2 Any other premiums, considerations and deposits not reported in Schedule T or Exhibit of Premiums and Losses Amounts, if applicable, that were deducted prior to determining amounts included in Lines 1 or 2 which are in the following categories: 3.1 Transfers to guaranteed Separate Accounts 3.2 Roll over of GICs or annuities into other companies 3.3 Surrenders or other benefits paid out 3.4 Excess interest credited to accounts 3.5 Aggregate write-ins for other amounts deducted prior to determining amounts included in Lines 1 or 2 3.99 Total (Lines 3.1 through 3.5) Transfers: 4.1 Enter in Column 2, as a negative number, and Column 4, as a positive number, the total of all amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, that are included in Column 2, Lines 1, 2 and 3.99 4.2 Enter in Column 2, as a positive number, and Column 4, as a negative number, any amounts reported in Column 4, Lines 1, 2 and 3.99 that are allocated. (Note: amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, should not be included in line 4.2) 4.3 Enter in Column 4, as a positive number, and Column 2, as a negative number, any amounts reported in Column 2, Lines 1, 2 and 3.99 that are unallocated 4.99 Total (Lines 4.1 + 4.2 + 4.3) Total (Lines 1 + 2 + 3.99 + 4.99) 1 2 3 Life Insurance Premiums Annuity Considerations A & H Premiums 4 Deposit-Type Contract Funds and Other Considerations 9,890,585 0 193,781,193 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 9,890,585 0 193,781,193 DEVELOPMENT OF AMOUNTS INCLUDED IN LINES 1 THROUGH 5 THAT SHOULD BE DEDUCTED IN DETERMINING THE BASE Do not include any amount more than once in Lines 6 through 9 Aggregate write-ins for amounts where the insurer is not subject to risk. Premiums for portions of policies or contracts NOT guaranteed or under which the entire investment risk is borne by the policyholder. (Please specify such deductions and indicate where such amounts were reported in the Annual Statement) Amounts NOT allocated to individuals or individual certificate holders or amounts received for such contracts in excess of limits: 7.1 Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans 7.2 Unallocated funding obligations that fund any employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation 7.3 Unallocated funding obligations that fund governmental lotteries or employee, union, or association of natural persons benefit plans in excess of $5 million per contract which are NOT: (a) government retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation 7.4 Total (Lines 7.1 + 7.2 + 7.3) Dividends/Experience rating credits paid or credited, but only if NOT guaranteed in advance (include only amounts NOT already deducted in determining Lines 1 and 2) Aggregate write-ins for Other Deductions Total (Lines 6 + 7.4 + 8 + 9) Current Year DETAILS OF WRITE-INS 0 0 0 0 0 0 0 XXX XXX XXX 0 XXX XXX XXX 0 XXX XXX XXX XXX XXX XXX 0 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 9,890,585 0 0 0 0 24,954,629 24,954,629 0 0 0 0 168,826,564 0 Summary of remaining write-ins for Line 3.5 from overflow page Totals (Lines 3.501 thru 3.503 plus 3.598)(Line 3.5 above) 0 0 0 0 0 0 0 0 Summary of remaining write-ins for Line 6 from overflow page Totals (Lines 0601 thru 0603 plus 0698)(Line 6 above) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 17,036,715 7,917,914 0 0 24,954,629 0 0 0 0 0 0 0 Medicare Part C & D Stop Loss Medicaid Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.MN *79413201830024100* ADJUSTMENTS TO THE LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Minnesota 1 2 Allocated Annuity and Other Allocated Fund Deposits Life Insurance Premiums 4 Unallocated Annuity & Other Unallocated Fund Deposits Accident & Health Premium 9,890,585 0 168,826,564 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. MODEL ACT BASE ( Line 11 of the Reconciliation Exhibit) 2. Enter in Column 2, as a positive number, and Column 4, as a negative number, the total of all amounts received to fund allocated contracts established under Section 403(b) of the U.S. Internal Revenue Code that are included in Column 4, Line 1 above 3. Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans: 4. 3 0 XXX 0 XXX 0 3.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 3.2 All amounts XXX XXX XXX 0 0 4.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 0 4.2 Amounts in excess of $1 million but NOT in excess of $5 million per contract XXX XXX XXX 4.3 Amounts in excess of $5 million per contract XXX XXX XXX 4.4 Total (Lines 4.1 + 4.2 + 4.3) XXX XXX XXX 4.5 Amounts up to $7.5 million, per contract (Minnesota only) XXX XXX XXX 0 0 0 0 5.1 Amounts in excess of $1 million per contract XXX XXX XXX 5.2 All amounts XXX XXX XXX 5.3 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 5.4 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 6.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 6.2 Amounts in excess of $1 million per contract XXX XXX XXX 6.3 Total (Lines 6.1 + 6.2) XXX XXX XXX 6.4 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 6.5 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 7.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 7.2 All amounts XXX XXX XXX Unallocated funding obligations issued to fund government lotteries or employee, union, or association of natural persons benefit plans which are NOT: (a) governmental retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation: 5. 6. 7. Unallocated funding obligations issued to fund governmental retirement plans established under Sections 401 and 457 of the U.S. Internal Revenue Code: 0 0 0 0 Unallocated funding obligations issued to fund governmental retirement plans established under Sections 403(b) of the U.S. Internal Revenue Code: 0 0 0 0 0 Unallocated funding obligations that fund employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation: 7.3 Amounts NOT in excess of $2 million per contract (New Jersey only) XXX XXX XXX 0 0 0 8. Unallocated funding obligations issued to fund government lotteries NOT in excess of $5 million per contractholder (New Jersey Only) XXX XXX XXX 0 9. Unallocated funding obligations that fund employee or association of natural persons benefit plans in excess of $2 million but NOT in excess of $5 million per contract (New Jersey Only) XXX 10. Aggregate write-ins for other deductions 0 0 0 0 0 9,890,585 0 168,826,564 0 0 0 0 0 0 0 0 0 XXX XXX BASE 11. Current Year (2018) DETAILS OF WRITE-INS 1001. 1002. 1003. 1098. Summary of remaining write-ins for Line 10 from overflow page 1099. Totals (Lines 1001 thru 1003 plus 1098)(Line 10 above) 300.MN *79413201829025100* LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Mississippi 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 3.501. 3.502. 3.503. 3.598. 3.599. 0601. 0602. 0603. 0698. 0699. 0901. 0902. 0903. 0998. 0999. PREMIUMS, CONSIDERATIONS AND DEPOSITS Premiums, considerations and deposits from Schedule T or Exhibit of Premiums and Losses Premiums, considerations and deposits NOT reported in Schedule T or Exhibit of Premiums and Losses, including investment contract receipts credited to a liability account 2.1 Contract fees for variable contracts with guarantees 2.2 Any other premiums, considerations and deposits not reported in Schedule T or Exhibit of Premiums and Losses Amounts, if applicable, that were deducted prior to determining amounts included in Lines 1 or 2 which are in the following categories: 3.1 Transfers to guaranteed Separate Accounts 3.2 Roll over of GICs or annuities into other companies 3.3 Surrenders or other benefits paid out 3.4 Excess interest credited to accounts 3.5 Aggregate write-ins for other amounts deducted prior to determining amounts included in Lines 1 or 2 3.99 Total (Lines 3.1 through 3.5) Transfers: 4.1 Enter in Column 2, as a negative number, and Column 4, as a positive number, the total of all amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, that are included in Column 2, Lines 1, 2 and 3.99 4.2 Enter in Column 2, as a positive number, and Column 4, as a negative number, any amounts reported in Column 4, Lines 1, 2 and 3.99 that are allocated. (Note: amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, should not be included in line 4.2) 4.3 Enter in Column 4, as a positive number, and Column 2, as a negative number, any amounts reported in Column 2, Lines 1, 2 and 3.99 that are unallocated 4.99 Total (Lines 4.1 + 4.2 + 4.3) Total (Lines 1 + 2 + 3.99 + 4.99) 1 2 3 Life Insurance Premiums Annuity Considerations A & H Premiums 4 Deposit-Type Contract Funds and Other Considerations 1,181,024 0 350,376,503 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,181,024 0 350,376,503 DEVELOPMENT OF AMOUNTS INCLUDED IN LINES 1 THROUGH 5 THAT SHOULD BE DEDUCTED IN DETERMINING THE BASE Do not include any amount more than once in Lines 6 through 9 Aggregate write-ins for amounts where the insurer is not subject to risk. Premiums for portions of policies or contracts NOT guaranteed or under which the entire investment risk is borne by the policyholder. (Please specify such deductions and indicate where such amounts were reported in the Annual Statement) Amounts NOT allocated to individuals or individual certificate holders or amounts received for such contracts in excess of limits: 7.1 Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans 7.2 Unallocated funding obligations that fund any employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation 7.3 Unallocated funding obligations that fund governmental lotteries or employee, union, or association of natural persons benefit plans in excess of $5 million per contract which are NOT: (a) government retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation 7.4 Total (Lines 7.1 + 7.2 + 7.3) Dividends/Experience rating credits paid or credited, but only if NOT guaranteed in advance (include only amounts NOT already deducted in determining Lines 1 and 2) Aggregate write-ins for Other Deductions Total (Lines 6 + 7.4 + 8 + 9) Current Year DETAILS OF WRITE-INS 0 0 0 0 0 0 0 XXX XXX XXX 0 XXX XXX XXX 0 XXX XXX XXX XXX XXX XXX 0 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 1,181,024 0 0 0 0 72,782,122 72,782,122 0 0 0 0 277,594,381 0 Summary of remaining write-ins for Line 3.5 from overflow page Totals (Lines 3.501 thru 3.503 plus 3.598)(Line 3.5 above) 0 0 0 0 0 0 0 0 Summary of remaining write-ins for Line 6 from overflow page Totals (Lines 0601 thru 0603 plus 0698)(Line 6 above) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 66,478,928 6,303,194 0 0 72,782,122 0 0 0 0 0 0 0 Medicare Part C & D Stop Loss Medicaid Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.MS *79413201830025100* ADJUSTMENTS TO THE LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Mississippi 1 2 Allocated Annuity and Other Allocated Fund Deposits Life Insurance Premiums 4 Unallocated Annuity & Other Unallocated Fund Deposits Accident & Health Premium 1,181,024 0 277,594,381 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. MODEL ACT BASE ( Line 11 of the Reconciliation Exhibit) 2. Enter in Column 2, as a positive number, and Column 4, as a negative number, the total of all amounts received to fund allocated contracts established under Section 403(b) of the U.S. Internal Revenue Code that are included in Column 4, Line 1 above 3. Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans: 4. 3 0 XXX 0 XXX 0 3.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 3.2 All amounts XXX XXX XXX 0 0 4.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 0 4.2 Amounts in excess of $1 million but NOT in excess of $5 million per contract XXX XXX XXX 4.3 Amounts in excess of $5 million per contract XXX XXX XXX 4.4 Total (Lines 4.1 + 4.2 + 4.3) XXX XXX XXX 4.5 Amounts up to $7.5 million, per contract (Minnesota only) XXX XXX XXX 0 0 0 0 5.1 Amounts in excess of $1 million per contract XXX XXX XXX 5.2 All amounts XXX XXX XXX 5.3 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 5.4 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 6.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 6.2 Amounts in excess of $1 million per contract XXX XXX XXX 6.3 Total (Lines 6.1 + 6.2) XXX XXX XXX 6.4 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 6.5 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 7.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 7.2 All amounts XXX XXX XXX Unallocated funding obligations issued to fund government lotteries or employee, union, or association of natural persons benefit plans which are NOT: (a) governmental retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation: 5. 6. 7. Unallocated funding obligations issued to fund governmental retirement plans established under Sections 401 and 457 of the U.S. Internal Revenue Code: 0 0 0 0 Unallocated funding obligations issued to fund governmental retirement plans established under Sections 403(b) of the U.S. Internal Revenue Code: 0 0 0 0 0 Unallocated funding obligations that fund employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation: 7.3 Amounts NOT in excess of $2 million per contract (New Jersey only) XXX XXX XXX 0 0 0 8. Unallocated funding obligations issued to fund government lotteries NOT in excess of $5 million per contractholder (New Jersey Only) XXX XXX XXX 0 9. Unallocated funding obligations that fund employee or association of natural persons benefit plans in excess of $2 million but NOT in excess of $5 million per contract (New Jersey Only) XXX 10. Aggregate write-ins for other deductions 0 0 0 0 0 1,181,024 0 277,594,381 0 0 0 0 0 0 0 0 0 XXX XXX BASE 11. Current Year (2018) DETAILS OF WRITE-INS 1001. 1002. 1003. 1098. Summary of remaining write-ins for Line 10 from overflow page 1099. Totals (Lines 1001 thru 1003 plus 1098)(Line 10 above) 300.MS *79413201829026100* LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Missouri 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 3.501. 3.502. 3.503. 3.598. 3.599. 0601. 0602. 0603. 0698. 0699. 0901. 0902. 0903. 0998. 0999. PREMIUMS, CONSIDERATIONS AND DEPOSITS Premiums, considerations and deposits from Schedule T or Exhibit of Premiums and Losses Premiums, considerations and deposits NOT reported in Schedule T or Exhibit of Premiums and Losses, including investment contract receipts credited to a liability account 2.1 Contract fees for variable contracts with guarantees 2.2 Any other premiums, considerations and deposits not reported in Schedule T or Exhibit of Premiums and Losses Amounts, if applicable, that were deducted prior to determining amounts included in Lines 1 or 2 which are in the following categories: 3.1 Transfers to guaranteed Separate Accounts 3.2 Roll over of GICs or annuities into other companies 3.3 Surrenders or other benefits paid out 3.4 Excess interest credited to accounts 3.5 Aggregate write-ins for other amounts deducted prior to determining amounts included in Lines 1 or 2 3.99 Total (Lines 3.1 through 3.5) Transfers: 4.1 Enter in Column 2, as a negative number, and Column 4, as a positive number, the total of all amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, that are included in Column 2, Lines 1, 2 and 3.99 4.2 Enter in Column 2, as a positive number, and Column 4, as a negative number, any amounts reported in Column 4, Lines 1, 2 and 3.99 that are allocated. (Note: amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, should not be included in line 4.2) 4.3 Enter in Column 4, as a positive number, and Column 2, as a negative number, any amounts reported in Column 2, Lines 1, 2 and 3.99 that are unallocated 4.99 Total (Lines 4.1 + 4.2 + 4.3) Total (Lines 1 + 2 + 3.99 + 4.99) 1 2 3 Life Insurance Premiums Annuity Considerations A & H Premiums 4 Deposit-Type Contract Funds and Other Considerations 4,865,466 0 1,527,746,151 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4,865,466 0 1,527,746,151 DEVELOPMENT OF AMOUNTS INCLUDED IN LINES 1 THROUGH 5 THAT SHOULD BE DEDUCTED IN DETERMINING THE BASE Do not include any amount more than once in Lines 6 through 9 Aggregate write-ins for amounts where the insurer is not subject to risk. Premiums for portions of policies or contracts NOT guaranteed or under which the entire investment risk is borne by the policyholder. (Please specify such deductions and indicate where such amounts were reported in the Annual Statement) Amounts NOT allocated to individuals or individual certificate holders or amounts received for such contracts in excess of limits: 7.1 Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans 7.2 Unallocated funding obligations that fund any employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation 7.3 Unallocated funding obligations that fund governmental lotteries or employee, union, or association of natural persons benefit plans in excess of $5 million per contract which are NOT: (a) government retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation 7.4 Total (Lines 7.1 + 7.2 + 7.3) Dividends/Experience rating credits paid or credited, but only if NOT guaranteed in advance (include only amounts NOT already deducted in determining Lines 1 and 2) Aggregate write-ins for Other Deductions Total (Lines 6 + 7.4 + 8 + 9) Current Year DETAILS OF WRITE-INS 0 0 0 0 0 0 0 XXX XXX XXX 0 XXX XXX XXX 0 XXX XXX XXX XXX XXX XXX 0 0 0 0 0 0 229,788,430 229,788,430 0 0 0 0 1,297,957,721 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 4,865,466 Summary of remaining write-ins for Line 3.5 from overflow page Totals (Lines 3.501 thru 3.503 plus 3.598)(Line 3.5 above) 0 0 0 0 0 0 0 0 Summary of remaining write-ins for Line 6 from overflow page Totals (Lines 0601 thru 0603 plus 0698)(Line 6 above) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 207,513,144 22,275,286 0 0 229,788,430 0 0 0 0 0 0 0 Medicare Part C & D Stop Loss Medicaid Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.MO *79413201830026100* ADJUSTMENTS TO THE LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Missouri 1 2 Allocated Annuity and Other Allocated Fund Deposits Life Insurance Premiums 4 Unallocated Annuity & Other Unallocated Fund Deposits Accident & Health Premium 4,865,466 0 1,297,957,721 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. MODEL ACT BASE ( Line 11 of the Reconciliation Exhibit) 2. Enter in Column 2, as a positive number, and Column 4, as a negative number, the total of all amounts received to fund allocated contracts established under Section 403(b) of the U.S. Internal Revenue Code that are included in Column 4, Line 1 above 3. Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans: 4. 3 0 XXX 0 XXX 0 3.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 3.2 All amounts XXX XXX XXX 0 0 4.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 0 4.2 Amounts in excess of $1 million but NOT in excess of $5 million per contract XXX XXX XXX 4.3 Amounts in excess of $5 million per contract XXX XXX XXX 4.4 Total (Lines 4.1 + 4.2 + 4.3) XXX XXX XXX 4.5 Amounts up to $7.5 million, per contract (Minnesota only) XXX XXX XXX 0 0 0 0 5.1 Amounts in excess of $1 million per contract XXX XXX XXX 5.2 All amounts XXX XXX XXX 5.3 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 5.4 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 6.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 6.2 Amounts in excess of $1 million per contract XXX XXX XXX 6.3 Total (Lines 6.1 + 6.2) XXX XXX XXX 6.4 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 6.5 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 7.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 7.2 All amounts XXX XXX XXX Unallocated funding obligations issued to fund government lotteries or employee, union, or association of natural persons benefit plans which are NOT: (a) governmental retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation: 5. 6. 7. Unallocated funding obligations issued to fund governmental retirement plans established under Sections 401 and 457 of the U.S. Internal Revenue Code: 0 0 0 0 Unallocated funding obligations issued to fund governmental retirement plans established under Sections 403(b) of the U.S. Internal Revenue Code: 0 0 0 0 0 Unallocated funding obligations that fund employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation: 7.3 Amounts NOT in excess of $2 million per contract (New Jersey only) XXX XXX XXX 0 0 0 8. Unallocated funding obligations issued to fund government lotteries NOT in excess of $5 million per contractholder (New Jersey Only) XXX XXX XXX 0 9. Unallocated funding obligations that fund employee or association of natural persons benefit plans in excess of $2 million but NOT in excess of $5 million per contract (New Jersey Only) XXX 10. Aggregate write-ins for other deductions 0 0 0 0 0 4,865,466 0 1,297,957,721 0 0 0 0 0 0 0 0 0 XXX XXX BASE 11. Current Year (2018) DETAILS OF WRITE-INS 1001. 1002. 1003. 1098. Summary of remaining write-ins for Line 10 from overflow page 1099. Totals (Lines 1001 thru 1003 plus 1098)(Line 10 above) 300.MO *79413201829027100* LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Montana 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 3.501. 3.502. 3.503. 3.598. 3.599. 0601. 0602. 0603. 0698. 0699. 0901. 0902. 0903. 0998. 0999. PREMIUMS, CONSIDERATIONS AND DEPOSITS Premiums, considerations and deposits from Schedule T or Exhibit of Premiums and Losses Premiums, considerations and deposits NOT reported in Schedule T or Exhibit of Premiums and Losses, including investment contract receipts credited to a liability account 2.1 Contract fees for variable contracts with guarantees 2.2 Any other premiums, considerations and deposits not reported in Schedule T or Exhibit of Premiums and Losses Amounts, if applicable, that were deducted prior to determining amounts included in Lines 1 or 2 which are in the following categories: 3.1 Transfers to guaranteed Separate Accounts 3.2 Roll over of GICs or annuities into other companies 3.3 Surrenders or other benefits paid out 3.4 Excess interest credited to accounts 3.5 Aggregate write-ins for other amounts deducted prior to determining amounts included in Lines 1 or 2 3.99 Total (Lines 3.1 through 3.5) Transfers: 4.1 Enter in Column 2, as a negative number, and Column 4, as a positive number, the total of all amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, that are included in Column 2, Lines 1, 2 and 3.99 4.2 Enter in Column 2, as a positive number, and Column 4, as a negative number, any amounts reported in Column 4, Lines 1, 2 and 3.99 that are allocated. (Note: amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, should not be included in line 4.2) 4.3 Enter in Column 4, as a positive number, and Column 2, as a negative number, any amounts reported in Column 2, Lines 1, 2 and 3.99 that are unallocated 4.99 Total (Lines 4.1 + 4.2 + 4.3) Total (Lines 1 + 2 + 3.99 + 4.99) 1 2 3 Life Insurance Premiums Annuity Considerations A & H Premiums 4 Deposit-Type Contract Funds and Other Considerations 34,034 0 56,597,910 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 34,034 0 56,597,910 DEVELOPMENT OF AMOUNTS INCLUDED IN LINES 1 THROUGH 5 THAT SHOULD BE DEDUCTED IN DETERMINING THE BASE Do not include any amount more than once in Lines 6 through 9 Aggregate write-ins for amounts where the insurer is not subject to risk. Premiums for portions of policies or contracts NOT guaranteed or under which the entire investment risk is borne by the policyholder. (Please specify such deductions and indicate where such amounts were reported in the Annual Statement) Amounts NOT allocated to individuals or individual certificate holders or amounts received for such contracts in excess of limits: 7.1 Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans 7.2 Unallocated funding obligations that fund any employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation 7.3 Unallocated funding obligations that fund governmental lotteries or employee, union, or association of natural persons benefit plans in excess of $5 million per contract which are NOT: (a) government retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation 7.4 Total (Lines 7.1 + 7.2 + 7.3) Dividends/Experience rating credits paid or credited, but only if NOT guaranteed in advance (include only amounts NOT already deducted in determining Lines 1 and 2) Aggregate write-ins for Other Deductions Total (Lines 6 + 7.4 + 8 + 9) Current Year DETAILS OF WRITE-INS 0 0 0 0 0 0 0 XXX XXX XXX 0 XXX XXX XXX 0 XXX XXX XXX XXX XXX XXX 0 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 34,034 0 0 0 0 12,653,407 12,653,407 0 0 0 0 43,944,503 0 Summary of remaining write-ins for Line 3.5 from overflow page Totals (Lines 3.501 thru 3.503 plus 3.598)(Line 3.5 above) 0 0 0 0 0 0 0 0 Summary of remaining write-ins for Line 6 from overflow page Totals (Lines 0601 thru 0603 plus 0698)(Line 6 above) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 12,265,480 387,927 0 0 12,653,407 0 0 0 0 0 0 0 Medicare Part C & D Stop Loss Medicaid Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.MT *79413201830027100* ADJUSTMENTS TO THE LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Montana 1 2 Allocated Annuity and Other Allocated Fund Deposits Life Insurance Premiums MODEL ACT BASE ( Line 11 of the Reconciliation Exhibit) 2. Enter in Column 2, as a positive number, and Column 4, as a negative number, the total of all amounts received to fund allocated contracts established under Section 403(b) of the U.S. Internal Revenue Code that are included in Column 4, Line 1 above 3. Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans: 0 XXX 4 Unallocated Annuity & Other Unallocated Fund Deposits Accident & Health Premium 34,034 0 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. 4. 3 43,944,503 0 XXX 0 3.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 3.2 All amounts XXX XXX XXX 0 0 4.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 0 4.2 Amounts in excess of $1 million but NOT in excess of $5 million per contract XXX XXX XXX 4.3 Amounts in excess of $5 million per contract XXX XXX XXX 4.4 Total (Lines 4.1 + 4.2 + 4.3) XXX XXX XXX 4.5 Amounts up to $7.5 million, per contract (Minnesota only) XXX XXX XXX 0 0 0 0 5.1 Amounts in excess of $1 million per contract XXX XXX XXX 5.2 All amounts XXX XXX XXX 5.3 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 5.4 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 6.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 6.2 Amounts in excess of $1 million per contract XXX XXX XXX 6.3 Total (Lines 6.1 + 6.2) XXX XXX XXX 6.4 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 6.5 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 7.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 7.2 All amounts XXX XXX XXX Unallocated funding obligations issued to fund government lotteries or employee, union, or association of natural persons benefit plans which are NOT: (a) governmental retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation: 5. 6. 7. Unallocated funding obligations issued to fund governmental retirement plans established under Sections 401 and 457 of the U.S. Internal Revenue Code: 0 0 0 0 Unallocated funding obligations issued to fund governmental retirement plans established under Sections 403(b) of the U.S. Internal Revenue Code: 0 0 0 0 0 Unallocated funding obligations that fund employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation: 7.3 Amounts NOT in excess of $2 million per contract (New Jersey only) XXX XXX XXX 0 0 0 8. Unallocated funding obligations issued to fund government lotteries NOT in excess of $5 million per contractholder (New Jersey Only) XXX XXX XXX 0 9. Unallocated funding obligations that fund employee or association of natural persons benefit plans in excess of $2 million but NOT in excess of $5 million per contract (New Jersey Only) XXX 10. Aggregate write-ins for other deductions 0 0 0 0 0 34,034 0 43,944,503 0 0 0 0 0 0 0 0 0 XXX XXX BASE 11. Current Year (2018) DETAILS OF WRITE-INS 1001. 1002. 1003. 1098. Summary of remaining write-ins for Line 10 from overflow page 1099. Totals (Lines 1001 thru 1003 plus 1098)(Line 10 above) 300.MT *79413201829028100* LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Nebraska 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 3.501. 3.502. 3.503. 3.598. 3.599. 0601. 0602. 0603. 0698. 0699. 0901. 0902. 0903. 0998. 0999. PREMIUMS, CONSIDERATIONS AND DEPOSITS Premiums, considerations and deposits from Schedule T or Exhibit of Premiums and Losses Premiums, considerations and deposits NOT reported in Schedule T or Exhibit of Premiums and Losses, including investment contract receipts credited to a liability account 2.1 Contract fees for variable contracts with guarantees 2.2 Any other premiums, considerations and deposits not reported in Schedule T or Exhibit of Premiums and Losses Amounts, if applicable, that were deducted prior to determining amounts included in Lines 1 or 2 which are in the following categories: 3.1 Transfers to guaranteed Separate Accounts 3.2 Roll over of GICs or annuities into other companies 3.3 Surrenders or other benefits paid out 3.4 Excess interest credited to accounts 3.5 Aggregate write-ins for other amounts deducted prior to determining amounts included in Lines 1 or 2 3.99 Total (Lines 3.1 through 3.5) Transfers: 4.1 Enter in Column 2, as a negative number, and Column 4, as a positive number, the total of all amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, that are included in Column 2, Lines 1, 2 and 3.99 4.2 Enter in Column 2, as a positive number, and Column 4, as a negative number, any amounts reported in Column 4, Lines 1, 2 and 3.99 that are allocated. (Note: amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, should not be included in line 4.2) 4.3 Enter in Column 4, as a positive number, and Column 2, as a negative number, any amounts reported in Column 2, Lines 1, 2 and 3.99 that are unallocated 4.99 Total (Lines 4.1 + 4.2 + 4.3) Total (Lines 1 + 2 + 3.99 + 4.99) 1 2 3 Life Insurance Premiums Annuity Considerations A & H Premiums 4 Deposit-Type Contract Funds and Other Considerations 732,580 0 466,664,562 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 732,580 0 466,664,562 DEVELOPMENT OF AMOUNTS INCLUDED IN LINES 1 THROUGH 5 THAT SHOULD BE DEDUCTED IN DETERMINING THE BASE Do not include any amount more than once in Lines 6 through 9 Aggregate write-ins for amounts where the insurer is not subject to risk. Premiums for portions of policies or contracts NOT guaranteed or under which the entire investment risk is borne by the policyholder. (Please specify such deductions and indicate where such amounts were reported in the Annual Statement) Amounts NOT allocated to individuals or individual certificate holders or amounts received for such contracts in excess of limits: 7.1 Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans 7.2 Unallocated funding obligations that fund any employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation 7.3 Unallocated funding obligations that fund governmental lotteries or employee, union, or association of natural persons benefit plans in excess of $5 million per contract which are NOT: (a) government retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation 7.4 Total (Lines 7.1 + 7.2 + 7.3) Dividends/Experience rating credits paid or credited, but only if NOT guaranteed in advance (include only amounts NOT already deducted in determining Lines 1 and 2) Aggregate write-ins for Other Deductions Total (Lines 6 + 7.4 + 8 + 9) Current Year DETAILS OF WRITE-INS 0 0 0 0 0 0 0 XXX XXX XXX 0 XXX XXX XXX 0 XXX XXX XXX XXX XXX XXX 0 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 732,580 0 0 0 0 82,962,776 82,962,776 0 0 0 0 383,701,786 0 Summary of remaining write-ins for Line 3.5 from overflow page Totals (Lines 3.501 thru 3.503 plus 3.598)(Line 3.5 above) 0 0 0 0 0 0 0 0 Summary of remaining write-ins for Line 6 from overflow page Totals (Lines 0601 thru 0603 plus 0698)(Line 6 above) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 74,931,338 8,031,438 0 0 82,962,776 0 0 0 0 0 0 0 Medicare Part C & D Stop Loss Medicaid Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.NE *79413201830028100* ADJUSTMENTS TO THE LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Nebraska 1 2 Allocated Annuity and Other Allocated Fund Deposits Life Insurance Premiums 4 Unallocated Annuity & Other Unallocated Fund Deposits Accident & Health Premium 732,580 0 383,701,786 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. MODEL ACT BASE ( Line 11 of the Reconciliation Exhibit) 2. Enter in Column 2, as a positive number, and Column 4, as a negative number, the total of all amounts received to fund allocated contracts established under Section 403(b) of the U.S. Internal Revenue Code that are included in Column 4, Line 1 above 3. Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans: 4. 3 0 XXX 0 XXX 0 3.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 3.2 All amounts XXX XXX XXX 0 0 4.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 0 4.2 Amounts in excess of $1 million but NOT in excess of $5 million per contract XXX XXX XXX 4.3 Amounts in excess of $5 million per contract XXX XXX XXX 4.4 Total (Lines 4.1 + 4.2 + 4.3) XXX XXX XXX 4.5 Amounts up to $7.5 million, per contract (Minnesota only) XXX XXX XXX 0 0 0 0 5.1 Amounts in excess of $1 million per contract XXX XXX XXX 5.2 All amounts XXX XXX XXX 5.3 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 5.4 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 6.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 6.2 Amounts in excess of $1 million per contract XXX XXX XXX 6.3 Total (Lines 6.1 + 6.2) XXX XXX XXX 6.4 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 6.5 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 7.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 7.2 All amounts XXX XXX XXX Unallocated funding obligations issued to fund government lotteries or employee, union, or association of natural persons benefit plans which are NOT: (a) governmental retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation: 5. 6. 7. Unallocated funding obligations issued to fund governmental retirement plans established under Sections 401 and 457 of the U.S. Internal Revenue Code: 0 0 0 0 Unallocated funding obligations issued to fund governmental retirement plans established under Sections 403(b) of the U.S. Internal Revenue Code: 0 0 0 0 0 Unallocated funding obligations that fund employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation: 7.3 Amounts NOT in excess of $2 million per contract (New Jersey only) XXX XXX XXX 0 0 0 8. Unallocated funding obligations issued to fund government lotteries NOT in excess of $5 million per contractholder (New Jersey Only) XXX XXX XXX 0 9. Unallocated funding obligations that fund employee or association of natural persons benefit plans in excess of $2 million but NOT in excess of $5 million per contract (New Jersey Only) XXX 10. Aggregate write-ins for other deductions 0 0 0 0 0 732,580 0 383,701,786 0 0 0 0 0 0 0 0 0 XXX XXX BASE 11. Current Year (2018) DETAILS OF WRITE-INS 1001. 1002. 1003. 1098. Summary of remaining write-ins for Line 10 from overflow page 1099. Totals (Lines 1001 thru 1003 plus 1098)(Line 10 above) 300.NE *79413201829029100* LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Nevada 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 3.501. 3.502. 3.503. 3.598. 3.599. 0601. 0602. 0603. 0698. 0699. 0901. 0902. 0903. 0998. 0999. PREMIUMS, CONSIDERATIONS AND DEPOSITS Premiums, considerations and deposits from Schedule T or Exhibit of Premiums and Losses Premiums, considerations and deposits NOT reported in Schedule T or Exhibit of Premiums and Losses, including investment contract receipts credited to a liability account 2.1 Contract fees for variable contracts with guarantees 2.2 Any other premiums, considerations and deposits not reported in Schedule T or Exhibit of Premiums and Losses Amounts, if applicable, that were deducted prior to determining amounts included in Lines 1 or 2 which are in the following categories: 3.1 Transfers to guaranteed Separate Accounts 3.2 Roll over of GICs or annuities into other companies 3.3 Surrenders or other benefits paid out 3.4 Excess interest credited to accounts 3.5 Aggregate write-ins for other amounts deducted prior to determining amounts included in Lines 1 or 2 3.99 Total (Lines 3.1 through 3.5) Transfers: 4.1 Enter in Column 2, as a negative number, and Column 4, as a positive number, the total of all amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, that are included in Column 2, Lines 1, 2 and 3.99 4.2 Enter in Column 2, as a positive number, and Column 4, as a negative number, any amounts reported in Column 4, Lines 1, 2 and 3.99 that are allocated. (Note: amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, should not be included in line 4.2) 4.3 Enter in Column 4, as a positive number, and Column 2, as a negative number, any amounts reported in Column 2, Lines 1, 2 and 3.99 that are unallocated 4.99 Total (Lines 4.1 + 4.2 + 4.3) Total (Lines 1 + 2 + 3.99 + 4.99) 1 2 3 Life Insurance Premiums Annuity Considerations A & H Premiums 4 Deposit-Type Contract Funds and Other Considerations 3,257,054 0 371,922,176 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3,257,054 0 371,922,176 DEVELOPMENT OF AMOUNTS INCLUDED IN LINES 1 THROUGH 5 THAT SHOULD BE DEDUCTED IN DETERMINING THE BASE Do not include any amount more than once in Lines 6 through 9 Aggregate write-ins for amounts where the insurer is not subject to risk. Premiums for portions of policies or contracts NOT guaranteed or under which the entire investment risk is borne by the policyholder. (Please specify such deductions and indicate where such amounts were reported in the Annual Statement) Amounts NOT allocated to individuals or individual certificate holders or amounts received for such contracts in excess of limits: 7.1 Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans 7.2 Unallocated funding obligations that fund any employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation 7.3 Unallocated funding obligations that fund governmental lotteries or employee, union, or association of natural persons benefit plans in excess of $5 million per contract which are NOT: (a) government retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation 7.4 Total (Lines 7.1 + 7.2 + 7.3) Dividends/Experience rating credits paid or credited, but only if NOT guaranteed in advance (include only amounts NOT already deducted in determining Lines 1 and 2) Aggregate write-ins for Other Deductions Total (Lines 6 + 7.4 + 8 + 9) Current Year DETAILS OF WRITE-INS 0 0 0 0 0 0 0 XXX XXX XXX 0 XXX XXX XXX 0 XXX XXX XXX XXX XXX XXX 0 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 3,257,054 0 0 0 0 37,765,146 37,765,146 0 0 0 0 334,157,030 0 Summary of remaining write-ins for Line 3.5 from overflow page Totals (Lines 3.501 thru 3.503 plus 3.598)(Line 3.5 above) 0 0 0 0 0 0 0 0 Summary of remaining write-ins for Line 6 from overflow page Totals (Lines 0601 thru 0603 plus 0698)(Line 6 above) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 32,882,789 4,882,357 0 0 37,765,146 0 0 0 0 0 0 0 Medicare Part C & D Stop Loss Medicaid Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.NV *79413201830029100* ADJUSTMENTS TO THE LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Nevada 1 2 Allocated Annuity and Other Allocated Fund Deposits Life Insurance Premiums 4 Unallocated Annuity & Other Unallocated Fund Deposits Accident & Health Premium 3,257,054 0 334,157,030 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. MODEL ACT BASE ( Line 11 of the Reconciliation Exhibit) 2. Enter in Column 2, as a positive number, and Column 4, as a negative number, the total of all amounts received to fund allocated contracts established under Section 403(b) of the U.S. Internal Revenue Code that are included in Column 4, Line 1 above 3. Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans: 4. 3 0 XXX 0 XXX 0 3.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 3.2 All amounts XXX XXX XXX 0 0 4.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 0 4.2 Amounts in excess of $1 million but NOT in excess of $5 million per contract XXX XXX XXX 4.3 Amounts in excess of $5 million per contract XXX XXX XXX 4.4 Total (Lines 4.1 + 4.2 + 4.3) XXX XXX XXX 4.5 Amounts up to $7.5 million, per contract (Minnesota only) XXX XXX XXX 0 0 0 0 5.1 Amounts in excess of $1 million per contract XXX XXX XXX 5.2 All amounts XXX XXX XXX 5.3 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 5.4 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 6.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 6.2 Amounts in excess of $1 million per contract XXX XXX XXX 6.3 Total (Lines 6.1 + 6.2) XXX XXX XXX 6.4 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 6.5 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 7.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 7.2 All amounts XXX XXX XXX Unallocated funding obligations issued to fund government lotteries or employee, union, or association of natural persons benefit plans which are NOT: (a) governmental retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation: 5. 6. 7. Unallocated funding obligations issued to fund governmental retirement plans established under Sections 401 and 457 of the U.S. Internal Revenue Code: 0 0 0 0 Unallocated funding obligations issued to fund governmental retirement plans established under Sections 403(b) of the U.S. Internal Revenue Code: 0 0 0 0 0 Unallocated funding obligations that fund employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation: 7.3 Amounts NOT in excess of $2 million per contract (New Jersey only) XXX XXX XXX 0 0 0 8. Unallocated funding obligations issued to fund government lotteries NOT in excess of $5 million per contractholder (New Jersey Only) XXX XXX XXX 0 9. Unallocated funding obligations that fund employee or association of natural persons benefit plans in excess of $2 million but NOT in excess of $5 million per contract (New Jersey Only) XXX 10. Aggregate write-ins for other deductions 0 0 0 0 0 3,257,054 0 334,157,030 0 0 0 0 0 0 0 0 0 XXX XXX BASE 11. Current Year (2018) DETAILS OF WRITE-INS 1001. 1002. 1003. 1098. Summary of remaining write-ins for Line 10 from overflow page 1099. Totals (Lines 1001 thru 1003 plus 1098)(Line 10 above) 300.NV *79413201829030100* LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: New Hampshire 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 3.501. 3.502. 3.503. 3.598. 3.599. 0601. 0602. 0603. 0698. 0699. 0901. 0902. 0903. 0998. 0999. PREMIUMS, CONSIDERATIONS AND DEPOSITS Premiums, considerations and deposits from Schedule T or Exhibit of Premiums and Losses Premiums, considerations and deposits NOT reported in Schedule T or Exhibit of Premiums and Losses, including investment contract receipts credited to a liability account 2.1 Contract fees for variable contracts with guarantees 2.2 Any other premiums, considerations and deposits not reported in Schedule T or Exhibit of Premiums and Losses Amounts, if applicable, that were deducted prior to determining amounts included in Lines 1 or 2 which are in the following categories: 3.1 Transfers to guaranteed Separate Accounts 3.2 Roll over of GICs or annuities into other companies 3.3 Surrenders or other benefits paid out 3.4 Excess interest credited to accounts 3.5 Aggregate write-ins for other amounts deducted prior to determining amounts included in Lines 1 or 2 3.99 Total (Lines 3.1 through 3.5) Transfers: 4.1 Enter in Column 2, as a negative number, and Column 4, as a positive number, the total of all amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, that are included in Column 2, Lines 1, 2 and 3.99 4.2 Enter in Column 2, as a positive number, and Column 4, as a negative number, any amounts reported in Column 4, Lines 1, 2 and 3.99 that are allocated. (Note: amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, should not be included in line 4.2) 4.3 Enter in Column 4, as a positive number, and Column 2, as a negative number, any amounts reported in Column 2, Lines 1, 2 and 3.99 that are unallocated 4.99 Total (Lines 4.1 + 4.2 + 4.3) Total (Lines 1 + 2 + 3.99 + 4.99) 1 2 3 Life Insurance Premiums Annuity Considerations A & H Premiums 4 Deposit-Type Contract Funds and Other Considerations 628,802 0 152,343,879 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 628,802 0 152,343,879 DEVELOPMENT OF AMOUNTS INCLUDED IN LINES 1 THROUGH 5 THAT SHOULD BE DEDUCTED IN DETERMINING THE BASE Do not include any amount more than once in Lines 6 through 9 Aggregate write-ins for amounts where the insurer is not subject to risk. Premiums for portions of policies or contracts NOT guaranteed or under which the entire investment risk is borne by the policyholder. (Please specify such deductions and indicate where such amounts were reported in the Annual Statement) Amounts NOT allocated to individuals or individual certificate holders or amounts received for such contracts in excess of limits: 7.1 Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans 7.2 Unallocated funding obligations that fund any employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation 7.3 Unallocated funding obligations that fund governmental lotteries or employee, union, or association of natural persons benefit plans in excess of $5 million per contract which are NOT: (a) government retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation 7.4 Total (Lines 7.1 + 7.2 + 7.3) Dividends/Experience rating credits paid or credited, but only if NOT guaranteed in advance (include only amounts NOT already deducted in determining Lines 1 and 2) Aggregate write-ins for Other Deductions Total (Lines 6 + 7.4 + 8 + 9) Current Year DETAILS OF WRITE-INS 0 0 0 0 0 0 0 XXX XXX XXX 0 XXX XXX XXX 0 XXX XXX XXX XXX XXX XXX 0 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 628,802 0 0 0 0 39,636,937 39,636,937 0 0 0 0 112,706,942 0 Summary of remaining write-ins for Line 3.5 from overflow page Totals (Lines 3.501 thru 3.503 plus 3.598)(Line 3.5 above) 0 0 0 0 0 0 0 0 Summary of remaining write-ins for Line 6 from overflow page Totals (Lines 0601 thru 0603 plus 0698)(Line 6 above) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 37,211,617 2,425,320 0 0 39,636,937 0 0 0 0 0 0 0 Medicare Part C & D Stop Loss Medicaid Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.NH *79413201830030100* ADJUSTMENTS TO THE LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: New Hampshire 1 2 Allocated Annuity and Other Allocated Fund Deposits Life Insurance Premiums 4 Unallocated Annuity & Other Unallocated Fund Deposits Accident & Health Premium 628,802 0 112,706,942 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. MODEL ACT BASE ( Line 11 of the Reconciliation Exhibit) 2. Enter in Column 2, as a positive number, and Column 4, as a negative number, the total of all amounts received to fund allocated contracts established under Section 403(b) of the U.S. Internal Revenue Code that are included in Column 4, Line 1 above 3. Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans: 4. 3 0 XXX 0 XXX 0 3.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 3.2 All amounts XXX XXX XXX 0 0 4.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 0 4.2 Amounts in excess of $1 million but NOT in excess of $5 million per contract XXX XXX XXX 4.3 Amounts in excess of $5 million per contract XXX XXX XXX 4.4 Total (Lines 4.1 + 4.2 + 4.3) XXX XXX XXX 4.5 Amounts up to $7.5 million, per contract (Minnesota only) XXX XXX XXX 0 0 0 0 5.1 Amounts in excess of $1 million per contract XXX XXX XXX 5.2 All amounts XXX XXX XXX 5.3 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 5.4 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 6.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 6.2 Amounts in excess of $1 million per contract XXX XXX XXX 6.3 Total (Lines 6.1 + 6.2) XXX XXX XXX 6.4 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 6.5 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 7.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 7.2 All amounts XXX XXX XXX Unallocated funding obligations issued to fund government lotteries or employee, union, or association of natural persons benefit plans which are NOT: (a) governmental retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation: 5. 6. 7. Unallocated funding obligations issued to fund governmental retirement plans established under Sections 401 and 457 of the U.S. Internal Revenue Code: 0 0 0 0 Unallocated funding obligations issued to fund governmental retirement plans established under Sections 403(b) of the U.S. Internal Revenue Code: 0 0 0 0 0 Unallocated funding obligations that fund employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation: 7.3 Amounts NOT in excess of $2 million per contract (New Jersey only) XXX XXX XXX 0 0 0 8. Unallocated funding obligations issued to fund government lotteries NOT in excess of $5 million per contractholder (New Jersey Only) XXX XXX XXX 0 9. Unallocated funding obligations that fund employee or association of natural persons benefit plans in excess of $2 million but NOT in excess of $5 million per contract (New Jersey Only) XXX 10. Aggregate write-ins for other deductions 0 0 0 0 0 628,802 0 112,706,942 0 0 0 0 0 0 0 0 0 XXX XXX BASE 11. Current Year (2018) DETAILS OF WRITE-INS 1001. 1002. 1003. 1098. Summary of remaining write-ins for Line 10 from overflow page 1099. Totals (Lines 1001 thru 1003 plus 1098)(Line 10 above) 300.NH *79413201829031100* LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: New Jersey 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 3.501. 3.502. 3.503. 3.598. 3.599. 0601. 0602. 0603. 0698. 0699. 0901. 0902. 0903. 0998. 0999. PREMIUMS, CONSIDERATIONS AND DEPOSITS Premiums, considerations and deposits from Schedule T or Exhibit of Premiums and Losses Premiums, considerations and deposits NOT reported in Schedule T or Exhibit of Premiums and Losses, including investment contract receipts credited to a liability account 2.1 Contract fees for variable contracts with guarantees 2.2 Any other premiums, considerations and deposits not reported in Schedule T or Exhibit of Premiums and Losses Amounts, if applicable, that were deducted prior to determining amounts included in Lines 1 or 2 which are in the following categories: 3.1 Transfers to guaranteed Separate Accounts 3.2 Roll over of GICs or annuities into other companies 3.3 Surrenders or other benefits paid out 3.4 Excess interest credited to accounts 3.5 Aggregate write-ins for other amounts deducted prior to determining amounts included in Lines 1 or 2 3.99 Total (Lines 3.1 through 3.5) Transfers: 4.1 Enter in Column 2, as a negative number, and Column 4, as a positive number, the total of all amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, that are included in Column 2, Lines 1, 2 and 3.99 4.2 Enter in Column 2, as a positive number, and Column 4, as a negative number, any amounts reported in Column 4, Lines 1, 2 and 3.99 that are allocated. (Note: amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, should not be included in line 4.2) 4.3 Enter in Column 4, as a positive number, and Column 2, as a negative number, any amounts reported in Column 2, Lines 1, 2 and 3.99 that are unallocated 4.99 Total (Lines 4.1 + 4.2 + 4.3) Total (Lines 1 + 2 + 3.99 + 4.99) 1 2 3 Life Insurance Premiums Annuity Considerations A & H Premiums 4 Deposit-Type Contract Funds and Other Considerations 1,778,168 0 1,298,146,826 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,778,168 0 1,298,146,826 DEVELOPMENT OF AMOUNTS INCLUDED IN LINES 1 THROUGH 5 THAT SHOULD BE DEDUCTED IN DETERMINING THE BASE Do not include any amount more than once in Lines 6 through 9 Aggregate write-ins for amounts where the insurer is not subject to risk. Premiums for portions of policies or contracts NOT guaranteed or under which the entire investment risk is borne by the policyholder. (Please specify such deductions and indicate where such amounts were reported in the Annual Statement) Amounts NOT allocated to individuals or individual certificate holders or amounts received for such contracts in excess of limits: 7.1 Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans 7.2 Unallocated funding obligations that fund any employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation 7.3 Unallocated funding obligations that fund governmental lotteries or employee, union, or association of natural persons benefit plans in excess of $5 million per contract which are NOT: (a) government retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation 7.4 Total (Lines 7.1 + 7.2 + 7.3) Dividends/Experience rating credits paid or credited, but only if NOT guaranteed in advance (include only amounts NOT already deducted in determining Lines 1 and 2) Aggregate write-ins for Other Deductions Total (Lines 6 + 7.4 + 8 + 9) Current Year DETAILS OF WRITE-INS 0 0 0 0 0 0 0 XXX XXX XXX 0 XXX XXX XXX 0 XXX XXX XXX XXX XXX XXX 0 0 0 0 0 0 273,479,553 273,479,553 0 0 0 0 1,024,667,273 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 1,778,168 Summary of remaining write-ins for Line 3.5 from overflow page Totals (Lines 3.501 thru 3.503 plus 3.598)(Line 3.5 above) 0 0 0 0 0 0 0 0 Summary of remaining write-ins for Line 6 from overflow page Totals (Lines 0601 thru 0603 plus 0698)(Line 6 above) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 255,402,872 18,076,681 0 0 273,479,553 0 0 0 0 0 0 0 Medicare Part C & D Stop Loss Medicaid Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.NJ *79413201830031100* ADJUSTMENTS TO THE LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: New Jersey 1 2 Allocated Annuity and Other Allocated Fund Deposits Life Insurance Premiums 4 Unallocated Annuity & Other Unallocated Fund Deposits Accident & Health Premium 1,778,168 0 1,024,667,273 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. MODEL ACT BASE ( Line 11 of the Reconciliation Exhibit) 2. Enter in Column 2, as a positive number, and Column 4, as a negative number, the total of all amounts received to fund allocated contracts established under Section 403(b) of the U.S. Internal Revenue Code that are included in Column 4, Line 1 above 3. Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans: 4. 3 0 XXX 0 XXX 0 3.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 3.2 All amounts XXX XXX XXX 0 0 4.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 0 4.2 Amounts in excess of $1 million but NOT in excess of $5 million per contract XXX XXX XXX 4.3 Amounts in excess of $5 million per contract XXX XXX XXX 4.4 Total (Lines 4.1 + 4.2 + 4.3) XXX XXX XXX 4.5 Amounts up to $7.5 million, per contract (Minnesota only) XXX XXX XXX 0 0 0 0 5.1 Amounts in excess of $1 million per contract XXX XXX XXX 5.2 All amounts XXX XXX XXX 5.3 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 5.4 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 6.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 6.2 Amounts in excess of $1 million per contract XXX XXX XXX 6.3 Total (Lines 6.1 + 6.2) XXX XXX XXX 6.4 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 6.5 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 7.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 7.2 All amounts XXX XXX XXX Unallocated funding obligations issued to fund government lotteries or employee, union, or association of natural persons benefit plans which are NOT: (a) governmental retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation: 5. 6. 7. Unallocated funding obligations issued to fund governmental retirement plans established under Sections 401 and 457 of the U.S. Internal Revenue Code: 0 0 0 0 Unallocated funding obligations issued to fund governmental retirement plans established under Sections 403(b) of the U.S. Internal Revenue Code: 0 0 0 0 0 Unallocated funding obligations that fund employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation: 7.3 Amounts NOT in excess of $2 million per contract (New Jersey only) XXX XXX XXX 0 0 0 8. Unallocated funding obligations issued to fund government lotteries NOT in excess of $5 million per contractholder (New Jersey Only) XXX XXX XXX 0 9. Unallocated funding obligations that fund employee or association of natural persons benefit plans in excess of $2 million but NOT in excess of $5 million per contract (New Jersey Only) XXX 10. Aggregate write-ins for other deductions 0 0 0 0 0 1,778,168 0 1,024,667,273 0 0 0 0 0 0 0 0 0 XXX XXX BASE 11. Current Year (2018) DETAILS OF WRITE-INS 1001. 1002. 1003. 1098. Summary of remaining write-ins for Line 10 from overflow page 1099. Totals (Lines 1001 thru 1003 plus 1098)(Line 10 above) 300.NJ *79413201829032100* LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: New Mexico 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 3.501. 3.502. 3.503. 3.598. 3.599. 0601. 0602. 0603. 0698. 0699. 0901. 0902. 0903. 0998. 0999. PREMIUMS, CONSIDERATIONS AND DEPOSITS Premiums, considerations and deposits from Schedule T or Exhibit of Premiums and Losses Premiums, considerations and deposits NOT reported in Schedule T or Exhibit of Premiums and Losses, including investment contract receipts credited to a liability account 2.1 Contract fees for variable contracts with guarantees 2.2 Any other premiums, considerations and deposits not reported in Schedule T or Exhibit of Premiums and Losses Amounts, if applicable, that were deducted prior to determining amounts included in Lines 1 or 2 which are in the following categories: 3.1 Transfers to guaranteed Separate Accounts 3.2 Roll over of GICs or annuities into other companies 3.3 Surrenders or other benefits paid out 3.4 Excess interest credited to accounts 3.5 Aggregate write-ins for other amounts deducted prior to determining amounts included in Lines 1 or 2 3.99 Total (Lines 3.1 through 3.5) Transfers: 4.1 Enter in Column 2, as a negative number, and Column 4, as a positive number, the total of all amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, that are included in Column 2, Lines 1, 2 and 3.99 4.2 Enter in Column 2, as a positive number, and Column 4, as a negative number, any amounts reported in Column 4, Lines 1, 2 and 3.99 that are allocated. (Note: amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, should not be included in line 4.2) 4.3 Enter in Column 4, as a positive number, and Column 2, as a negative number, any amounts reported in Column 2, Lines 1, 2 and 3.99 that are unallocated 4.99 Total (Lines 4.1 + 4.2 + 4.3) Total (Lines 1 + 2 + 3.99 + 4.99) 1 2 3 Life Insurance Premiums Annuity Considerations A & H Premiums 4 Deposit-Type Contract Funds and Other Considerations 764,059 0 599,296,697 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 764,059 0 599,296,697 DEVELOPMENT OF AMOUNTS INCLUDED IN LINES 1 THROUGH 5 THAT SHOULD BE DEDUCTED IN DETERMINING THE BASE Do not include any amount more than once in Lines 6 through 9 Aggregate write-ins for amounts where the insurer is not subject to risk. Premiums for portions of policies or contracts NOT guaranteed or under which the entire investment risk is borne by the policyholder. (Please specify such deductions and indicate where such amounts were reported in the Annual Statement) Amounts NOT allocated to individuals or individual certificate holders or amounts received for such contracts in excess of limits: 7.1 Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans 7.2 Unallocated funding obligations that fund any employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation 7.3 Unallocated funding obligations that fund governmental lotteries or employee, union, or association of natural persons benefit plans in excess of $5 million per contract which are NOT: (a) government retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation 7.4 Total (Lines 7.1 + 7.2 + 7.3) Dividends/Experience rating credits paid or credited, but only if NOT guaranteed in advance (include only amounts NOT already deducted in determining Lines 1 and 2) Aggregate write-ins for Other Deductions Total (Lines 6 + 7.4 + 8 + 9) Current Year DETAILS OF WRITE-INS 0 0 0 0 0 0 0 XXX XXX XXX 0 XXX XXX XXX 0 XXX XXX XXX XXX XXX XXX 0 0 0 0 0 0 410,461,182 410,461,182 0 0 0 0 188,835,515 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 764,059 Summary of remaining write-ins for Line 3.5 from overflow page Totals (Lines 3.501 thru 3.503 plus 3.598)(Line 3.5 above) 0 0 0 0 0 0 0 0 Summary of remaining write-ins for Line 6 from overflow page Totals (Lines 0601 thru 0603 plus 0698)(Line 6 above) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 406,439,803 4,021,379 0 0 410,461,182 0 0 0 0 0 0 0 Medicare Part C & D Stop Loss Medicaid Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.NM *79413201830032100* ADJUSTMENTS TO THE LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: New Mexico 1 2 Allocated Annuity and Other Allocated Fund Deposits Life Insurance Premiums 4 Unallocated Annuity & Other Unallocated Fund Deposits Accident & Health Premium 764,059 0 188,835,515 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. MODEL ACT BASE ( Line 11 of the Reconciliation Exhibit) 2. Enter in Column 2, as a positive number, and Column 4, as a negative number, the total of all amounts received to fund allocated contracts established under Section 403(b) of the U.S. Internal Revenue Code that are included in Column 4, Line 1 above 3. Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans: 4. 3 0 XXX 0 XXX 0 3.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 3.2 All amounts XXX XXX XXX 0 0 4.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 0 4.2 Amounts in excess of $1 million but NOT in excess of $5 million per contract XXX XXX XXX 4.3 Amounts in excess of $5 million per contract XXX XXX XXX 4.4 Total (Lines 4.1 + 4.2 + 4.3) XXX XXX XXX 4.5 Amounts up to $7.5 million, per contract (Minnesota only) XXX XXX XXX 0 0 0 0 5.1 Amounts in excess of $1 million per contract XXX XXX XXX 5.2 All amounts XXX XXX XXX 5.3 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 5.4 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 6.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 6.2 Amounts in excess of $1 million per contract XXX XXX XXX 6.3 Total (Lines 6.1 + 6.2) XXX XXX XXX 6.4 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 6.5 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 7.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 7.2 All amounts XXX XXX XXX Unallocated funding obligations issued to fund government lotteries or employee, union, or association of natural persons benefit plans which are NOT: (a) governmental retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation: 5. 6. 7. Unallocated funding obligations issued to fund governmental retirement plans established under Sections 401 and 457 of the U.S. Internal Revenue Code: 0 0 0 0 Unallocated funding obligations issued to fund governmental retirement plans established under Sections 403(b) of the U.S. Internal Revenue Code: 0 0 0 0 0 Unallocated funding obligations that fund employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation: 7.3 Amounts NOT in excess of $2 million per contract (New Jersey only) XXX XXX XXX 0 0 0 8. Unallocated funding obligations issued to fund government lotteries NOT in excess of $5 million per contractholder (New Jersey Only) XXX XXX XXX 0 9. Unallocated funding obligations that fund employee or association of natural persons benefit plans in excess of $2 million but NOT in excess of $5 million per contract (New Jersey Only) XXX 10. Aggregate write-ins for other deductions 0 0 0 0 0 764,059 0 188,835,515 0 0 0 0 0 0 0 0 0 XXX XXX BASE 11. Current Year (2018) DETAILS OF WRITE-INS 1001. 1002. 1003. 1098. Summary of remaining write-ins for Line 10 from overflow page 1099. Totals (Lines 1001 thru 1003 plus 1098)(Line 10 above) 300.NM *79413201829033100* LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: New York 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 3.501. 3.502. 3.503. 3.598. 3.599. 0601. 0602. 0603. 0698. 0699. 0901. 0902. 0903. 0998. 0999. PREMIUMS, CONSIDERATIONS AND DEPOSITS Premiums, considerations and deposits from Schedule T or Exhibit of Premiums and Losses Premiums, considerations and deposits NOT reported in Schedule T or Exhibit of Premiums and Losses, including investment contract receipts credited to a liability account 2.1 Contract fees for variable contracts with guarantees 2.2 Any other premiums, considerations and deposits not reported in Schedule T or Exhibit of Premiums and Losses Amounts, if applicable, that were deducted prior to determining amounts included in Lines 1 or 2 which are in the following categories: 3.1 Transfers to guaranteed Separate Accounts 3.2 Roll over of GICs or annuities into other companies 3.3 Surrenders or other benefits paid out 3.4 Excess interest credited to accounts 3.5 Aggregate write-ins for other amounts deducted prior to determining amounts included in Lines 1 or 2 3.99 Total (Lines 3.1 through 3.5) Transfers: 4.1 Enter in Column 2, as a negative number, and Column 4, as a positive number, the total of all amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, that are included in Column 2, Lines 1, 2 and 3.99 4.2 Enter in Column 2, as a positive number, and Column 4, as a negative number, any amounts reported in Column 4, Lines 1, 2 and 3.99 that are allocated. (Note: amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, should not be included in line 4.2) 4.3 Enter in Column 4, as a positive number, and Column 2, as a negative number, any amounts reported in Column 2, Lines 1, 2 and 3.99 that are unallocated 4.99 Total (Lines 4.1 + 4.2 + 4.3) Total (Lines 1 + 2 + 3.99 + 4.99) 1 2 3 Life Insurance Premiums Annuity Considerations A & H Premiums 4 Deposit-Type Contract Funds and Other Considerations 2,812,830 0 282,183,490 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,812,830 0 282,183,490 DEVELOPMENT OF AMOUNTS INCLUDED IN LINES 1 THROUGH 5 THAT SHOULD BE DEDUCTED IN DETERMINING THE BASE Do not include any amount more than once in Lines 6 through 9 Aggregate write-ins for amounts where the insurer is not subject to risk. Premiums for portions of policies or contracts NOT guaranteed or under which the entire investment risk is borne by the policyholder. (Please specify such deductions and indicate where such amounts were reported in the Annual Statement) Amounts NOT allocated to individuals or individual certificate holders or amounts received for such contracts in excess of limits: 7.1 Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans 7.2 Unallocated funding obligations that fund any employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation 7.3 Unallocated funding obligations that fund governmental lotteries or employee, union, or association of natural persons benefit plans in excess of $5 million per contract which are NOT: (a) government retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation 7.4 Total (Lines 7.1 + 7.2 + 7.3) Dividends/Experience rating credits paid or credited, but only if NOT guaranteed in advance (include only amounts NOT already deducted in determining Lines 1 and 2) Aggregate write-ins for Other Deductions Total (Lines 6 + 7.4 + 8 + 9) Current Year DETAILS OF WRITE-INS 0 0 0 0 0 0 0 XXX XXX XXX 0 XXX XXX XXX 0 XXX XXX XXX XXX XXX XXX 0 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 2,812,830 0 0 0 0 11,158,966 11,158,966 0 0 0 0 271,024,524 0 Summary of remaining write-ins for Line 3.5 from overflow page Totals (Lines 3.501 thru 3.503 plus 3.598)(Line 3.5 above) 0 0 0 0 0 0 0 0 Summary of remaining write-ins for Line 6 from overflow page Totals (Lines 0601 thru 0603 plus 0698)(Line 6 above) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 11,158,966 0 0 11,158,966 0 0 0 0 0 0 0 Medicare Part C & D Stop Loss Medicaid Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.NY *79413201830033100* ADJUSTMENTS TO THE LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: New York 1 2 Allocated Annuity and Other Allocated Fund Deposits Life Insurance Premiums 4 Unallocated Annuity & Other Unallocated Fund Deposits Accident & Health Premium 2,812,830 0 271,024,524 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. MODEL ACT BASE ( Line 11 of the Reconciliation Exhibit) 2. Enter in Column 2, as a positive number, and Column 4, as a negative number, the total of all amounts received to fund allocated contracts established under Section 403(b) of the U.S. Internal Revenue Code that are included in Column 4, Line 1 above 3. Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans: 4. 3 0 XXX 0 XXX 0 3.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 3.2 All amounts XXX XXX XXX 0 0 4.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 0 4.2 Amounts in excess of $1 million but NOT in excess of $5 million per contract XXX XXX XXX 4.3 Amounts in excess of $5 million per contract XXX XXX XXX 4.4 Total (Lines 4.1 + 4.2 + 4.3) XXX XXX XXX 4.5 Amounts up to $7.5 million, per contract (Minnesota only) XXX XXX XXX 0 0 0 0 5.1 Amounts in excess of $1 million per contract XXX XXX XXX 5.2 All amounts XXX XXX XXX 5.3 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 5.4 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 6.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 6.2 Amounts in excess of $1 million per contract XXX XXX XXX 6.3 Total (Lines 6.1 + 6.2) XXX XXX XXX 6.4 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 6.5 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 7.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 7.2 All amounts XXX XXX XXX Unallocated funding obligations issued to fund government lotteries or employee, union, or association of natural persons benefit plans which are NOT: (a) governmental retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation: 5. 6. 7. Unallocated funding obligations issued to fund governmental retirement plans established under Sections 401 and 457 of the U.S. Internal Revenue Code: 0 0 0 0 Unallocated funding obligations issued to fund governmental retirement plans established under Sections 403(b) of the U.S. Internal Revenue Code: 0 0 0 0 0 Unallocated funding obligations that fund employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation: 7.3 Amounts NOT in excess of $2 million per contract (New Jersey only) XXX XXX XXX 0 0 0 8. Unallocated funding obligations issued to fund government lotteries NOT in excess of $5 million per contractholder (New Jersey Only) XXX XXX XXX 0 9. Unallocated funding obligations that fund employee or association of natural persons benefit plans in excess of $2 million but NOT in excess of $5 million per contract (New Jersey Only) XXX 10. Aggregate write-ins for other deductions 0 0 0 0 0 2,812,830 0 271,024,524 0 0 0 0 0 0 0 0 0 XXX XXX BASE 11. Current Year (2018) DETAILS OF WRITE-INS 1001. 1002. 1003. 1098. Summary of remaining write-ins for Line 10 from overflow page 1099. Totals (Lines 1001 thru 1003 plus 1098)(Line 10 above) 300.NY *79413201829034100* LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: North Carolina 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 3.501. 3.502. 3.503. 3.598. 3.599. 0601. 0602. 0603. 0698. 0699. 0901. 0902. 0903. 0998. 0999. PREMIUMS, CONSIDERATIONS AND DEPOSITS Premiums, considerations and deposits from Schedule T or Exhibit of Premiums and Losses Premiums, considerations and deposits NOT reported in Schedule T or Exhibit of Premiums and Losses, including investment contract receipts credited to a liability account 2.1 Contract fees for variable contracts with guarantees 2.2 Any other premiums, considerations and deposits not reported in Schedule T or Exhibit of Premiums and Losses Amounts, if applicable, that were deducted prior to determining amounts included in Lines 1 or 2 which are in the following categories: 3.1 Transfers to guaranteed Separate Accounts 3.2 Roll over of GICs or annuities into other companies 3.3 Surrenders or other benefits paid out 3.4 Excess interest credited to accounts 3.5 Aggregate write-ins for other amounts deducted prior to determining amounts included in Lines 1 or 2 3.99 Total (Lines 3.1 through 3.5) Transfers: 4.1 Enter in Column 2, as a negative number, and Column 4, as a positive number, the total of all amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, that are included in Column 2, Lines 1, 2 and 3.99 4.2 Enter in Column 2, as a positive number, and Column 4, as a negative number, any amounts reported in Column 4, Lines 1, 2 and 3.99 that are allocated. (Note: amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, should not be included in line 4.2) 4.3 Enter in Column 4, as a positive number, and Column 2, as a negative number, any amounts reported in Column 2, Lines 1, 2 and 3.99 that are unallocated 4.99 Total (Lines 4.1 + 4.2 + 4.3) Total (Lines 1 + 2 + 3.99 + 4.99) 1 2 3 Life Insurance Premiums Annuity Considerations A & H Premiums 4 Deposit-Type Contract Funds and Other Considerations 8,825,738 0 1,546,880,952 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8,825,738 0 1,546,880,952 DEVELOPMENT OF AMOUNTS INCLUDED IN LINES 1 THROUGH 5 THAT SHOULD BE DEDUCTED IN DETERMINING THE BASE Do not include any amount more than once in Lines 6 through 9 Aggregate write-ins for amounts where the insurer is not subject to risk. Premiums for portions of policies or contracts NOT guaranteed or under which the entire investment risk is borne by the policyholder. (Please specify such deductions and indicate where such amounts were reported in the Annual Statement) Amounts NOT allocated to individuals or individual certificate holders or amounts received for such contracts in excess of limits: 7.1 Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans 7.2 Unallocated funding obligations that fund any employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation 7.3 Unallocated funding obligations that fund governmental lotteries or employee, union, or association of natural persons benefit plans in excess of $5 million per contract which are NOT: (a) government retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation 7.4 Total (Lines 7.1 + 7.2 + 7.3) Dividends/Experience rating credits paid or credited, but only if NOT guaranteed in advance (include only amounts NOT already deducted in determining Lines 1 and 2) Aggregate write-ins for Other Deductions Total (Lines 6 + 7.4 + 8 + 9) Current Year DETAILS OF WRITE-INS 0 0 0 0 0 0 0 XXX XXX XXX 0 XXX XXX XXX 0 XXX XXX XXX XXX XXX XXX 0 0 0 0 0 0 316,759,444 316,759,444 0 0 0 0 1,230,121,508 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 8,825,738 Summary of remaining write-ins for Line 3.5 from overflow page Totals (Lines 3.501 thru 3.503 plus 3.598)(Line 3.5 above) 0 0 0 0 0 0 0 0 Summary of remaining write-ins for Line 6 from overflow page Totals (Lines 0601 thru 0603 plus 0698)(Line 6 above) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 301,073,824 15,685,620 0 0 316,759,444 0 0 0 0 0 0 0 Medicare Part C & D Stop Loss Medicaid Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.NC *79413201829035100* LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: North Dakota 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 3.501. 3.502. 3.503. 3.598. 3.599. 0601. 0602. 0603. 0698. 0699. 0901. 0902. 0903. 0998. 0999. PREMIUMS, CONSIDERATIONS AND DEPOSITS Premiums, considerations and deposits from Schedule T or Exhibit of Premiums and Losses Premiums, considerations and deposits NOT reported in Schedule T or Exhibit of Premiums and Losses, including investment contract receipts credited to a liability account 2.1 Contract fees for variable contracts with guarantees 2.2 Any other premiums, considerations and deposits not reported in Schedule T or Exhibit of Premiums and Losses Amounts, if applicable, that were deducted prior to determining amounts included in Lines 1 or 2 which are in the following categories: 3.1 Transfers to guaranteed Separate Accounts 3.2 Roll over of GICs or annuities into other companies 3.3 Surrenders or other benefits paid out 3.4 Excess interest credited to accounts 3.5 Aggregate write-ins for other amounts deducted prior to determining amounts included in Lines 1 or 2 3.99 Total (Lines 3.1 through 3.5) Transfers: 4.1 Enter in Column 2, as a negative number, and Column 4, as a positive number, the total of all amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, that are included in Column 2, Lines 1, 2 and 3.99 4.2 Enter in Column 2, as a positive number, and Column 4, as a negative number, any amounts reported in Column 4, Lines 1, 2 and 3.99 that are allocated. (Note: amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, should not be included in line 4.2) 4.3 Enter in Column 4, as a positive number, and Column 2, as a negative number, any amounts reported in Column 2, Lines 1, 2 and 3.99 that are unallocated 4.99 Total (Lines 4.1 + 4.2 + 4.3) Total (Lines 1 + 2 + 3.99 + 4.99) 1 2 3 Life Insurance Premiums Annuity Considerations A & H Premiums 4 Deposit-Type Contract Funds and Other Considerations 58,073 0 23,219,349 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 58,073 0 23,219,349 DEVELOPMENT OF AMOUNTS INCLUDED IN LINES 1 THROUGH 5 THAT SHOULD BE DEDUCTED IN DETERMINING THE BASE Do not include any amount more than once in Lines 6 through 9 Aggregate write-ins for amounts where the insurer is not subject to risk. Premiums for portions of policies or contracts NOT guaranteed or under which the entire investment risk is borne by the policyholder. (Please specify such deductions and indicate where such amounts were reported in the Annual Statement) Amounts NOT allocated to individuals or individual certificate holders or amounts received for such contracts in excess of limits: 7.1 Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans 7.2 Unallocated funding obligations that fund any employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation 7.3 Unallocated funding obligations that fund governmental lotteries or employee, union, or association of natural persons benefit plans in excess of $5 million per contract which are NOT: (a) government retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation 7.4 Total (Lines 7.1 + 7.2 + 7.3) Dividends/Experience rating credits paid or credited, but only if NOT guaranteed in advance (include only amounts NOT already deducted in determining Lines 1 and 2) Aggregate write-ins for Other Deductions Total (Lines 6 + 7.4 + 8 + 9) Current Year DETAILS OF WRITE-INS 0 0 0 0 0 0 0 XXX XXX XXX 0 XXX XXX XXX 0 XXX XXX XXX XXX XXX XXX 0 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 58,073 0 0 0 0 3,448,273 3,448,273 0 0 0 0 19,771,076 0 Summary of remaining write-ins for Line 3.5 from overflow page Totals (Lines 3.501 thru 3.503 plus 3.598)(Line 3.5 above) 0 0 0 0 0 0 0 0 Summary of remaining write-ins for Line 6 from overflow page Totals (Lines 0601 thru 0603 plus 0698)(Line 6 above) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3,128,675 319,598 0 0 3,448,273 0 0 0 0 0 0 0 Medicare Part C & D Stop Loss Medicaid Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.ND *79413201830035100* ADJUSTMENTS TO THE LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: North Dakota 1 2 Allocated Annuity and Other Allocated Fund Deposits Life Insurance Premiums MODEL ACT BASE ( Line 11 of the Reconciliation Exhibit) 2. Enter in Column 2, as a positive number, and Column 4, as a negative number, the total of all amounts received to fund allocated contracts established under Section 403(b) of the U.S. Internal Revenue Code that are included in Column 4, Line 1 above 3. Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans: 0 XXX 4 Unallocated Annuity & Other Unallocated Fund Deposits Accident & Health Premium 58,073 0 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. 4. 3 19,771,076 0 XXX 0 3.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 3.2 All amounts XXX XXX XXX 0 0 4.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 0 4.2 Amounts in excess of $1 million but NOT in excess of $5 million per contract XXX XXX XXX 4.3 Amounts in excess of $5 million per contract XXX XXX XXX 4.4 Total (Lines 4.1 + 4.2 + 4.3) XXX XXX XXX 4.5 Amounts up to $7.5 million, per contract (Minnesota only) XXX XXX XXX 0 0 0 0 5.1 Amounts in excess of $1 million per contract XXX XXX XXX 5.2 All amounts XXX XXX XXX 5.3 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 5.4 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 6.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 6.2 Amounts in excess of $1 million per contract XXX XXX XXX 6.3 Total (Lines 6.1 + 6.2) XXX XXX XXX 6.4 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 6.5 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 7.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 7.2 All amounts XXX XXX XXX Unallocated funding obligations issued to fund government lotteries or employee, union, or association of natural persons benefit plans which are NOT: (a) governmental retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation: 5. 6. 7. Unallocated funding obligations issued to fund governmental retirement plans established under Sections 401 and 457 of the U.S. Internal Revenue Code: 0 0 0 0 Unallocated funding obligations issued to fund governmental retirement plans established under Sections 403(b) of the U.S. Internal Revenue Code: 0 0 0 0 0 Unallocated funding obligations that fund employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation: 7.3 Amounts NOT in excess of $2 million per contract (New Jersey only) XXX XXX XXX 0 0 0 8. Unallocated funding obligations issued to fund government lotteries NOT in excess of $5 million per contractholder (New Jersey Only) XXX XXX XXX 0 9. Unallocated funding obligations that fund employee or association of natural persons benefit plans in excess of $2 million but NOT in excess of $5 million per contract (New Jersey Only) XXX 10. Aggregate write-ins for other deductions 0 0 0 0 0 58,073 0 19,771,076 0 0 0 0 0 0 0 0 0 XXX XXX BASE 11. Current Year (2018) DETAILS OF WRITE-INS 1001. 1002. 1003. 1098. Summary of remaining write-ins for Line 10 from overflow page 1099. Totals (Lines 1001 thru 1003 plus 1098)(Line 10 above) 300.ND *79413201829036100* LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Ohio 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 3.501. 3.502. 3.503. 3.598. 3.599. 0601. 0602. 0603. 0698. 0699. 0901. 0902. 0903. 0998. 0999. PREMIUMS, CONSIDERATIONS AND DEPOSITS Premiums, considerations and deposits from Schedule T or Exhibit of Premiums and Losses Premiums, considerations and deposits NOT reported in Schedule T or Exhibit of Premiums and Losses, including investment contract receipts credited to a liability account 2.1 Contract fees for variable contracts with guarantees 2.2 Any other premiums, considerations and deposits not reported in Schedule T or Exhibit of Premiums and Losses Amounts, if applicable, that were deducted prior to determining amounts included in Lines 1 or 2 which are in the following categories: 3.1 Transfers to guaranteed Separate Accounts 3.2 Roll over of GICs or annuities into other companies 3.3 Surrenders or other benefits paid out 3.4 Excess interest credited to accounts 3.5 Aggregate write-ins for other amounts deducted prior to determining amounts included in Lines 1 or 2 3.99 Total (Lines 3.1 through 3.5) Transfers: 4.1 Enter in Column 2, as a negative number, and Column 4, as a positive number, the total of all amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, that are included in Column 2, Lines 1, 2 and 3.99 4.2 Enter in Column 2, as a positive number, and Column 4, as a negative number, any amounts reported in Column 4, Lines 1, 2 and 3.99 that are allocated. (Note: amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, should not be included in line 4.2) 4.3 Enter in Column 4, as a positive number, and Column 2, as a negative number, any amounts reported in Column 2, Lines 1, 2 and 3.99 that are unallocated 4.99 Total (Lines 4.1 + 4.2 + 4.3) Total (Lines 1 + 2 + 3.99 + 4.99) 1 2 3 Life Insurance Premiums Annuity Considerations A & H Premiums 4 Deposit-Type Contract Funds and Other Considerations 4,513,163 0 1,557,897,332 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4,513,163 0 1,557,897,332 DEVELOPMENT OF AMOUNTS INCLUDED IN LINES 1 THROUGH 5 THAT SHOULD BE DEDUCTED IN DETERMINING THE BASE Do not include any amount more than once in Lines 6 through 9 Aggregate write-ins for amounts where the insurer is not subject to risk. Premiums for portions of policies or contracts NOT guaranteed or under which the entire investment risk is borne by the policyholder. (Please specify such deductions and indicate where such amounts were reported in the Annual Statement) Amounts NOT allocated to individuals or individual certificate holders or amounts received for such contracts in excess of limits: 7.1 Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans 7.2 Unallocated funding obligations that fund any employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation 7.3 Unallocated funding obligations that fund governmental lotteries or employee, union, or association of natural persons benefit plans in excess of $5 million per contract which are NOT: (a) government retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation 7.4 Total (Lines 7.1 + 7.2 + 7.3) Dividends/Experience rating credits paid or credited, but only if NOT guaranteed in advance (include only amounts NOT already deducted in determining Lines 1 and 2) Aggregate write-ins for Other Deductions Total (Lines 6 + 7.4 + 8 + 9) Current Year DETAILS OF WRITE-INS 0 0 0 0 0 0 0 XXX XXX XXX 0 XXX XXX XXX 0 XXX XXX XXX XXX XXX XXX 0 0 0 0 0 0 210,827,091 210,827,091 0 0 0 0 1,347,070,241 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 4,513,163 Summary of remaining write-ins for Line 3.5 from overflow page Totals (Lines 3.501 thru 3.503 plus 3.598)(Line 3.5 above) 0 0 0 0 0 0 0 0 Summary of remaining write-ins for Line 6 from overflow page Totals (Lines 0601 thru 0603 plus 0698)(Line 6 above) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 156,375,228 54,451,863 0 0 210,827,091 0 0 0 0 0 0 0 Medicare Part C & D Stop Loss Medicaid Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.OH *79413201830036100* ADJUSTMENTS TO THE LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Ohio 1 2 Allocated Annuity and Other Allocated Fund Deposits Life Insurance Premiums 4 Unallocated Annuity & Other Unallocated Fund Deposits Accident & Health Premium 4,513,163 0 1,347,070,241 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. MODEL ACT BASE ( Line 11 of the Reconciliation Exhibit) 2. Enter in Column 2, as a positive number, and Column 4, as a negative number, the total of all amounts received to fund allocated contracts established under Section 403(b) of the U.S. Internal Revenue Code that are included in Column 4, Line 1 above 3. Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans: 4. 3 0 XXX 0 XXX 0 3.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 3.2 All amounts XXX XXX XXX 0 0 4.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 0 4.2 Amounts in excess of $1 million but NOT in excess of $5 million per contract XXX XXX XXX 4.3 Amounts in excess of $5 million per contract XXX XXX XXX 4.4 Total (Lines 4.1 + 4.2 + 4.3) XXX XXX XXX 4.5 Amounts up to $7.5 million, per contract (Minnesota only) XXX XXX XXX 0 0 0 0 5.1 Amounts in excess of $1 million per contract XXX XXX XXX 5.2 All amounts XXX XXX XXX 5.3 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 5.4 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 6.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 6.2 Amounts in excess of $1 million per contract XXX XXX XXX 6.3 Total (Lines 6.1 + 6.2) XXX XXX XXX 6.4 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 6.5 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 7.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 7.2 All amounts XXX XXX XXX Unallocated funding obligations issued to fund government lotteries or employee, union, or association of natural persons benefit plans which are NOT: (a) governmental retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation: 5. 6. 7. Unallocated funding obligations issued to fund governmental retirement plans established under Sections 401 and 457 of the U.S. Internal Revenue Code: 0 0 0 0 Unallocated funding obligations issued to fund governmental retirement plans established under Sections 403(b) of the U.S. Internal Revenue Code: 0 0 0 0 0 Unallocated funding obligations that fund employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation: 7.3 Amounts NOT in excess of $2 million per contract (New Jersey only) XXX XXX XXX 0 0 0 8. Unallocated funding obligations issued to fund government lotteries NOT in excess of $5 million per contractholder (New Jersey Only) XXX XXX XXX 0 9. Unallocated funding obligations that fund employee or association of natural persons benefit plans in excess of $2 million but NOT in excess of $5 million per contract (New Jersey Only) XXX 10. Aggregate write-ins for other deductions 0 0 0 0 0 4,513,163 0 1,347,070,241 0 0 0 0 0 0 0 0 0 XXX XXX BASE 11. Current Year (2018) DETAILS OF WRITE-INS 1001. 1002. 1003. 1098. Summary of remaining write-ins for Line 10 from overflow page 1099. Totals (Lines 1001 thru 1003 plus 1098)(Line 10 above) 300.OH *79413201829037100* LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Oklahoma 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 3.501. 3.502. 3.503. 3.598. 3.599. 0601. 0602. 0603. 0698. 0699. 0901. 0902. 0903. 0998. 0999. PREMIUMS, CONSIDERATIONS AND DEPOSITS Premiums, considerations and deposits from Schedule T or Exhibit of Premiums and Losses Premiums, considerations and deposits NOT reported in Schedule T or Exhibit of Premiums and Losses, including investment contract receipts credited to a liability account 2.1 Contract fees for variable contracts with guarantees 2.2 Any other premiums, considerations and deposits not reported in Schedule T or Exhibit of Premiums and Losses Amounts, if applicable, that were deducted prior to determining amounts included in Lines 1 or 2 which are in the following categories: 3.1 Transfers to guaranteed Separate Accounts 3.2 Roll over of GICs or annuities into other companies 3.3 Surrenders or other benefits paid out 3.4 Excess interest credited to accounts 3.5 Aggregate write-ins for other amounts deducted prior to determining amounts included in Lines 1 or 2 3.99 Total (Lines 3.1 through 3.5) Transfers: 4.1 Enter in Column 2, as a negative number, and Column 4, as a positive number, the total of all amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, that are included in Column 2, Lines 1, 2 and 3.99 4.2 Enter in Column 2, as a positive number, and Column 4, as a negative number, any amounts reported in Column 4, Lines 1, 2 and 3.99 that are allocated. (Note: amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, should not be included in line 4.2) 4.3 Enter in Column 4, as a positive number, and Column 2, as a negative number, any amounts reported in Column 2, Lines 1, 2 and 3.99 that are unallocated 4.99 Total (Lines 4.1 + 4.2 + 4.3) Total (Lines 1 + 2 + 3.99 + 4.99) 1 2 3 Life Insurance Premiums Annuity Considerations A & H Premiums 4 Deposit-Type Contract Funds and Other Considerations 1,468,344 0 513,262,138 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,468,344 0 513,262,138 DEVELOPMENT OF AMOUNTS INCLUDED IN LINES 1 THROUGH 5 THAT SHOULD BE DEDUCTED IN DETERMINING THE BASE Do not include any amount more than once in Lines 6 through 9 Aggregate write-ins for amounts where the insurer is not subject to risk. Premiums for portions of policies or contracts NOT guaranteed or under which the entire investment risk is borne by the policyholder. (Please specify such deductions and indicate where such amounts were reported in the Annual Statement) Amounts NOT allocated to individuals or individual certificate holders or amounts received for such contracts in excess of limits: 7.1 Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans 7.2 Unallocated funding obligations that fund any employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation 7.3 Unallocated funding obligations that fund governmental lotteries or employee, union, or association of natural persons benefit plans in excess of $5 million per contract which are NOT: (a) government retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation 7.4 Total (Lines 7.1 + 7.2 + 7.3) Dividends/Experience rating credits paid or credited, but only if NOT guaranteed in advance (include only amounts NOT already deducted in determining Lines 1 and 2) Aggregate write-ins for Other Deductions Total (Lines 6 + 7.4 + 8 + 9) Current Year DETAILS OF WRITE-INS 0 0 0 0 0 0 0 XXX XXX XXX 0 XXX XXX XXX 0 XXX XXX XXX XXX XXX XXX 0 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 1,468,344 0 0 0 0 48,026,487 48,026,487 0 0 0 0 465,235,651 0 Summary of remaining write-ins for Line 3.5 from overflow page Totals (Lines 3.501 thru 3.503 plus 3.598)(Line 3.5 above) 0 0 0 0 0 0 0 0 Summary of remaining write-ins for Line 6 from overflow page Totals (Lines 0601 thru 0603 plus 0698)(Line 6 above) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 42,766,844 5,259,643 0 0 48,026,487 0 0 0 0 0 0 0 Medicare Part C & D Stop Loss Medicaid Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.OK *79413201830037100* ADJUSTMENTS TO THE LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Oklahoma 1 2 Allocated Annuity and Other Allocated Fund Deposits Life Insurance Premiums 4 Unallocated Annuity & Other Unallocated Fund Deposits Accident & Health Premium 1,468,344 0 465,235,651 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. MODEL ACT BASE ( Line 11 of the Reconciliation Exhibit) 2. Enter in Column 2, as a positive number, and Column 4, as a negative number, the total of all amounts received to fund allocated contracts established under Section 403(b) of the U.S. Internal Revenue Code that are included in Column 4, Line 1 above 3. Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans: 4. 3 0 XXX 0 XXX 0 3.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 3.2 All amounts XXX XXX XXX 0 0 4.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 0 4.2 Amounts in excess of $1 million but NOT in excess of $5 million per contract XXX XXX XXX 4.3 Amounts in excess of $5 million per contract XXX XXX XXX 4.4 Total (Lines 4.1 + 4.2 + 4.3) XXX XXX XXX 4.5 Amounts up to $7.5 million, per contract (Minnesota only) XXX XXX XXX 0 0 0 0 5.1 Amounts in excess of $1 million per contract XXX XXX XXX 5.2 All amounts XXX XXX XXX 5.3 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 5.4 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 6.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 6.2 Amounts in excess of $1 million per contract XXX XXX XXX 6.3 Total (Lines 6.1 + 6.2) XXX XXX XXX 6.4 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 6.5 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 7.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 7.2 All amounts XXX XXX XXX Unallocated funding obligations issued to fund government lotteries or employee, union, or association of natural persons benefit plans which are NOT: (a) governmental retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation: 5. 6. 7. Unallocated funding obligations issued to fund governmental retirement plans established under Sections 401 and 457 of the U.S. Internal Revenue Code: 0 0 0 0 Unallocated funding obligations issued to fund governmental retirement plans established under Sections 403(b) of the U.S. Internal Revenue Code: 0 0 0 0 0 Unallocated funding obligations that fund employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation: 7.3 Amounts NOT in excess of $2 million per contract (New Jersey only) XXX XXX XXX 0 0 0 8. Unallocated funding obligations issued to fund government lotteries NOT in excess of $5 million per contractholder (New Jersey Only) XXX XXX XXX 0 9. Unallocated funding obligations that fund employee or association of natural persons benefit plans in excess of $2 million but NOT in excess of $5 million per contract (New Jersey Only) XXX 10. Aggregate write-ins for other deductions 0 0 0 0 0 1,468,344 0 465,235,651 0 0 0 0 0 0 0 0 0 XXX XXX BASE 11. Current Year (2018) DETAILS OF WRITE-INS 1001. 1002. 1003. 1098. Summary of remaining write-ins for Line 10 from overflow page 1099. Totals (Lines 1001 thru 1003 plus 1098)(Line 10 above) 300.OK *79413201829038100* LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Oregon 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 3.501. 3.502. 3.503. 3.598. 3.599. 0601. 0602. 0603. 0698. 0699. 0901. 0902. 0903. 0998. 0999. PREMIUMS, CONSIDERATIONS AND DEPOSITS Premiums, considerations and deposits from Schedule T or Exhibit of Premiums and Losses Premiums, considerations and deposits NOT reported in Schedule T or Exhibit of Premiums and Losses, including investment contract receipts credited to a liability account 2.1 Contract fees for variable contracts with guarantees 2.2 Any other premiums, considerations and deposits not reported in Schedule T or Exhibit of Premiums and Losses Amounts, if applicable, that were deducted prior to determining amounts included in Lines 1 or 2 which are in the following categories: 3.1 Transfers to guaranteed Separate Accounts 3.2 Roll over of GICs or annuities into other companies 3.3 Surrenders or other benefits paid out 3.4 Excess interest credited to accounts 3.5 Aggregate write-ins for other amounts deducted prior to determining amounts included in Lines 1 or 2 3.99 Total (Lines 3.1 through 3.5) Transfers: 4.1 Enter in Column 2, as a negative number, and Column 4, as a positive number, the total of all amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, that are included in Column 2, Lines 1, 2 and 3.99 4.2 Enter in Column 2, as a positive number, and Column 4, as a negative number, any amounts reported in Column 4, Lines 1, 2 and 3.99 that are allocated. (Note: amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, should not be included in line 4.2) 4.3 Enter in Column 4, as a positive number, and Column 2, as a negative number, any amounts reported in Column 2, Lines 1, 2 and 3.99 that are unallocated 4.99 Total (Lines 4.1 + 4.2 + 4.3) Total (Lines 1 + 2 + 3.99 + 4.99) 1 2 3 Life Insurance Premiums Annuity Considerations A & H Premiums 4 Deposit-Type Contract Funds and Other Considerations 548,708 0 567,446,401 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 548,708 0 567,446,401 DEVELOPMENT OF AMOUNTS INCLUDED IN LINES 1 THROUGH 5 THAT SHOULD BE DEDUCTED IN DETERMINING THE BASE Do not include any amount more than once in Lines 6 through 9 Aggregate write-ins for amounts where the insurer is not subject to risk. Premiums for portions of policies or contracts NOT guaranteed or under which the entire investment risk is borne by the policyholder. (Please specify such deductions and indicate where such amounts were reported in the Annual Statement) Amounts NOT allocated to individuals or individual certificate holders or amounts received for such contracts in excess of limits: 7.1 Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans 7.2 Unallocated funding obligations that fund any employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation 7.3 Unallocated funding obligations that fund governmental lotteries or employee, union, or association of natural persons benefit plans in excess of $5 million per contract which are NOT: (a) government retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation 7.4 Total (Lines 7.1 + 7.2 + 7.3) Dividends/Experience rating credits paid or credited, but only if NOT guaranteed in advance (include only amounts NOT already deducted in determining Lines 1 and 2) Aggregate write-ins for Other Deductions Total (Lines 6 + 7.4 + 8 + 9) Current Year DETAILS OF WRITE-INS 0 0 0 0 0 0 0 XXX XXX XXX 0 XXX XXX XXX 0 XXX XXX XXX XXX XXX XXX 0 0 0 0 0 0 193,464,498 193,464,498 0 0 0 0 373,981,903 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 548,708 Summary of remaining write-ins for Line 3.5 from overflow page Totals (Lines 3.501 thru 3.503 plus 3.598)(Line 3.5 above) 0 0 0 0 0 0 0 0 Summary of remaining write-ins for Line 6 from overflow page Totals (Lines 0601 thru 0603 plus 0698)(Line 6 above) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 183,330,254 10,134,244 0 0 193,464,498 0 0 0 0 0 0 0 Medicare Part C & D Stop Loss Medicaid Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.OR *79413201830038100* ADJUSTMENTS TO THE LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Oregon 1 2 Allocated Annuity and Other Allocated Fund Deposits Life Insurance Premiums 4 Unallocated Annuity & Other Unallocated Fund Deposits Accident & Health Premium 548,708 0 373,981,903 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. MODEL ACT BASE ( Line 11 of the Reconciliation Exhibit) 2. Enter in Column 2, as a positive number, and Column 4, as a negative number, the total of all amounts received to fund allocated contracts established under Section 403(b) of the U.S. Internal Revenue Code that are included in Column 4, Line 1 above 3. Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans: 4. 3 0 XXX 0 XXX 0 3.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 3.2 All amounts XXX XXX XXX 0 0 4.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 0 4.2 Amounts in excess of $1 million but NOT in excess of $5 million per contract XXX XXX XXX 4.3 Amounts in excess of $5 million per contract XXX XXX XXX 4.4 Total (Lines 4.1 + 4.2 + 4.3) XXX XXX XXX 4.5 Amounts up to $7.5 million, per contract (Minnesota only) XXX XXX XXX 0 0 0 0 5.1 Amounts in excess of $1 million per contract XXX XXX XXX 5.2 All amounts XXX XXX XXX 5.3 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 5.4 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 6.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 6.2 Amounts in excess of $1 million per contract XXX XXX XXX 6.3 Total (Lines 6.1 + 6.2) XXX XXX XXX 6.4 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 6.5 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 7.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 7.2 All amounts XXX XXX XXX Unallocated funding obligations issued to fund government lotteries or employee, union, or association of natural persons benefit plans which are NOT: (a) governmental retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation: 5. 6. 7. Unallocated funding obligations issued to fund governmental retirement plans established under Sections 401 and 457 of the U.S. Internal Revenue Code: 0 0 0 0 Unallocated funding obligations issued to fund governmental retirement plans established under Sections 403(b) of the U.S. Internal Revenue Code: 0 0 0 0 0 Unallocated funding obligations that fund employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation: 7.3 Amounts NOT in excess of $2 million per contract (New Jersey only) XXX XXX XXX 0 0 0 8. Unallocated funding obligations issued to fund government lotteries NOT in excess of $5 million per contractholder (New Jersey Only) XXX XXX XXX 0 9. Unallocated funding obligations that fund employee or association of natural persons benefit plans in excess of $2 million but NOT in excess of $5 million per contract (New Jersey Only) XXX 10. Aggregate write-ins for other deductions 0 0 0 0 0 548,708 0 373,981,903 0 0 0 0 0 0 0 0 0 XXX XXX BASE 11. Current Year (2018) DETAILS OF WRITE-INS 1001. 1002. 1003. 1098. Summary of remaining write-ins for Line 10 from overflow page 1099. Totals (Lines 1001 thru 1003 plus 1098)(Line 10 above) 300.OR *79413201829039100* LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Pennsylvania 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 3.501. 3.502. 3.503. 3.598. 3.599. 0601. 0602. 0603. 0698. 0699. 0901. 0902. 0903. 0998. 0999. PREMIUMS, CONSIDERATIONS AND DEPOSITS Premiums, considerations and deposits from Schedule T or Exhibit of Premiums and Losses Premiums, considerations and deposits NOT reported in Schedule T or Exhibit of Premiums and Losses, including investment contract receipts credited to a liability account 2.1 Contract fees for variable contracts with guarantees 2.2 Any other premiums, considerations and deposits not reported in Schedule T or Exhibit of Premiums and Losses Amounts, if applicable, that were deducted prior to determining amounts included in Lines 1 or 2 which are in the following categories: 3.1 Transfers to guaranteed Separate Accounts 3.2 Roll over of GICs or annuities into other companies 3.3 Surrenders or other benefits paid out 3.4 Excess interest credited to accounts 3.5 Aggregate write-ins for other amounts deducted prior to determining amounts included in Lines 1 or 2 3.99 Total (Lines 3.1 through 3.5) Transfers: 4.1 Enter in Column 2, as a negative number, and Column 4, as a positive number, the total of all amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, that are included in Column 2, Lines 1, 2 and 3.99 4.2 Enter in Column 2, as a positive number, and Column 4, as a negative number, any amounts reported in Column 4, Lines 1, 2 and 3.99 that are allocated. (Note: amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, should not be included in line 4.2) 4.3 Enter in Column 4, as a positive number, and Column 2, as a negative number, any amounts reported in Column 2, Lines 1, 2 and 3.99 that are unallocated 4.99 Total (Lines 4.1 + 4.2 + 4.3) Total (Lines 1 + 2 + 3.99 + 4.99) 1 2 3 Life Insurance Premiums Annuity Considerations A & H Premiums 4 Deposit-Type Contract Funds and Other Considerations 2,868,644 0 1,552,645,058 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,868,644 0 1,552,645,058 DEVELOPMENT OF AMOUNTS INCLUDED IN LINES 1 THROUGH 5 THAT SHOULD BE DEDUCTED IN DETERMINING THE BASE Do not include any amount more than once in Lines 6 through 9 Aggregate write-ins for amounts where the insurer is not subject to risk. Premiums for portions of policies or contracts NOT guaranteed or under which the entire investment risk is borne by the policyholder. (Please specify such deductions and indicate where such amounts were reported in the Annual Statement) Amounts NOT allocated to individuals or individual certificate holders or amounts received for such contracts in excess of limits: 7.1 Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans 7.2 Unallocated funding obligations that fund any employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation 7.3 Unallocated funding obligations that fund governmental lotteries or employee, union, or association of natural persons benefit plans in excess of $5 million per contract which are NOT: (a) government retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation 7.4 Total (Lines 7.1 + 7.2 + 7.3) Dividends/Experience rating credits paid or credited, but only if NOT guaranteed in advance (include only amounts NOT already deducted in determining Lines 1 and 2) Aggregate write-ins for Other Deductions Total (Lines 6 + 7.4 + 8 + 9) Current Year DETAILS OF WRITE-INS 0 0 0 0 0 0 0 XXX XXX XXX 0 XXX XXX XXX 0 XXX XXX XXX XXX XXX XXX 0 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 2,868,644 0 0 0 0 13,472,417 13,472,417 0 0 0 0 1,539,172,641 0 Summary of remaining write-ins for Line 3.5 from overflow page Totals (Lines 3.501 thru 3.503 plus 3.598)(Line 3.5 above) 0 0 0 0 0 0 0 0 Summary of remaining write-ins for Line 6 from overflow page Totals (Lines 0601 thru 0603 plus 0698)(Line 6 above) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 13,472,417 0 0 13,472,417 0 0 0 0 0 0 0 Medicare Part C & D Stop Loss Medicaid Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.PA *79413201829040100* LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Rhode Island 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 3.501. 3.502. 3.503. 3.598. 3.599. 0601. 0602. 0603. 0698. 0699. 0901. 0902. 0903. 0998. 0999. PREMIUMS, CONSIDERATIONS AND DEPOSITS Premiums, considerations and deposits from Schedule T or Exhibit of Premiums and Losses Premiums, considerations and deposits NOT reported in Schedule T or Exhibit of Premiums and Losses, including investment contract receipts credited to a liability account 2.1 Contract fees for variable contracts with guarantees 2.2 Any other premiums, considerations and deposits not reported in Schedule T or Exhibit of Premiums and Losses Amounts, if applicable, that were deducted prior to determining amounts included in Lines 1 or 2 which are in the following categories: 3.1 Transfers to guaranteed Separate Accounts 3.2 Roll over of GICs or annuities into other companies 3.3 Surrenders or other benefits paid out 3.4 Excess interest credited to accounts 3.5 Aggregate write-ins for other amounts deducted prior to determining amounts included in Lines 1 or 2 3.99 Total (Lines 3.1 through 3.5) Transfers: 4.1 Enter in Column 2, as a negative number, and Column 4, as a positive number, the total of all amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, that are included in Column 2, Lines 1, 2 and 3.99 4.2 Enter in Column 2, as a positive number, and Column 4, as a negative number, any amounts reported in Column 4, Lines 1, 2 and 3.99 that are allocated. (Note: amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, should not be included in line 4.2) 4.3 Enter in Column 4, as a positive number, and Column 2, as a negative number, any amounts reported in Column 2, Lines 1, 2 and 3.99 that are unallocated 4.99 Total (Lines 4.1 + 4.2 + 4.3) Total (Lines 1 + 2 + 3.99 + 4.99) 1 2 3 Life Insurance Premiums Annuity Considerations A & H Premiums 4 Deposit-Type Contract Funds and Other Considerations 381,884 0 283,574,917 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 381,884 0 283,574,917 DEVELOPMENT OF AMOUNTS INCLUDED IN LINES 1 THROUGH 5 THAT SHOULD BE DEDUCTED IN DETERMINING THE BASE Do not include any amount more than once in Lines 6 through 9 Aggregate write-ins for amounts where the insurer is not subject to risk. Premiums for portions of policies or contracts NOT guaranteed or under which the entire investment risk is borne by the policyholder. (Please specify such deductions and indicate where such amounts were reported in the Annual Statement) Amounts NOT allocated to individuals or individual certificate holders or amounts received for such contracts in excess of limits: 7.1 Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans 7.2 Unallocated funding obligations that fund any employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation 7.3 Unallocated funding obligations that fund governmental lotteries or employee, union, or association of natural persons benefit plans in excess of $5 million per contract which are NOT: (a) government retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation 7.4 Total (Lines 7.1 + 7.2 + 7.3) Dividends/Experience rating credits paid or credited, but only if NOT guaranteed in advance (include only amounts NOT already deducted in determining Lines 1 and 2) Aggregate write-ins for Other Deductions Total (Lines 6 + 7.4 + 8 + 9) Current Year DETAILS OF WRITE-INS 0 0 0 0 0 0 0 XXX XXX XXX 0 XXX XXX XXX 0 XXX XXX XXX XXX XXX XXX 0 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 381,884 0 0 0 0 82,497,208 82,497,208 0 0 0 0 201,077,709 0 Summary of remaining write-ins for Line 3.5 from overflow page Totals (Lines 3.501 thru 3.503 plus 3.598)(Line 3.5 above) 0 0 0 0 0 0 0 0 Summary of remaining write-ins for Line 6 from overflow page Totals (Lines 0601 thru 0603 plus 0698)(Line 6 above) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 73,019,920 9,477,288 0 0 82,497,208 0 0 0 0 0 0 0 Medicare Part C & D Stop Loss Medicaid Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.RI *79413201830040100* ADJUSTMENTS TO THE LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Rhode Island 1 2 Allocated Annuity and Other Allocated Fund Deposits Life Insurance Premiums 4 Unallocated Annuity & Other Unallocated Fund Deposits Accident & Health Premium 381,884 0 201,077,709 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. MODEL ACT BASE ( Line 11 of the Reconciliation Exhibit) 2. Enter in Column 2, as a positive number, and Column 4, as a negative number, the total of all amounts received to fund allocated contracts established under Section 403(b) of the U.S. Internal Revenue Code that are included in Column 4, Line 1 above 3. Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans: 4. 3 0 XXX 0 XXX 0 3.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 3.2 All amounts XXX XXX XXX 0 0 4.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 0 4.2 Amounts in excess of $1 million but NOT in excess of $5 million per contract XXX XXX XXX 4.3 Amounts in excess of $5 million per contract XXX XXX XXX 4.4 Total (Lines 4.1 + 4.2 + 4.3) XXX XXX XXX 4.5 Amounts up to $7.5 million, per contract (Minnesota only) XXX XXX XXX 0 0 0 0 5.1 Amounts in excess of $1 million per contract XXX XXX XXX 5.2 All amounts XXX XXX XXX 5.3 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 5.4 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 6.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 6.2 Amounts in excess of $1 million per contract XXX XXX XXX 6.3 Total (Lines 6.1 + 6.2) XXX XXX XXX 6.4 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 6.5 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 7.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 7.2 All amounts XXX XXX XXX Unallocated funding obligations issued to fund government lotteries or employee, union, or association of natural persons benefit plans which are NOT: (a) governmental retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation: 5. 6. 7. Unallocated funding obligations issued to fund governmental retirement plans established under Sections 401 and 457 of the U.S. Internal Revenue Code: 0 0 0 0 Unallocated funding obligations issued to fund governmental retirement plans established under Sections 403(b) of the U.S. Internal Revenue Code: 0 0 0 0 0 Unallocated funding obligations that fund employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation: 7.3 Amounts NOT in excess of $2 million per contract (New Jersey only) XXX XXX XXX 0 0 0 8. Unallocated funding obligations issued to fund government lotteries NOT in excess of $5 million per contractholder (New Jersey Only) XXX XXX XXX 0 9. Unallocated funding obligations that fund employee or association of natural persons benefit plans in excess of $2 million but NOT in excess of $5 million per contract (New Jersey Only) XXX 10. Aggregate write-ins for other deductions 0 0 0 0 0 381,884 0 201,077,709 0 0 0 0 0 0 0 0 0 XXX XXX BASE 11. Current Year (2018) DETAILS OF WRITE-INS 1001. 1002. 1003. 1098. Summary of remaining write-ins for Line 10 from overflow page 1099. Totals (Lines 1001 thru 1003 plus 1098)(Line 10 above) 300.RI *79413201829041100* LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: South Carolina 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 3.501. 3.502. 3.503. 3.598. 3.599. 0601. 0602. 0603. 0698. 0699. 0901. 0902. 0903. 0998. 0999. PREMIUMS, CONSIDERATIONS AND DEPOSITS Premiums, considerations and deposits from Schedule T or Exhibit of Premiums and Losses Premiums, considerations and deposits NOT reported in Schedule T or Exhibit of Premiums and Losses, including investment contract receipts credited to a liability account 2.1 Contract fees for variable contracts with guarantees 2.2 Any other premiums, considerations and deposits not reported in Schedule T or Exhibit of Premiums and Losses Amounts, if applicable, that were deducted prior to determining amounts included in Lines 1 or 2 which are in the following categories: 3.1 Transfers to guaranteed Separate Accounts 3.2 Roll over of GICs or annuities into other companies 3.3 Surrenders or other benefits paid out 3.4 Excess interest credited to accounts 3.5 Aggregate write-ins for other amounts deducted prior to determining amounts included in Lines 1 or 2 3.99 Total (Lines 3.1 through 3.5) Transfers: 4.1 Enter in Column 2, as a negative number, and Column 4, as a positive number, the total of all amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, that are included in Column 2, Lines 1, 2 and 3.99 4.2 Enter in Column 2, as a positive number, and Column 4, as a negative number, any amounts reported in Column 4, Lines 1, 2 and 3.99 that are allocated. (Note: amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, should not be included in line 4.2) 4.3 Enter in Column 4, as a positive number, and Column 2, as a negative number, any amounts reported in Column 2, Lines 1, 2 and 3.99 that are unallocated 4.99 Total (Lines 4.1 + 4.2 + 4.3) Total (Lines 1 + 2 + 3.99 + 4.99) 1 2 3 Life Insurance Premiums Annuity Considerations A & H Premiums 4 Deposit-Type Contract Funds and Other Considerations 1,354,139 0 2,240,031,879 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,354,139 0 2,240,031,879 DEVELOPMENT OF AMOUNTS INCLUDED IN LINES 1 THROUGH 5 THAT SHOULD BE DEDUCTED IN DETERMINING THE BASE Do not include any amount more than once in Lines 6 through 9 Aggregate write-ins for amounts where the insurer is not subject to risk. Premiums for portions of policies or contracts NOT guaranteed or under which the entire investment risk is borne by the policyholder. (Please specify such deductions and indicate where such amounts were reported in the Annual Statement) Amounts NOT allocated to individuals or individual certificate holders or amounts received for such contracts in excess of limits: 7.1 Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans 7.2 Unallocated funding obligations that fund any employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation 7.3 Unallocated funding obligations that fund governmental lotteries or employee, union, or association of natural persons benefit plans in excess of $5 million per contract which are NOT: (a) government retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation 7.4 Total (Lines 7.1 + 7.2 + 7.3) Dividends/Experience rating credits paid or credited, but only if NOT guaranteed in advance (include only amounts NOT already deducted in determining Lines 1 and 2) Aggregate write-ins for Other Deductions Total (Lines 6 + 7.4 + 8 + 9) Current Year DETAILS OF WRITE-INS 0 0 0 0 0 0 0 XXX XXX XXX 0 XXX XXX XXX 0 XXX XXX XXX XXX XXX XXX 0 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 1,354,139 0 0 0 0 1,856,992,572 1,856,992,572 0 0 0 0 383,039,307 0 Summary of remaining write-ins for Line 3.5 from overflow page Totals (Lines 3.501 thru 3.503 plus 3.598)(Line 3.5 above) 0 0 0 0 0 0 0 0 Summary of remaining write-ins for Line 6 from overflow page Totals (Lines 0601 thru 0603 plus 0698)(Line 6 above) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,850,760,275 6,232,297 0 0 1,856,992,572 0 0 0 0 0 0 0 Medicare Part C & D Stop Loss Medicaid Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.SC *79413201830041100* ADJUSTMENTS TO THE LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: South Carolina 1 2 Allocated Annuity and Other Allocated Fund Deposits Life Insurance Premiums 4 Unallocated Annuity & Other Unallocated Fund Deposits Accident & Health Premium 1,354,139 0 383,039,307 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. MODEL ACT BASE ( Line 11 of the Reconciliation Exhibit) 2. Enter in Column 2, as a positive number, and Column 4, as a negative number, the total of all amounts received to fund allocated contracts established under Section 403(b) of the U.S. Internal Revenue Code that are included in Column 4, Line 1 above 3. Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans: 4. 3 0 XXX 0 XXX 0 3.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 3.2 All amounts XXX XXX XXX 0 0 4.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 0 4.2 Amounts in excess of $1 million but NOT in excess of $5 million per contract XXX XXX XXX 4.3 Amounts in excess of $5 million per contract XXX XXX XXX 4.4 Total (Lines 4.1 + 4.2 + 4.3) XXX XXX XXX 4.5 Amounts up to $7.5 million, per contract (Minnesota only) XXX XXX XXX 0 0 0 0 5.1 Amounts in excess of $1 million per contract XXX XXX XXX 5.2 All amounts XXX XXX XXX 5.3 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 5.4 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 6.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 6.2 Amounts in excess of $1 million per contract XXX XXX XXX 6.3 Total (Lines 6.1 + 6.2) XXX XXX XXX 6.4 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 6.5 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 7.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 7.2 All amounts XXX XXX XXX Unallocated funding obligations issued to fund government lotteries or employee, union, or association of natural persons benefit plans which are NOT: (a) governmental retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation: 5. 6. 7. Unallocated funding obligations issued to fund governmental retirement plans established under Sections 401 and 457 of the U.S. Internal Revenue Code: 0 0 0 0 Unallocated funding obligations issued to fund governmental retirement plans established under Sections 403(b) of the U.S. Internal Revenue Code: 0 0 0 0 0 Unallocated funding obligations that fund employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation: 7.3 Amounts NOT in excess of $2 million per contract (New Jersey only) XXX XXX XXX 0 0 0 8. Unallocated funding obligations issued to fund government lotteries NOT in excess of $5 million per contractholder (New Jersey Only) XXX XXX XXX 0 9. Unallocated funding obligations that fund employee or association of natural persons benefit plans in excess of $2 million but NOT in excess of $5 million per contract (New Jersey Only) XXX 10. Aggregate write-ins for other deductions 0 0 0 0 0 1,354,139 0 383,039,307 0 0 0 0 0 0 0 0 0 XXX XXX BASE 11. Current Year (2018) DETAILS OF WRITE-INS 1001. 1002. 1003. 1098. Summary of remaining write-ins for Line 10 from overflow page 1099. Totals (Lines 1001 thru 1003 plus 1098)(Line 10 above) 300.SC *79413201829042100* LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: South Dakota 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 3.501. 3.502. 3.503. 3.598. 3.599. 0601. 0602. 0603. 0698. 0699. 0901. 0902. 0903. 0998. 0999. PREMIUMS, CONSIDERATIONS AND DEPOSITS Premiums, considerations and deposits from Schedule T or Exhibit of Premiums and Losses Premiums, considerations and deposits NOT reported in Schedule T or Exhibit of Premiums and Losses, including investment contract receipts credited to a liability account 2.1 Contract fees for variable contracts with guarantees 2.2 Any other premiums, considerations and deposits not reported in Schedule T or Exhibit of Premiums and Losses Amounts, if applicable, that were deducted prior to determining amounts included in Lines 1 or 2 which are in the following categories: 3.1 Transfers to guaranteed Separate Accounts 3.2 Roll over of GICs or annuities into other companies 3.3 Surrenders or other benefits paid out 3.4 Excess interest credited to accounts 3.5 Aggregate write-ins for other amounts deducted prior to determining amounts included in Lines 1 or 2 3.99 Total (Lines 3.1 through 3.5) Transfers: 4.1 Enter in Column 2, as a negative number, and Column 4, as a positive number, the total of all amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, that are included in Column 2, Lines 1, 2 and 3.99 4.2 Enter in Column 2, as a positive number, and Column 4, as a negative number, any amounts reported in Column 4, Lines 1, 2 and 3.99 that are allocated. (Note: amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, should not be included in line 4.2) 4.3 Enter in Column 4, as a positive number, and Column 2, as a negative number, any amounts reported in Column 2, Lines 1, 2 and 3.99 that are unallocated 4.99 Total (Lines 4.1 + 4.2 + 4.3) Total (Lines 1 + 2 + 3.99 + 4.99) 1 2 3 Life Insurance Premiums Annuity Considerations A & H Premiums 4 Deposit-Type Contract Funds and Other Considerations 47,739 0 27,090,039 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 47,739 0 27,090,039 DEVELOPMENT OF AMOUNTS INCLUDED IN LINES 1 THROUGH 5 THAT SHOULD BE DEDUCTED IN DETERMINING THE BASE Do not include any amount more than once in Lines 6 through 9 Aggregate write-ins for amounts where the insurer is not subject to risk. Premiums for portions of policies or contracts NOT guaranteed or under which the entire investment risk is borne by the policyholder. (Please specify such deductions and indicate where such amounts were reported in the Annual Statement) Amounts NOT allocated to individuals or individual certificate holders or amounts received for such contracts in excess of limits: 7.1 Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans 7.2 Unallocated funding obligations that fund any employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation 7.3 Unallocated funding obligations that fund governmental lotteries or employee, union, or association of natural persons benefit plans in excess of $5 million per contract which are NOT: (a) government retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation 7.4 Total (Lines 7.1 + 7.2 + 7.3) Dividends/Experience rating credits paid or credited, but only if NOT guaranteed in advance (include only amounts NOT already deducted in determining Lines 1 and 2) Aggregate write-ins for Other Deductions Total (Lines 6 + 7.4 + 8 + 9) Current Year DETAILS OF WRITE-INS 0 0 0 0 0 0 0 XXX XXX XXX 0 XXX XXX XXX 0 XXX XXX XXX XXX XXX XXX 0 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 47,739 0 0 0 0 5,213,554 5,213,554 0 0 0 0 21,876,485 0 Summary of remaining write-ins for Line 3.5 from overflow page Totals (Lines 3.501 thru 3.503 plus 3.598)(Line 3.5 above) 0 0 0 0 0 0 0 0 Summary of remaining write-ins for Line 6 from overflow page Totals (Lines 0601 thru 0603 plus 0698)(Line 6 above) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4,874,475 339,079 0 0 5,213,554 0 0 0 0 0 0 0 Medicare Part C & D Stop Loss Medicaid Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.SD *79413201830042100* ADJUSTMENTS TO THE LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: South Dakota 1 2 Allocated Annuity and Other Allocated Fund Deposits Life Insurance Premiums MODEL ACT BASE ( Line 11 of the Reconciliation Exhibit) 2. Enter in Column 2, as a positive number, and Column 4, as a negative number, the total of all amounts received to fund allocated contracts established under Section 403(b) of the U.S. Internal Revenue Code that are included in Column 4, Line 1 above 3. Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans: 0 XXX 4 Unallocated Annuity & Other Unallocated Fund Deposits Accident & Health Premium 47,739 0 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. 4. 3 21,876,485 0 XXX 0 3.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 3.2 All amounts XXX XXX XXX 0 0 4.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 0 4.2 Amounts in excess of $1 million but NOT in excess of $5 million per contract XXX XXX XXX 4.3 Amounts in excess of $5 million per contract XXX XXX XXX 4.4 Total (Lines 4.1 + 4.2 + 4.3) XXX XXX XXX 4.5 Amounts up to $7.5 million, per contract (Minnesota only) XXX XXX XXX 0 0 0 0 5.1 Amounts in excess of $1 million per contract XXX XXX XXX 5.2 All amounts XXX XXX XXX 5.3 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 5.4 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 6.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 6.2 Amounts in excess of $1 million per contract XXX XXX XXX 6.3 Total (Lines 6.1 + 6.2) XXX XXX XXX 6.4 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 6.5 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 7.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 7.2 All amounts XXX XXX XXX Unallocated funding obligations issued to fund government lotteries or employee, union, or association of natural persons benefit plans which are NOT: (a) governmental retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation: 5. 6. 7. Unallocated funding obligations issued to fund governmental retirement plans established under Sections 401 and 457 of the U.S. Internal Revenue Code: 0 0 0 0 Unallocated funding obligations issued to fund governmental retirement plans established under Sections 403(b) of the U.S. Internal Revenue Code: 0 0 0 0 0 Unallocated funding obligations that fund employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation: 7.3 Amounts NOT in excess of $2 million per contract (New Jersey only) XXX XXX XXX 0 0 0 8. Unallocated funding obligations issued to fund government lotteries NOT in excess of $5 million per contractholder (New Jersey Only) XXX XXX XXX 0 9. Unallocated funding obligations that fund employee or association of natural persons benefit plans in excess of $2 million but NOT in excess of $5 million per contract (New Jersey Only) XXX 10. Aggregate write-ins for other deductions 0 0 0 0 0 47,739 0 21,876,485 0 0 0 0 0 0 0 0 0 XXX XXX BASE 11. Current Year (2018) DETAILS OF WRITE-INS 1001. 1002. 1003. 1098. Summary of remaining write-ins for Line 10 from overflow page 1099. Totals (Lines 1001 thru 1003 plus 1098)(Line 10 above) 300.SD *79413201829043100* LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Tennessee 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 3.501. 3.502. 3.503. 3.598. 3.599. 0601. 0602. 0603. 0698. 0699. 0901. 0902. 0903. 0998. 0999. PREMIUMS, CONSIDERATIONS AND DEPOSITS Premiums, considerations and deposits from Schedule T or Exhibit of Premiums and Losses Premiums, considerations and deposits NOT reported in Schedule T or Exhibit of Premiums and Losses, including investment contract receipts credited to a liability account 2.1 Contract fees for variable contracts with guarantees 2.2 Any other premiums, considerations and deposits not reported in Schedule T or Exhibit of Premiums and Losses Amounts, if applicable, that were deducted prior to determining amounts included in Lines 1 or 2 which are in the following categories: 3.1 Transfers to guaranteed Separate Accounts 3.2 Roll over of GICs or annuities into other companies 3.3 Surrenders or other benefits paid out 3.4 Excess interest credited to accounts 3.5 Aggregate write-ins for other amounts deducted prior to determining amounts included in Lines 1 or 2 3.99 Total (Lines 3.1 through 3.5) Transfers: 4.1 Enter in Column 2, as a negative number, and Column 4, as a positive number, the total of all amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, that are included in Column 2, Lines 1, 2 and 3.99 4.2 Enter in Column 2, as a positive number, and Column 4, as a negative number, any amounts reported in Column 4, Lines 1, 2 and 3.99 that are allocated. (Note: amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, should not be included in line 4.2) 4.3 Enter in Column 4, as a positive number, and Column 2, as a negative number, any amounts reported in Column 2, Lines 1, 2 and 3.99 that are unallocated 4.99 Total (Lines 4.1 + 4.2 + 4.3) Total (Lines 1 + 2 + 3.99 + 4.99) 1 2 3 Life Insurance Premiums Annuity Considerations A & H Premiums 4 Deposit-Type Contract Funds and Other Considerations 3,853,679 0 587,995,467 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3,853,679 0 587,995,467 DEVELOPMENT OF AMOUNTS INCLUDED IN LINES 1 THROUGH 5 THAT SHOULD BE DEDUCTED IN DETERMINING THE BASE Do not include any amount more than once in Lines 6 through 9 Aggregate write-ins for amounts where the insurer is not subject to risk. Premiums for portions of policies or contracts NOT guaranteed or under which the entire investment risk is borne by the policyholder. (Please specify such deductions and indicate where such amounts were reported in the Annual Statement) Amounts NOT allocated to individuals or individual certificate holders or amounts received for such contracts in excess of limits: 7.1 Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans 7.2 Unallocated funding obligations that fund any employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation 7.3 Unallocated funding obligations that fund governmental lotteries or employee, union, or association of natural persons benefit plans in excess of $5 million per contract which are NOT: (a) government retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation 7.4 Total (Lines 7.1 + 7.2 + 7.3) Dividends/Experience rating credits paid or credited, but only if NOT guaranteed in advance (include only amounts NOT already deducted in determining Lines 1 and 2) Aggregate write-ins for Other Deductions Total (Lines 6 + 7.4 + 8 + 9) Current Year DETAILS OF WRITE-INS 0 0 0 0 0 0 0 XXX XXX XXX 0 XXX XXX XXX 0 XXX XXX XXX XXX XXX XXX 0 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 3,853,679 0 0 0 0 75,094,347 75,094,347 0 0 0 0 512,901,120 0 Summary of remaining write-ins for Line 3.5 from overflow page Totals (Lines 3.501 thru 3.503 plus 3.598)(Line 3.5 above) 0 0 0 0 0 0 0 0 Summary of remaining write-ins for Line 6 from overflow page Totals (Lines 0601 thru 0603 plus 0698)(Line 6 above) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 65,949,861 9,144,486 0 0 75,094,347 0 0 0 0 0 0 0 Medicare Part C & D Stop Loss Medicaid Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.TN *79413201830043100* ADJUSTMENTS TO THE LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Tennessee 1 2 Allocated Annuity and Other Allocated Fund Deposits Life Insurance Premiums 4 Unallocated Annuity & Other Unallocated Fund Deposits Accident & Health Premium 3,853,679 0 512,901,120 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. MODEL ACT BASE ( Line 11 of the Reconciliation Exhibit) 2. Enter in Column 2, as a positive number, and Column 4, as a negative number, the total of all amounts received to fund allocated contracts established under Section 403(b) of the U.S. Internal Revenue Code that are included in Column 4, Line 1 above 3. Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans: 4. 3 0 XXX 0 XXX 0 3.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 3.2 All amounts XXX XXX XXX 0 0 4.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 0 4.2 Amounts in excess of $1 million but NOT in excess of $5 million per contract XXX XXX XXX 4.3 Amounts in excess of $5 million per contract XXX XXX XXX 4.4 Total (Lines 4.1 + 4.2 + 4.3) XXX XXX XXX 4.5 Amounts up to $7.5 million, per contract (Minnesota only) XXX XXX XXX 0 0 0 0 5.1 Amounts in excess of $1 million per contract XXX XXX XXX 5.2 All amounts XXX XXX XXX 5.3 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 5.4 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 6.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 6.2 Amounts in excess of $1 million per contract XXX XXX XXX 6.3 Total (Lines 6.1 + 6.2) XXX XXX XXX 6.4 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 6.5 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 7.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 7.2 All amounts XXX XXX XXX Unallocated funding obligations issued to fund government lotteries or employee, union, or association of natural persons benefit plans which are NOT: (a) governmental retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation: 5. 6. 7. Unallocated funding obligations issued to fund governmental retirement plans established under Sections 401 and 457 of the U.S. Internal Revenue Code: 0 0 0 0 Unallocated funding obligations issued to fund governmental retirement plans established under Sections 403(b) of the U.S. Internal Revenue Code: 0 0 0 0 0 Unallocated funding obligations that fund employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation: 7.3 Amounts NOT in excess of $2 million per contract (New Jersey only) XXX XXX XXX 0 0 0 8. Unallocated funding obligations issued to fund government lotteries NOT in excess of $5 million per contractholder (New Jersey Only) XXX XXX XXX 0 9. Unallocated funding obligations that fund employee or association of natural persons benefit plans in excess of $2 million but NOT in excess of $5 million per contract (New Jersey Only) XXX 10. Aggregate write-ins for other deductions 0 0 0 0 0 3,853,679 0 512,901,120 0 0 0 0 0 0 0 0 0 XXX XXX BASE 11. Current Year (2018) DETAILS OF WRITE-INS 1001. 1002. 1003. 1098. Summary of remaining write-ins for Line 10 from overflow page 1099. Totals (Lines 1001 thru 1003 plus 1098)(Line 10 above) 300.TN *79413201829044100* LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Texas 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 3.501. 3.502. 3.503. 3.598. 3.599. 0601. 0602. 0603. 0698. 0699. 0901. 0902. 0903. 0998. 0999. PREMIUMS, CONSIDERATIONS AND DEPOSITS Premiums, considerations and deposits from Schedule T or Exhibit of Premiums and Losses Premiums, considerations and deposits NOT reported in Schedule T or Exhibit of Premiums and Losses, including investment contract receipts credited to a liability account 2.1 Contract fees for variable contracts with guarantees 2.2 Any other premiums, considerations and deposits not reported in Schedule T or Exhibit of Premiums and Losses Amounts, if applicable, that were deducted prior to determining amounts included in Lines 1 or 2 which are in the following categories: 3.1 Transfers to guaranteed Separate Accounts 3.2 Roll over of GICs or annuities into other companies 3.3 Surrenders or other benefits paid out 3.4 Excess interest credited to accounts 3.5 Aggregate write-ins for other amounts deducted prior to determining amounts included in Lines 1 or 2 3.99 Total (Lines 3.1 through 3.5) Transfers: 4.1 Enter in Column 2, as a negative number, and Column 4, as a positive number, the total of all amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, that are included in Column 2, Lines 1, 2 and 3.99 4.2 Enter in Column 2, as a positive number, and Column 4, as a negative number, any amounts reported in Column 4, Lines 1, 2 and 3.99 that are allocated. (Note: amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, should not be included in line 4.2) 4.3 Enter in Column 4, as a positive number, and Column 2, as a negative number, any amounts reported in Column 2, Lines 1, 2 and 3.99 that are unallocated 4.99 Total (Lines 4.1 + 4.2 + 4.3) Total (Lines 1 + 2 + 3.99 + 4.99) 1 2 3 Life Insurance Premiums Annuity Considerations A & H Premiums 4 Deposit-Type Contract Funds and Other Considerations 15,850,121 0 6,330,236,807 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 15,850,121 0 6,330,236,807 DEVELOPMENT OF AMOUNTS INCLUDED IN LINES 1 THROUGH 5 THAT SHOULD BE DEDUCTED IN DETERMINING THE BASE Do not include any amount more than once in Lines 6 through 9 Aggregate write-ins for amounts where the insurer is not subject to risk. Premiums for portions of policies or contracts NOT guaranteed or under which the entire investment risk is borne by the policyholder. (Please specify such deductions and indicate where such amounts were reported in the Annual Statement) Amounts NOT allocated to individuals or individual certificate holders or amounts received for such contracts in excess of limits: 7.1 Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans 7.2 Unallocated funding obligations that fund any employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation 7.3 Unallocated funding obligations that fund governmental lotteries or employee, union, or association of natural persons benefit plans in excess of $5 million per contract which are NOT: (a) government retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation 7.4 Total (Lines 7.1 + 7.2 + 7.3) Dividends/Experience rating credits paid or credited, but only if NOT guaranteed in advance (include only amounts NOT already deducted in determining Lines 1 and 2) Aggregate write-ins for Other Deductions Total (Lines 6 + 7.4 + 8 + 9) Current Year DETAILS OF WRITE-INS 0 0 0 0 0 0 0 XXX XXX XXX 0 XXX XXX XXX 0 XXX XXX XXX XXX XXX XXX 0 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 15,850,121 0 0 0 0 1,966,097,820 1,966,097,820 0 0 0 0 4,364,138,987 0 Summary of remaining write-ins for Line 3.5 from overflow page Totals (Lines 3.501 thru 3.503 plus 3.598)(Line 3.5 above) 0 0 0 0 0 0 0 0 Summary of remaining write-ins for Line 6 from overflow page Totals (Lines 0601 thru 0603 plus 0698)(Line 6 above) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 614,097,785 117,042,001 1,234,958,034 0 1,966,097,820 0 0 0 0 0 0 0 Medicare Part C & D Stop Loss Medicaid Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.TX *79413201830044100* ADJUSTMENTS TO THE LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Texas 1 2 Allocated Annuity and Other Allocated Fund Deposits Life Insurance Premiums 4 Unallocated Annuity & Other Unallocated Fund Deposits Accident & Health Premium 15,850,121 0 4,364,138,987 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. MODEL ACT BASE ( Line 11 of the Reconciliation Exhibit) 2. Enter in Column 2, as a positive number, and Column 4, as a negative number, the total of all amounts received to fund allocated contracts established under Section 403(b) of the U.S. Internal Revenue Code that are included in Column 4, Line 1 above 3. Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans: 4. 3 0 XXX 0 XXX 0 3.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 3.2 All amounts XXX XXX XXX 0 0 4.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 0 4.2 Amounts in excess of $1 million but NOT in excess of $5 million per contract XXX XXX XXX 4.3 Amounts in excess of $5 million per contract XXX XXX XXX 4.4 Total (Lines 4.1 + 4.2 + 4.3) XXX XXX XXX 4.5 Amounts up to $7.5 million, per contract (Minnesota only) XXX XXX XXX 0 0 0 0 5.1 Amounts in excess of $1 million per contract XXX XXX XXX 5.2 All amounts XXX XXX XXX 5.3 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 5.4 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 6.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 6.2 Amounts in excess of $1 million per contract XXX XXX XXX 6.3 Total (Lines 6.1 + 6.2) XXX XXX XXX 6.4 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 6.5 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 7.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 7.2 All amounts XXX XXX XXX Unallocated funding obligations issued to fund government lotteries or employee, union, or association of natural persons benefit plans which are NOT: (a) governmental retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation: 5. 6. 7. Unallocated funding obligations issued to fund governmental retirement plans established under Sections 401 and 457 of the U.S. Internal Revenue Code: 0 0 0 0 Unallocated funding obligations issued to fund governmental retirement plans established under Sections 403(b) of the U.S. Internal Revenue Code: 0 0 0 0 0 Unallocated funding obligations that fund employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation: 7.3 Amounts NOT in excess of $2 million per contract (New Jersey only) XXX XXX XXX 0 0 0 8. Unallocated funding obligations issued to fund government lotteries NOT in excess of $5 million per contractholder (New Jersey Only) XXX XXX XXX 0 9. Unallocated funding obligations that fund employee or association of natural persons benefit plans in excess of $2 million but NOT in excess of $5 million per contract (New Jersey Only) XXX 10. Aggregate write-ins for other deductions 0 0 0 0 0 15,850,121 0 4,364,138,987 0 0 0 0 0 0 0 0 0 XXX XXX BASE 11. Current Year (2018) DETAILS OF WRITE-INS 1001. 1002. 1003. 1098. Summary of remaining write-ins for Line 10 from overflow page 1099. Totals (Lines 1001 thru 1003 plus 1098)(Line 10 above) 300.TX *79413201829045100* LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Utah 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 3.501. 3.502. 3.503. 3.598. 3.599. 0601. 0602. 0603. 0698. 0699. 0901. 0902. 0903. 0998. 0999. PREMIUMS, CONSIDERATIONS AND DEPOSITS Premiums, considerations and deposits from Schedule T or Exhibit of Premiums and Losses Premiums, considerations and deposits NOT reported in Schedule T or Exhibit of Premiums and Losses, including investment contract receipts credited to a liability account 2.1 Contract fees for variable contracts with guarantees 2.2 Any other premiums, considerations and deposits not reported in Schedule T or Exhibit of Premiums and Losses Amounts, if applicable, that were deducted prior to determining amounts included in Lines 1 or 2 which are in the following categories: 3.1 Transfers to guaranteed Separate Accounts 3.2 Roll over of GICs or annuities into other companies 3.3 Surrenders or other benefits paid out 3.4 Excess interest credited to accounts 3.5 Aggregate write-ins for other amounts deducted prior to determining amounts included in Lines 1 or 2 3.99 Total (Lines 3.1 through 3.5) Transfers: 4.1 Enter in Column 2, as a negative number, and Column 4, as a positive number, the total of all amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, that are included in Column 2, Lines 1, 2 and 3.99 4.2 Enter in Column 2, as a positive number, and Column 4, as a negative number, any amounts reported in Column 4, Lines 1, 2 and 3.99 that are allocated. (Note: amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, should not be included in line 4.2) 4.3 Enter in Column 4, as a positive number, and Column 2, as a negative number, any amounts reported in Column 2, Lines 1, 2 and 3.99 that are unallocated 4.99 Total (Lines 4.1 + 4.2 + 4.3) Total (Lines 1 + 2 + 3.99 + 4.99) 1 2 3 Life Insurance Premiums Annuity Considerations A & H Premiums 4 Deposit-Type Contract Funds and Other Considerations 1,184,362 0 383,901,529 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,184,362 0 383,901,529 DEVELOPMENT OF AMOUNTS INCLUDED IN LINES 1 THROUGH 5 THAT SHOULD BE DEDUCTED IN DETERMINING THE BASE Do not include any amount more than once in Lines 6 through 9 Aggregate write-ins for amounts where the insurer is not subject to risk. Premiums for portions of policies or contracts NOT guaranteed or under which the entire investment risk is borne by the policyholder. (Please specify such deductions and indicate where such amounts were reported in the Annual Statement) Amounts NOT allocated to individuals or individual certificate holders or amounts received for such contracts in excess of limits: 7.1 Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans 7.2 Unallocated funding obligations that fund any employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation 7.3 Unallocated funding obligations that fund governmental lotteries or employee, union, or association of natural persons benefit plans in excess of $5 million per contract which are NOT: (a) government retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation 7.4 Total (Lines 7.1 + 7.2 + 7.3) Dividends/Experience rating credits paid or credited, but only if NOT guaranteed in advance (include only amounts NOT already deducted in determining Lines 1 and 2) Aggregate write-ins for Other Deductions Total (Lines 6 + 7.4 + 8 + 9) Current Year DETAILS OF WRITE-INS 0 0 0 0 0 0 0 XXX XXX XXX 0 XXX XXX XXX 0 XXX XXX XXX XXX XXX XXX 0 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 1,184,362 0 0 0 0 23,841,762 23,841,762 0 0 0 0 360,059,767 0 Summary of remaining write-ins for Line 3.5 from overflow page Totals (Lines 3.501 thru 3.503 plus 3.598)(Line 3.5 above) 0 0 0 0 0 0 0 0 Summary of remaining write-ins for Line 6 from overflow page Totals (Lines 0601 thru 0603 plus 0698)(Line 6 above) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 14,457,610 9,384,152 0 0 23,841,762 0 0 0 0 0 0 0 Medicare Part C & D Stop Loss Medicaid Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.UT *79413201830045100* ADJUSTMENTS TO THE LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Utah 1 2 Allocated Annuity and Other Allocated Fund Deposits Life Insurance Premiums 4 Unallocated Annuity & Other Unallocated Fund Deposits Accident & Health Premium 1,184,362 0 360,059,767 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. MODEL ACT BASE ( Line 11 of the Reconciliation Exhibit) 2. Enter in Column 2, as a positive number, and Column 4, as a negative number, the total of all amounts received to fund allocated contracts established under Section 403(b) of the U.S. Internal Revenue Code that are included in Column 4, Line 1 above 3. Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans: 4. 3 0 XXX 0 XXX 0 3.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 3.2 All amounts XXX XXX XXX 0 0 4.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 0 4.2 Amounts in excess of $1 million but NOT in excess of $5 million per contract XXX XXX XXX 4.3 Amounts in excess of $5 million per contract XXX XXX XXX 4.4 Total (Lines 4.1 + 4.2 + 4.3) XXX XXX XXX 4.5 Amounts up to $7.5 million, per contract (Minnesota only) XXX XXX XXX 0 0 0 0 5.1 Amounts in excess of $1 million per contract XXX XXX XXX 5.2 All amounts XXX XXX XXX 5.3 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 5.4 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 6.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 6.2 Amounts in excess of $1 million per contract XXX XXX XXX 6.3 Total (Lines 6.1 + 6.2) XXX XXX XXX 6.4 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 6.5 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 7.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 7.2 All amounts XXX XXX XXX Unallocated funding obligations issued to fund government lotteries or employee, union, or association of natural persons benefit plans which are NOT: (a) governmental retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation: 5. 6. 7. Unallocated funding obligations issued to fund governmental retirement plans established under Sections 401 and 457 of the U.S. Internal Revenue Code: 0 0 0 0 Unallocated funding obligations issued to fund governmental retirement plans established under Sections 403(b) of the U.S. Internal Revenue Code: 0 0 0 0 0 Unallocated funding obligations that fund employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation: 7.3 Amounts NOT in excess of $2 million per contract (New Jersey only) XXX XXX XXX 0 0 0 8. Unallocated funding obligations issued to fund government lotteries NOT in excess of $5 million per contractholder (New Jersey Only) XXX XXX XXX 0 9. Unallocated funding obligations that fund employee or association of natural persons benefit plans in excess of $2 million but NOT in excess of $5 million per contract (New Jersey Only) XXX 10. Aggregate write-ins for other deductions 0 0 0 0 0 1,184,362 0 360,059,767 0 0 0 0 0 0 0 0 0 XXX XXX BASE 11. Current Year (2018) DETAILS OF WRITE-INS 1001. 1002. 1003. 1098. Summary of remaining write-ins for Line 10 from overflow page 1099. Totals (Lines 1001 thru 1003 plus 1098)(Line 10 above) 300.UT *79413201829046100* LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Vermont 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 3.501. 3.502. 3.503. 3.598. 3.599. 0601. 0602. 0603. 0698. 0699. 0901. 0902. 0903. 0998. 0999. PREMIUMS, CONSIDERATIONS AND DEPOSITS Premiums, considerations and deposits from Schedule T or Exhibit of Premiums and Losses Premiums, considerations and deposits NOT reported in Schedule T or Exhibit of Premiums and Losses, including investment contract receipts credited to a liability account 2.1 Contract fees for variable contracts with guarantees 2.2 Any other premiums, considerations and deposits not reported in Schedule T or Exhibit of Premiums and Losses Amounts, if applicable, that were deducted prior to determining amounts included in Lines 1 or 2 which are in the following categories: 3.1 Transfers to guaranteed Separate Accounts 3.2 Roll over of GICs or annuities into other companies 3.3 Surrenders or other benefits paid out 3.4 Excess interest credited to accounts 3.5 Aggregate write-ins for other amounts deducted prior to determining amounts included in Lines 1 or 2 3.99 Total (Lines 3.1 through 3.5) Transfers: 4.1 Enter in Column 2, as a negative number, and Column 4, as a positive number, the total of all amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, that are included in Column 2, Lines 1, 2 and 3.99 4.2 Enter in Column 2, as a positive number, and Column 4, as a negative number, any amounts reported in Column 4, Lines 1, 2 and 3.99 that are allocated. (Note: amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, should not be included in line 4.2) 4.3 Enter in Column 4, as a positive number, and Column 2, as a negative number, any amounts reported in Column 2, Lines 1, 2 and 3.99 that are unallocated 4.99 Total (Lines 4.1 + 4.2 + 4.3) Total (Lines 1 + 2 + 3.99 + 4.99) 1 2 3 Life Insurance Premiums Annuity Considerations A & H Premiums 4 Deposit-Type Contract Funds and Other Considerations 34,276 0 126,449,416 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 34,276 0 126,449,416 DEVELOPMENT OF AMOUNTS INCLUDED IN LINES 1 THROUGH 5 THAT SHOULD BE DEDUCTED IN DETERMINING THE BASE Do not include any amount more than once in Lines 6 through 9 Aggregate write-ins for amounts where the insurer is not subject to risk. Premiums for portions of policies or contracts NOT guaranteed or under which the entire investment risk is borne by the policyholder. (Please specify such deductions and indicate where such amounts were reported in the Annual Statement) Amounts NOT allocated to individuals or individual certificate holders or amounts received for such contracts in excess of limits: 7.1 Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans 7.2 Unallocated funding obligations that fund any employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation 7.3 Unallocated funding obligations that fund governmental lotteries or employee, union, or association of natural persons benefit plans in excess of $5 million per contract which are NOT: (a) government retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation 7.4 Total (Lines 7.1 + 7.2 + 7.3) Dividends/Experience rating credits paid or credited, but only if NOT guaranteed in advance (include only amounts NOT already deducted in determining Lines 1 and 2) Aggregate write-ins for Other Deductions Total (Lines 6 + 7.4 + 8 + 9) Current Year DETAILS OF WRITE-INS 0 0 0 0 0 0 0 XXX XXX XXX 0 XXX XXX XXX 0 XXX XXX XXX XXX XXX XXX 0 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 34,276 0 0 0 0 76,563,739 76,563,739 0 0 0 0 49,885,677 0 Summary of remaining write-ins for Line 3.5 from overflow page Totals (Lines 3.501 thru 3.503 plus 3.598)(Line 3.5 above) 0 0 0 0 0 0 0 0 Summary of remaining write-ins for Line 6 from overflow page Totals (Lines 0601 thru 0603 plus 0698)(Line 6 above) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 76,367,424 196,315 0 0 76,563,739 0 0 0 0 0 0 0 Medicare Part C & D Stop Loss Medicaid Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.VT *79413201830046100* ADJUSTMENTS TO THE LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Vermont 1 2 Allocated Annuity and Other Allocated Fund Deposits Life Insurance Premiums MODEL ACT BASE ( Line 11 of the Reconciliation Exhibit) 2. Enter in Column 2, as a positive number, and Column 4, as a negative number, the total of all amounts received to fund allocated contracts established under Section 403(b) of the U.S. Internal Revenue Code that are included in Column 4, Line 1 above 3. Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans: 0 XXX 4 Unallocated Annuity & Other Unallocated Fund Deposits Accident & Health Premium 34,276 0 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. 4. 3 49,885,677 0 XXX 0 3.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 3.2 All amounts XXX XXX XXX 0 0 4.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 0 4.2 Amounts in excess of $1 million but NOT in excess of $5 million per contract XXX XXX XXX 4.3 Amounts in excess of $5 million per contract XXX XXX XXX 4.4 Total (Lines 4.1 + 4.2 + 4.3) XXX XXX XXX 4.5 Amounts up to $7.5 million, per contract (Minnesota only) XXX XXX XXX 0 0 0 0 5.1 Amounts in excess of $1 million per contract XXX XXX XXX 5.2 All amounts XXX XXX XXX 5.3 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 5.4 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 6.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 6.2 Amounts in excess of $1 million per contract XXX XXX XXX 6.3 Total (Lines 6.1 + 6.2) XXX XXX XXX 6.4 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 6.5 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 7.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 7.2 All amounts XXX XXX XXX Unallocated funding obligations issued to fund government lotteries or employee, union, or association of natural persons benefit plans which are NOT: (a) governmental retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation: 5. 6. 7. Unallocated funding obligations issued to fund governmental retirement plans established under Sections 401 and 457 of the U.S. Internal Revenue Code: 0 0 0 0 Unallocated funding obligations issued to fund governmental retirement plans established under Sections 403(b) of the U.S. Internal Revenue Code: 0 0 0 0 0 Unallocated funding obligations that fund employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation: 7.3 Amounts NOT in excess of $2 million per contract (New Jersey only) XXX XXX XXX 0 0 0 8. Unallocated funding obligations issued to fund government lotteries NOT in excess of $5 million per contractholder (New Jersey Only) XXX XXX XXX 0 9. Unallocated funding obligations that fund employee or association of natural persons benefit plans in excess of $2 million but NOT in excess of $5 million per contract (New Jersey Only) XXX 10. Aggregate write-ins for other deductions 0 0 0 0 0 34,276 0 49,885,677 0 0 0 0 0 0 0 0 0 XXX XXX BASE 11. Current Year (2018) DETAILS OF WRITE-INS 1001. 1002. 1003. 1098. Summary of remaining write-ins for Line 10 from overflow page 1099. Totals (Lines 1001 thru 1003 plus 1098)(Line 10 above) 300.VT *79413201829047100* LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Virginia 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 3.501. 3.502. 3.503. 3.598. 3.599. 0601. 0602. 0603. 0698. 0699. 0901. 0902. 0903. 0998. 0999. PREMIUMS, CONSIDERATIONS AND DEPOSITS Premiums, considerations and deposits from Schedule T or Exhibit of Premiums and Losses Premiums, considerations and deposits NOT reported in Schedule T or Exhibit of Premiums and Losses, including investment contract receipts credited to a liability account 2.1 Contract fees for variable contracts with guarantees 2.2 Any other premiums, considerations and deposits not reported in Schedule T or Exhibit of Premiums and Losses Amounts, if applicable, that were deducted prior to determining amounts included in Lines 1 or 2 which are in the following categories: 3.1 Transfers to guaranteed Separate Accounts 3.2 Roll over of GICs or annuities into other companies 3.3 Surrenders or other benefits paid out 3.4 Excess interest credited to accounts 3.5 Aggregate write-ins for other amounts deducted prior to determining amounts included in Lines 1 or 2 3.99 Total (Lines 3.1 through 3.5) Transfers: 4.1 Enter in Column 2, as a negative number, and Column 4, as a positive number, the total of all amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, that are included in Column 2, Lines 1, 2 and 3.99 4.2 Enter in Column 2, as a positive number, and Column 4, as a negative number, any amounts reported in Column 4, Lines 1, 2 and 3.99 that are allocated. (Note: amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, should not be included in line 4.2) 4.3 Enter in Column 4, as a positive number, and Column 2, as a negative number, any amounts reported in Column 2, Lines 1, 2 and 3.99 that are unallocated 4.99 Total (Lines 4.1 + 4.2 + 4.3) Total (Lines 1 + 2 + 3.99 + 4.99) 1 2 3 Life Insurance Premiums Annuity Considerations A & H Premiums 4 Deposit-Type Contract Funds and Other Considerations 2,694,342 0 1,732,904,884 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,694,342 0 1,732,904,884 DEVELOPMENT OF AMOUNTS INCLUDED IN LINES 1 THROUGH 5 THAT SHOULD BE DEDUCTED IN DETERMINING THE BASE Do not include any amount more than once in Lines 6 through 9 Aggregate write-ins for amounts where the insurer is not subject to risk. Premiums for portions of policies or contracts NOT guaranteed or under which the entire investment risk is borne by the policyholder. (Please specify such deductions and indicate where such amounts were reported in the Annual Statement) Amounts NOT allocated to individuals or individual certificate holders or amounts received for such contracts in excess of limits: 7.1 Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans 7.2 Unallocated funding obligations that fund any employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation 7.3 Unallocated funding obligations that fund governmental lotteries or employee, union, or association of natural persons benefit plans in excess of $5 million per contract which are NOT: (a) government retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation 7.4 Total (Lines 7.1 + 7.2 + 7.3) Dividends/Experience rating credits paid or credited, but only if NOT guaranteed in advance (include only amounts NOT already deducted in determining Lines 1 and 2) Aggregate write-ins for Other Deductions Total (Lines 6 + 7.4 + 8 + 9) Current Year DETAILS OF WRITE-INS 0 0 0 0 0 0 0 XXX XXX XXX 0 XXX XXX XXX 0 XXX XXX XXX XXX XXX XXX 0 0 0 0 0 0 602,546,777 602,546,777 0 0 0 0 1,130,358,107 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 2,694,342 Summary of remaining write-ins for Line 3.5 from overflow page Totals (Lines 3.501 thru 3.503 plus 3.598)(Line 3.5 above) 0 0 0 0 0 0 0 0 Summary of remaining write-ins for Line 6 from overflow page Totals (Lines 0601 thru 0603 plus 0698)(Line 6 above) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 159,796,998 22,160,465 420,589,314 0 602,546,777 0 0 0 0 0 0 0 Medicare Part C & D Stop Loss Medicaid Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.VA *79413201830047100* ADJUSTMENTS TO THE LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Virginia 1 2 Allocated Annuity and Other Allocated Fund Deposits Life Insurance Premiums 4 Unallocated Annuity & Other Unallocated Fund Deposits Accident & Health Premium 2,694,342 0 1,130,358,107 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. MODEL ACT BASE ( Line 11 of the Reconciliation Exhibit) 2. Enter in Column 2, as a positive number, and Column 4, as a negative number, the total of all amounts received to fund allocated contracts established under Section 403(b) of the U.S. Internal Revenue Code that are included in Column 4, Line 1 above 3. Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans: 4. 3 0 XXX 0 XXX 0 3.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 3.2 All amounts XXX XXX XXX 0 0 4.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 0 4.2 Amounts in excess of $1 million but NOT in excess of $5 million per contract XXX XXX XXX 4.3 Amounts in excess of $5 million per contract XXX XXX XXX 4.4 Total (Lines 4.1 + 4.2 + 4.3) XXX XXX XXX 4.5 Amounts up to $7.5 million, per contract (Minnesota only) XXX XXX XXX 0 0 0 0 5.1 Amounts in excess of $1 million per contract XXX XXX XXX 5.2 All amounts XXX XXX XXX 5.3 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 5.4 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 6.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 6.2 Amounts in excess of $1 million per contract XXX XXX XXX 6.3 Total (Lines 6.1 + 6.2) XXX XXX XXX 6.4 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 6.5 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 7.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 7.2 All amounts XXX XXX XXX Unallocated funding obligations issued to fund government lotteries or employee, union, or association of natural persons benefit plans which are NOT: (a) governmental retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation: 5. 6. 7. Unallocated funding obligations issued to fund governmental retirement plans established under Sections 401 and 457 of the U.S. Internal Revenue Code: 0 0 0 0 Unallocated funding obligations issued to fund governmental retirement plans established under Sections 403(b) of the U.S. Internal Revenue Code: 0 0 0 0 0 Unallocated funding obligations that fund employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation: 7.3 Amounts NOT in excess of $2 million per contract (New Jersey only) XXX XXX XXX 0 0 0 8. Unallocated funding obligations issued to fund government lotteries NOT in excess of $5 million per contractholder (New Jersey Only) XXX XXX XXX 0 9. Unallocated funding obligations that fund employee or association of natural persons benefit plans in excess of $2 million but NOT in excess of $5 million per contract (New Jersey Only) XXX 10. Aggregate write-ins for other deductions 0 0 0 0 0 2,694,342 0 1,130,358,107 0 0 0 0 0 0 0 0 0 XXX XXX BASE 11. Current Year (2018) DETAILS OF WRITE-INS 1001. 1002. 1003. 1098. Summary of remaining write-ins for Line 10 from overflow page 1099. Totals (Lines 1001 thru 1003 plus 1098)(Line 10 above) 300.VA *79413201829048100* LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Washington 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 3.501. 3.502. 3.503. 3.598. 3.599. 0601. 0602. 0603. 0698. 0699. 0901. 0902. 0903. 0998. 0999. PREMIUMS, CONSIDERATIONS AND DEPOSITS Premiums, considerations and deposits from Schedule T or Exhibit of Premiums and Losses Premiums, considerations and deposits NOT reported in Schedule T or Exhibit of Premiums and Losses, including investment contract receipts credited to a liability account 2.1 Contract fees for variable contracts with guarantees 2.2 Any other premiums, considerations and deposits not reported in Schedule T or Exhibit of Premiums and Losses Amounts, if applicable, that were deducted prior to determining amounts included in Lines 1 or 2 which are in the following categories: 3.1 Transfers to guaranteed Separate Accounts 3.2 Roll over of GICs or annuities into other companies 3.3 Surrenders or other benefits paid out 3.4 Excess interest credited to accounts 3.5 Aggregate write-ins for other amounts deducted prior to determining amounts included in Lines 1 or 2 3.99 Total (Lines 3.1 through 3.5) Transfers: 4.1 Enter in Column 2, as a negative number, and Column 4, as a positive number, the total of all amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, that are included in Column 2, Lines 1, 2 and 3.99 4.2 Enter in Column 2, as a positive number, and Column 4, as a negative number, any amounts reported in Column 4, Lines 1, 2 and 3.99 that are allocated. (Note: amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, should not be included in line 4.2) 4.3 Enter in Column 4, as a positive number, and Column 2, as a negative number, any amounts reported in Column 2, Lines 1, 2 and 3.99 that are unallocated 4.99 Total (Lines 4.1 + 4.2 + 4.3) Total (Lines 1 + 2 + 3.99 + 4.99) 1 2 3 Life Insurance Premiums Annuity Considerations A & H Premiums 4 Deposit-Type Contract Funds and Other Considerations 1,040,521 0 1,351,491,712 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,040,521 0 1,351,491,712 DEVELOPMENT OF AMOUNTS INCLUDED IN LINES 1 THROUGH 5 THAT SHOULD BE DEDUCTED IN DETERMINING THE BASE Do not include any amount more than once in Lines 6 through 9 Aggregate write-ins for amounts where the insurer is not subject to risk. Premiums for portions of policies or contracts NOT guaranteed or under which the entire investment risk is borne by the policyholder. (Please specify such deductions and indicate where such amounts were reported in the Annual Statement) Amounts NOT allocated to individuals or individual certificate holders or amounts received for such contracts in excess of limits: 7.1 Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans 7.2 Unallocated funding obligations that fund any employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation 7.3 Unallocated funding obligations that fund governmental lotteries or employee, union, or association of natural persons benefit plans in excess of $5 million per contract which are NOT: (a) government retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation 7.4 Total (Lines 7.1 + 7.2 + 7.3) Dividends/Experience rating credits paid or credited, but only if NOT guaranteed in advance (include only amounts NOT already deducted in determining Lines 1 and 2) Aggregate write-ins for Other Deductions Total (Lines 6 + 7.4 + 8 + 9) Current Year DETAILS OF WRITE-INS 0 0 0 0 0 0 0 XXX XXX XXX 0 XXX XXX XXX 0 XXX XXX XXX XXX XXX XXX 0 0 0 0 0 0 725,506,385 725,506,385 0 0 0 0 625,985,327 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 1,040,521 Summary of remaining write-ins for Line 3.5 from overflow page Totals (Lines 3.501 thru 3.503 plus 3.598)(Line 3.5 above) 0 0 0 0 0 0 0 0 Summary of remaining write-ins for Line 6 from overflow page Totals (Lines 0601 thru 0603 plus 0698)(Line 6 above) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 712,159,095 13,347,290 0 0 725,506,385 0 0 0 0 0 0 0 Medicare Part C & D Stop Loss Medicaid Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.WA *79413201830048100* ADJUSTMENTS TO THE LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Washington 1 2 Allocated Annuity and Other Allocated Fund Deposits Life Insurance Premiums 4 Unallocated Annuity & Other Unallocated Fund Deposits Accident & Health Premium 1,040,521 0 625,985,327 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. MODEL ACT BASE ( Line 11 of the Reconciliation Exhibit) 2. Enter in Column 2, as a positive number, and Column 4, as a negative number, the total of all amounts received to fund allocated contracts established under Section 403(b) of the U.S. Internal Revenue Code that are included in Column 4, Line 1 above 3. Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans: 4. 3 0 XXX 0 XXX 0 3.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 3.2 All amounts XXX XXX XXX 0 0 4.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 0 4.2 Amounts in excess of $1 million but NOT in excess of $5 million per contract XXX XXX XXX 4.3 Amounts in excess of $5 million per contract XXX XXX XXX 4.4 Total (Lines 4.1 + 4.2 + 4.3) XXX XXX XXX 4.5 Amounts up to $7.5 million, per contract (Minnesota only) XXX XXX XXX 0 0 0 0 5.1 Amounts in excess of $1 million per contract XXX XXX XXX 5.2 All amounts XXX XXX XXX 5.3 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 5.4 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 6.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 6.2 Amounts in excess of $1 million per contract XXX XXX XXX 6.3 Total (Lines 6.1 + 6.2) XXX XXX XXX 6.4 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 6.5 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 7.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 7.2 All amounts XXX XXX XXX Unallocated funding obligations issued to fund government lotteries or employee, union, or association of natural persons benefit plans which are NOT: (a) governmental retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation: 5. 6. 7. Unallocated funding obligations issued to fund governmental retirement plans established under Sections 401 and 457 of the U.S. Internal Revenue Code: 0 0 0 0 Unallocated funding obligations issued to fund governmental retirement plans established under Sections 403(b) of the U.S. Internal Revenue Code: 0 0 0 0 0 Unallocated funding obligations that fund employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation: 7.3 Amounts NOT in excess of $2 million per contract (New Jersey only) XXX XXX XXX 0 0 0 8. Unallocated funding obligations issued to fund government lotteries NOT in excess of $5 million per contractholder (New Jersey Only) XXX XXX XXX 0 9. Unallocated funding obligations that fund employee or association of natural persons benefit plans in excess of $2 million but NOT in excess of $5 million per contract (New Jersey Only) XXX 10. Aggregate write-ins for other deductions 0 0 0 0 0 1,040,521 0 625,985,327 0 0 0 0 0 0 0 0 0 XXX XXX BASE 11. Current Year (2018) DETAILS OF WRITE-INS 1001. 1002. 1003. 1098. Summary of remaining write-ins for Line 10 from overflow page 1099. Totals (Lines 1001 thru 1003 plus 1098)(Line 10 above) 300.WA *79413201829049100* LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: West Virginia 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 3.501. 3.502. 3.503. 3.598. 3.599. 0601. 0602. 0603. 0698. 0699. 0901. 0902. 0903. 0998. 0999. PREMIUMS, CONSIDERATIONS AND DEPOSITS Premiums, considerations and deposits from Schedule T or Exhibit of Premiums and Losses Premiums, considerations and deposits NOT reported in Schedule T or Exhibit of Premiums and Losses, including investment contract receipts credited to a liability account 2.1 Contract fees for variable contracts with guarantees 2.2 Any other premiums, considerations and deposits not reported in Schedule T or Exhibit of Premiums and Losses Amounts, if applicable, that were deducted prior to determining amounts included in Lines 1 or 2 which are in the following categories: 3.1 Transfers to guaranteed Separate Accounts 3.2 Roll over of GICs or annuities into other companies 3.3 Surrenders or other benefits paid out 3.4 Excess interest credited to accounts 3.5 Aggregate write-ins for other amounts deducted prior to determining amounts included in Lines 1 or 2 3.99 Total (Lines 3.1 through 3.5) Transfers: 4.1 Enter in Column 2, as a negative number, and Column 4, as a positive number, the total of all amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, that are included in Column 2, Lines 1, 2 and 3.99 4.2 Enter in Column 2, as a positive number, and Column 4, as a negative number, any amounts reported in Column 4, Lines 1, 2 and 3.99 that are allocated. (Note: amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, should not be included in line 4.2) 4.3 Enter in Column 4, as a positive number, and Column 2, as a negative number, any amounts reported in Column 2, Lines 1, 2 and 3.99 that are unallocated 4.99 Total (Lines 4.1 + 4.2 + 4.3) Total (Lines 1 + 2 + 3.99 + 4.99) 1 2 3 Life Insurance Premiums Annuity Considerations A & H Premiums 4 Deposit-Type Contract Funds and Other Considerations 292,262 0 202,635,657 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 292,262 0 202,635,657 DEVELOPMENT OF AMOUNTS INCLUDED IN LINES 1 THROUGH 5 THAT SHOULD BE DEDUCTED IN DETERMINING THE BASE Do not include any amount more than once in Lines 6 through 9 Aggregate write-ins for amounts where the insurer is not subject to risk. Premiums for portions of policies or contracts NOT guaranteed or under which the entire investment risk is borne by the policyholder. (Please specify such deductions and indicate where such amounts were reported in the Annual Statement) Amounts NOT allocated to individuals or individual certificate holders or amounts received for such contracts in excess of limits: 7.1 Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans 7.2 Unallocated funding obligations that fund any employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation 7.3 Unallocated funding obligations that fund governmental lotteries or employee, union, or association of natural persons benefit plans in excess of $5 million per contract which are NOT: (a) government retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation 7.4 Total (Lines 7.1 + 7.2 + 7.3) Dividends/Experience rating credits paid or credited, but only if NOT guaranteed in advance (include only amounts NOT already deducted in determining Lines 1 and 2) Aggregate write-ins for Other Deductions Total (Lines 6 + 7.4 + 8 + 9) Current Year DETAILS OF WRITE-INS 0 0 0 0 0 0 0 XXX XXX XXX 0 XXX XXX XXX 0 XXX XXX XXX XXX XXX XXX 0 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 292,262 0 0 0 0 36,529,593 36,529,593 0 0 0 0 166,106,064 0 Summary of remaining write-ins for Line 3.5 from overflow page Totals (Lines 3.501 thru 3.503 plus 3.598)(Line 3.5 above) 0 0 0 0 0 0 0 0 Summary of remaining write-ins for Line 6 from overflow page Totals (Lines 0601 thru 0603 plus 0698)(Line 6 above) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 34,308,874 2,220,719 0 0 36,529,593 0 0 0 0 0 0 0 Medicare Part C & D Stop Loss Medicaid Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.WV *79413201830049100* ADJUSTMENTS TO THE LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: West Virginia 1 2 Allocated Annuity and Other Allocated Fund Deposits Life Insurance Premiums 4 Unallocated Annuity & Other Unallocated Fund Deposits Accident & Health Premium 292,262 0 166,106,064 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. MODEL ACT BASE ( Line 11 of the Reconciliation Exhibit) 2. Enter in Column 2, as a positive number, and Column 4, as a negative number, the total of all amounts received to fund allocated contracts established under Section 403(b) of the U.S. Internal Revenue Code that are included in Column 4, Line 1 above 3. Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans: 4. 3 0 XXX 0 XXX 0 3.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 3.2 All amounts XXX XXX XXX 0 0 4.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 0 4.2 Amounts in excess of $1 million but NOT in excess of $5 million per contract XXX XXX XXX 4.3 Amounts in excess of $5 million per contract XXX XXX XXX 4.4 Total (Lines 4.1 + 4.2 + 4.3) XXX XXX XXX 4.5 Amounts up to $7.5 million, per contract (Minnesota only) XXX XXX XXX 0 0 0 0 5.1 Amounts in excess of $1 million per contract XXX XXX XXX 5.2 All amounts XXX XXX XXX 5.3 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 5.4 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 6.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 6.2 Amounts in excess of $1 million per contract XXX XXX XXX 6.3 Total (Lines 6.1 + 6.2) XXX XXX XXX 6.4 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 6.5 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 7.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 7.2 All amounts XXX XXX XXX Unallocated funding obligations issued to fund government lotteries or employee, union, or association of natural persons benefit plans which are NOT: (a) governmental retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation: 5. 6. 7. Unallocated funding obligations issued to fund governmental retirement plans established under Sections 401 and 457 of the U.S. Internal Revenue Code: 0 0 0 0 Unallocated funding obligations issued to fund governmental retirement plans established under Sections 403(b) of the U.S. Internal Revenue Code: 0 0 0 0 0 Unallocated funding obligations that fund employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation: 7.3 Amounts NOT in excess of $2 million per contract (New Jersey only) XXX XXX XXX 0 0 0 8. Unallocated funding obligations issued to fund government lotteries NOT in excess of $5 million per contractholder (New Jersey Only) XXX XXX XXX 0 9. Unallocated funding obligations that fund employee or association of natural persons benefit plans in excess of $2 million but NOT in excess of $5 million per contract (New Jersey Only) XXX 10. Aggregate write-ins for other deductions 0 0 0 0 0 292,262 0 166,106,064 0 0 0 0 0 0 0 0 0 XXX XXX BASE 11. Current Year (2018) DETAILS OF WRITE-INS 1001. 1002. 1003. 1098. Summary of remaining write-ins for Line 10 from overflow page 1099. Totals (Lines 1001 thru 1003 plus 1098)(Line 10 above) 300.WV *79413201829050100* LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Wisconsin 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 3.501. 3.502. 3.503. 3.598. 3.599. 0601. 0602. 0603. 0698. 0699. 0901. 0902. 0903. 0998. 0999. PREMIUMS, CONSIDERATIONS AND DEPOSITS Premiums, considerations and deposits from Schedule T or Exhibit of Premiums and Losses Premiums, considerations and deposits NOT reported in Schedule T or Exhibit of Premiums and Losses, including investment contract receipts credited to a liability account 2.1 Contract fees for variable contracts with guarantees 2.2 Any other premiums, considerations and deposits not reported in Schedule T or Exhibit of Premiums and Losses Amounts, if applicable, that were deducted prior to determining amounts included in Lines 1 or 2 which are in the following categories: 3.1 Transfers to guaranteed Separate Accounts 3.2 Roll over of GICs or annuities into other companies 3.3 Surrenders or other benefits paid out 3.4 Excess interest credited to accounts 3.5 Aggregate write-ins for other amounts deducted prior to determining amounts included in Lines 1 or 2 3.99 Total (Lines 3.1 through 3.5) Transfers: 4.1 Enter in Column 2, as a negative number, and Column 4, as a positive number, the total of all amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, that are included in Column 2, Lines 1, 2 and 3.99 4.2 Enter in Column 2, as a positive number, and Column 4, as a negative number, any amounts reported in Column 4, Lines 1, 2 and 3.99 that are allocated. (Note: amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, should not be included in line 4.2) 4.3 Enter in Column 4, as a positive number, and Column 2, as a negative number, any amounts reported in Column 2, Lines 1, 2 and 3.99 that are unallocated 4.99 Total (Lines 4.1 + 4.2 + 4.3) Total (Lines 1 + 2 + 3.99 + 4.99) 1 2 3 Life Insurance Premiums Annuity Considerations A & H Premiums 4 Deposit-Type Contract Funds and Other Considerations 8,822,954 0 1,178,897,332 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8,822,954 0 1,178,897,332 DEVELOPMENT OF AMOUNTS INCLUDED IN LINES 1 THROUGH 5 THAT SHOULD BE DEDUCTED IN DETERMINING THE BASE Do not include any amount more than once in Lines 6 through 9 Aggregate write-ins for amounts where the insurer is not subject to risk. Premiums for portions of policies or contracts NOT guaranteed or under which the entire investment risk is borne by the policyholder. (Please specify such deductions and indicate where such amounts were reported in the Annual Statement) Amounts NOT allocated to individuals or individual certificate holders or amounts received for such contracts in excess of limits: 7.1 Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans 7.2 Unallocated funding obligations that fund any employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation 7.3 Unallocated funding obligations that fund governmental lotteries or employee, union, or association of natural persons benefit plans in excess of $5 million per contract which are NOT: (a) government retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation 7.4 Total (Lines 7.1 + 7.2 + 7.3) Dividends/Experience rating credits paid or credited, but only if NOT guaranteed in advance (include only amounts NOT already deducted in determining Lines 1 and 2) Aggregate write-ins for Other Deductions Total (Lines 6 + 7.4 + 8 + 9) Current Year DETAILS OF WRITE-INS 0 0 0 0 0 0 0 XXX XXX XXX 0 XXX XXX XXX 0 XXX XXX XXX XXX XXX XXX 0 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 8,822,954 0 0 0 0 54,460,453 54,460,453 0 0 0 0 1,124,436,879 0 Summary of remaining write-ins for Line 3.5 from overflow page Totals (Lines 3.501 thru 3.503 plus 3.598)(Line 3.5 above) 0 0 0 0 0 0 0 0 Summary of remaining write-ins for Line 6 from overflow page Totals (Lines 0601 thru 0603 plus 0698)(Line 6 above) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 54,460,453 0 0 0 54,460,453 0 0 0 0 0 0 0 Medicare Part C & D Stop Loss Medicaid Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.WI *79413201830050100* ADJUSTMENTS TO THE LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Wisconsin 1 2 Allocated Annuity and Other Allocated Fund Deposits Life Insurance Premiums 4 Unallocated Annuity & Other Unallocated Fund Deposits Accident & Health Premium 8,822,954 0 1,124,436,879 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. MODEL ACT BASE ( Line 11 of the Reconciliation Exhibit) 2. Enter in Column 2, as a positive number, and Column 4, as a negative number, the total of all amounts received to fund allocated contracts established under Section 403(b) of the U.S. Internal Revenue Code that are included in Column 4, Line 1 above 3. Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans: 4. 3 0 XXX 0 XXX 0 3.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 3.2 All amounts XXX XXX XXX 0 0 4.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 0 4.2 Amounts in excess of $1 million but NOT in excess of $5 million per contract XXX XXX XXX 4.3 Amounts in excess of $5 million per contract XXX XXX XXX 4.4 Total (Lines 4.1 + 4.2 + 4.3) XXX XXX XXX 4.5 Amounts up to $7.5 million, per contract (Minnesota only) XXX XXX XXX 0 0 0 0 5.1 Amounts in excess of $1 million per contract XXX XXX XXX 5.2 All amounts XXX XXX XXX 5.3 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 5.4 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 6.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 6.2 Amounts in excess of $1 million per contract XXX XXX XXX 6.3 Total (Lines 6.1 + 6.2) XXX XXX XXX 6.4 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 6.5 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 7.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 7.2 All amounts XXX XXX XXX Unallocated funding obligations issued to fund government lotteries or employee, union, or association of natural persons benefit plans which are NOT: (a) governmental retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation: 5. 6. 7. Unallocated funding obligations issued to fund governmental retirement plans established under Sections 401 and 457 of the U.S. Internal Revenue Code: 0 0 0 0 Unallocated funding obligations issued to fund governmental retirement plans established under Sections 403(b) of the U.S. Internal Revenue Code: 0 0 0 0 0 Unallocated funding obligations that fund employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation: 7.3 Amounts NOT in excess of $2 million per contract (New Jersey only) XXX XXX XXX 0 0 0 8. Unallocated funding obligations issued to fund government lotteries NOT in excess of $5 million per contractholder (New Jersey Only) XXX XXX XXX 0 9. Unallocated funding obligations that fund employee or association of natural persons benefit plans in excess of $2 million but NOT in excess of $5 million per contract (New Jersey Only) XXX 10. Aggregate write-ins for other deductions 0 0 0 0 0 8,822,954 0 1,124,436,879 0 0 0 0 0 0 0 0 0 XXX XXX BASE 11. Current Year (2018) DETAILS OF WRITE-INS 1001. 1002. 1003. 1098. Summary of remaining write-ins for Line 10 from overflow page 1099. Totals (Lines 1001 thru 1003 plus 1098)(Line 10 above) 300.WI *79413201829051100* LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Wyoming 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 3.501. 3.502. 3.503. 3.598. 3.599. 0601. 0602. 0603. 0698. 0699. 0901. 0902. 0903. 0998. 0999. PREMIUMS, CONSIDERATIONS AND DEPOSITS Premiums, considerations and deposits from Schedule T or Exhibit of Premiums and Losses Premiums, considerations and deposits NOT reported in Schedule T or Exhibit of Premiums and Losses, including investment contract receipts credited to a liability account 2.1 Contract fees for variable contracts with guarantees 2.2 Any other premiums, considerations and deposits not reported in Schedule T or Exhibit of Premiums and Losses Amounts, if applicable, that were deducted prior to determining amounts included in Lines 1 or 2 which are in the following categories: 3.1 Transfers to guaranteed Separate Accounts 3.2 Roll over of GICs or annuities into other companies 3.3 Surrenders or other benefits paid out 3.4 Excess interest credited to accounts 3.5 Aggregate write-ins for other amounts deducted prior to determining amounts included in Lines 1 or 2 3.99 Total (Lines 3.1 through 3.5) Transfers: 4.1 Enter in Column 2, as a negative number, and Column 4, as a positive number, the total of all amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, that are included in Column 2, Lines 1, 2 and 3.99 4.2 Enter in Column 2, as a positive number, and Column 4, as a negative number, any amounts reported in Column 4, Lines 1, 2 and 3.99 that are allocated. (Note: amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, should not be included in line 4.2) 4.3 Enter in Column 4, as a positive number, and Column 2, as a negative number, any amounts reported in Column 2, Lines 1, 2 and 3.99 that are unallocated 4.99 Total (Lines 4.1 + 4.2 + 4.3) Total (Lines 1 + 2 + 3.99 + 4.99) 1 2 3 Life Insurance Premiums Annuity Considerations A & H Premiums 4 Deposit-Type Contract Funds and Other Considerations 134,143 0 109,700,477 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 134,143 0 109,700,477 DEVELOPMENT OF AMOUNTS INCLUDED IN LINES 1 THROUGH 5 THAT SHOULD BE DEDUCTED IN DETERMINING THE BASE Do not include any amount more than once in Lines 6 through 9 Aggregate write-ins for amounts where the insurer is not subject to risk. Premiums for portions of policies or contracts NOT guaranteed or under which the entire investment risk is borne by the policyholder. (Please specify such deductions and indicate where such amounts were reported in the Annual Statement) Amounts NOT allocated to individuals or individual certificate holders or amounts received for such contracts in excess of limits: 7.1 Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans 7.2 Unallocated funding obligations that fund any employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation 7.3 Unallocated funding obligations that fund governmental lotteries or employee, union, or association of natural persons benefit plans in excess of $5 million per contract which are NOT: (a) government retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation 7.4 Total (Lines 7.1 + 7.2 + 7.3) Dividends/Experience rating credits paid or credited, but only if NOT guaranteed in advance (include only amounts NOT already deducted in determining Lines 1 and 2) Aggregate write-ins for Other Deductions Total (Lines 6 + 7.4 + 8 + 9) Current Year DETAILS OF WRITE-INS 0 0 0 0 0 0 0 XXX XXX XXX 0 XXX XXX XXX 0 XXX XXX XXX XXX XXX XXX 0 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 134,143 0 0 0 0 26,929,281 26,929,281 0 0 0 0 82,771,196 0 Summary of remaining write-ins for Line 3.5 from overflow page Totals (Lines 3.501 thru 3.503 plus 3.598)(Line 3.5 above) 0 0 0 0 0 0 0 0 Summary of remaining write-ins for Line 6 from overflow page Totals (Lines 0601 thru 0603 plus 0698)(Line 6 above) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 25,653,619 1,275,662 0 0 26,929,281 0 0 0 0 0 0 0 Medicare Part C & D Stop Loss Medicaid Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.WY *79413201830051100* ADJUSTMENTS TO THE LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Wyoming 1 2 Allocated Annuity and Other Allocated Fund Deposits Life Insurance Premiums MODEL ACT BASE ( Line 11 of the Reconciliation Exhibit) 2. Enter in Column 2, as a positive number, and Column 4, as a negative number, the total of all amounts received to fund allocated contracts established under Section 403(b) of the U.S. Internal Revenue Code that are included in Column 4, Line 1 above 3. Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans: 0 XXX 4 Unallocated Annuity & Other Unallocated Fund Deposits Accident & Health Premium 134,143 0 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. 4. 3 82,771,196 0 XXX 0 3.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 3.2 All amounts XXX XXX XXX 0 0 4.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 0 4.2 Amounts in excess of $1 million but NOT in excess of $5 million per contract XXX XXX XXX 4.3 Amounts in excess of $5 million per contract XXX XXX XXX 4.4 Total (Lines 4.1 + 4.2 + 4.3) XXX XXX XXX 4.5 Amounts up to $7.5 million, per contract (Minnesota only) XXX XXX XXX 0 0 0 0 5.1 Amounts in excess of $1 million per contract XXX XXX XXX 5.2 All amounts XXX XXX XXX 5.3 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 5.4 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 6.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 6.2 Amounts in excess of $1 million per contract XXX XXX XXX 6.3 Total (Lines 6.1 + 6.2) XXX XXX XXX 6.4 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 6.5 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 7.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 7.2 All amounts XXX XXX XXX Unallocated funding obligations issued to fund government lotteries or employee, union, or association of natural persons benefit plans which are NOT: (a) governmental retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation: 5. 6. 7. Unallocated funding obligations issued to fund governmental retirement plans established under Sections 401 and 457 of the U.S. Internal Revenue Code: 0 0 0 0 Unallocated funding obligations issued to fund governmental retirement plans established under Sections 403(b) of the U.S. Internal Revenue Code: 0 0 0 0 0 Unallocated funding obligations that fund employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation: 7.3 Amounts NOT in excess of $2 million per contract (New Jersey only) XXX XXX XXX 0 0 0 8. Unallocated funding obligations issued to fund government lotteries NOT in excess of $5 million per contractholder (New Jersey Only) XXX XXX XXX 0 9. Unallocated funding obligations that fund employee or association of natural persons benefit plans in excess of $2 million but NOT in excess of $5 million per contract (New Jersey Only) XXX 10. Aggregate write-ins for other deductions 0 0 0 0 0 134,143 0 82,771,196 0 0 0 0 0 0 0 0 0 XXX XXX BASE 11. Current Year (2018) DETAILS OF WRITE-INS 1001. 1002. 1003. 1098. Summary of remaining write-ins for Line 10 from overflow page 1099. Totals (Lines 1001 thru 1003 plus 1098)(Line 10 above) 300.WY *79413201829054100* LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Puerto Rico 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 3.501. 3.502. 3.503. 3.598. 3.599. 0601. 0602. 0603. 0698. 0699. 0901. 0902. 0903. 0998. 0999. PREMIUMS, CONSIDERATIONS AND DEPOSITS Premiums, considerations and deposits from Schedule T or Exhibit of Premiums and Losses Premiums, considerations and deposits NOT reported in Schedule T or Exhibit of Premiums and Losses, including investment contract receipts credited to a liability account 2.1 Contract fees for variable contracts with guarantees 2.2 Any other premiums, considerations and deposits not reported in Schedule T or Exhibit of Premiums and Losses Amounts, if applicable, that were deducted prior to determining amounts included in Lines 1 or 2 which are in the following categories: 3.1 Transfers to guaranteed Separate Accounts 3.2 Roll over of GICs or annuities into other companies 3.3 Surrenders or other benefits paid out 3.4 Excess interest credited to accounts 3.5 Aggregate write-ins for other amounts deducted prior to determining amounts included in Lines 1 or 2 3.99 Total (Lines 3.1 through 3.5) Transfers: 4.1 Enter in Column 2, as a negative number, and Column 4, as a positive number, the total of all amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, that are included in Column 2, Lines 1, 2 and 3.99 4.2 Enter in Column 2, as a positive number, and Column 4, as a negative number, any amounts reported in Column 4, Lines 1, 2 and 3.99 that are allocated. (Note: amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, should not be included in line 4.2) 4.3 Enter in Column 4, as a positive number, and Column 2, as a negative number, any amounts reported in Column 2, Lines 1, 2 and 3.99 that are unallocated 4.99 Total (Lines 4.1 + 4.2 + 4.3) Total (Lines 1 + 2 + 3.99 + 4.99) 1 2 3 Life Insurance Premiums Annuity Considerations A & H Premiums 4 Deposit-Type Contract Funds and Other Considerations 32,547 0 15,589,519 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 32,547 0 15,589,519 DEVELOPMENT OF AMOUNTS INCLUDED IN LINES 1 THROUGH 5 THAT SHOULD BE DEDUCTED IN DETERMINING THE BASE Do not include any amount more than once in Lines 6 through 9 Aggregate write-ins for amounts where the insurer is not subject to risk. Premiums for portions of policies or contracts NOT guaranteed or under which the entire investment risk is borne by the policyholder. (Please specify such deductions and indicate where such amounts were reported in the Annual Statement) Amounts NOT allocated to individuals or individual certificate holders or amounts received for such contracts in excess of limits: 7.1 Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans 7.2 Unallocated funding obligations that fund any employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation 7.3 Unallocated funding obligations that fund governmental lotteries or employee, union, or association of natural persons benefit plans in excess of $5 million per contract which are NOT: (a) government retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation 7.4 Total (Lines 7.1 + 7.2 + 7.3) Dividends/Experience rating credits paid or credited, but only if NOT guaranteed in advance (include only amounts NOT already deducted in determining Lines 1 and 2) Aggregate write-ins for Other Deductions Total (Lines 6 + 7.4 + 8 + 9) Current Year DETAILS OF WRITE-INS 0 0 0 0 0 0 0 XXX XXX XXX 0 XXX XXX XXX 0 XXX XXX XXX XXX XXX XXX 0 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 32,547 0 0 0 0 4,419,378 4,419,378 0 0 0 0 11,170,141 0 Summary of remaining write-ins for Line 3.5 from overflow page Totals (Lines 3.501 thru 3.503 plus 3.598)(Line 3.5 above) 0 0 0 0 0 0 0 0 Summary of remaining write-ins for Line 6 from overflow page Totals (Lines 0601 thru 0603 plus 0698)(Line 6 above) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4,404,600 14,778 0 0 4,419,378 0 0 0 0 0 0 0 Medicare Part C & D Stop Loss Medicaid Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.PR *79413201830054100* ADJUSTMENTS TO THE LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Puerto Rico 1 2 Allocated Annuity and Other Allocated Fund Deposits Life Insurance Premiums MODEL ACT BASE ( Line 11 of the Reconciliation Exhibit) 2. Enter in Column 2, as a positive number, and Column 4, as a negative number, the total of all amounts received to fund allocated contracts established under Section 403(b) of the U.S. Internal Revenue Code that are included in Column 4, Line 1 above 3. Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans: 0 XXX 4 Unallocated Annuity & Other Unallocated Fund Deposits Accident & Health Premium 32,547 0 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. 4. 3 11,170,141 0 XXX 0 3.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 3.2 All amounts XXX XXX XXX 0 0 4.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 0 4.2 Amounts in excess of $1 million but NOT in excess of $5 million per contract XXX XXX XXX 4.3 Amounts in excess of $5 million per contract XXX XXX XXX 4.4 Total (Lines 4.1 + 4.2 + 4.3) XXX XXX XXX 4.5 Amounts up to $7.5 million, per contract (Minnesota only) XXX XXX XXX 0 0 0 0 5.1 Amounts in excess of $1 million per contract XXX XXX XXX 5.2 All amounts XXX XXX XXX 5.3 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 5.4 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 6.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 6.2 Amounts in excess of $1 million per contract XXX XXX XXX 6.3 Total (Lines 6.1 + 6.2) XXX XXX XXX 6.4 Amounts in excess of $2 million per contract (New Jersey Only) XXX XXX XXX 6.5 Amounts not in excess of $7.5 million per contract (Minnesota Only) XXX XXX XXX 7.1 Amounts NOT in excess of $1 million per contract XXX XXX XXX 7.2 All amounts XXX XXX XXX Unallocated funding obligations issued to fund government lotteries or employee, union, or association of natural persons benefit plans which are NOT: (a) governmental retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation: 5. 6. 7. Unallocated funding obligations issued to fund governmental retirement plans established under Sections 401 and 457 of the U.S. Internal Revenue Code: 0 0 0 0 Unallocated funding obligations issued to fund governmental retirement plans established under Sections 403(b) of the U.S. Internal Revenue Code: 0 0 0 0 0 Unallocated funding obligations that fund employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation: 7.3 Amounts NOT in excess of $2 million per contract (New Jersey only) XXX XXX XXX 0 0 0 8. Unallocated funding obligations issued to fund government lotteries NOT in excess of $5 million per contractholder (New Jersey Only) XXX XXX XXX 0 9. Unallocated funding obligations that fund employee or association of natural persons benefit plans in excess of $2 million but NOT in excess of $5 million per contract (New Jersey Only) XXX 10. Aggregate write-ins for other deductions 0 0 0 0 0 32,547 0 11,170,141 0 0 0 0 0 0 0 0 0 XXX XXX BASE 11. Current Year (2018) DETAILS OF WRITE-INS 1001. 1002. 1003. 1098. Summary of remaining write-ins for Line 10 from overflow page 1099. Totals (Lines 1001 thru 1003 plus 1098)(Line 10 above) 300.PR *79413201829059100* LIFE, HEALTH & ANNUITY GUARANTY ASSOCIATION MODEL ACT ASSESSMENT BASE RECONCILIATION EXHIBIT FOR THE YEAR ENDED DECEMBER 31, 2018 (To Be Filed by April 1) OF THE NAIC COMPANY CODE UnitedHealthcare Insurance Company 79413 DIRECT BUSINESS IN THE STATE OF: Grand Total 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 3.501. 3.502. 3.503. 3.598. 3.599. 0601. 0602. 0603. 0698. 0699. 0901. 0902. 0903. 0998. 0999. PREMIUMS, CONSIDERATIONS AND DEPOSITS Premiums, considerations and deposits from Schedule T or Exhibit of Premiums and Losses Premiums, considerations and deposits NOT reported in Schedule T or Exhibit of Premiums and Losses, including investment contract receipts credited to a liability account 2.1 Contract fees for variable contracts with guarantees 2.2 Any other premiums, considerations and deposits not reported in Schedule T or Exhibit of Premiums and Losses Amounts, if applicable, that were deducted prior to determining amounts included in Lines 1 or 2 which are in the following categories: 3.1 Transfers to guaranteed Separate Accounts 3.2 Roll over of GICs or annuities into other companies 3.3 Surrenders or other benefits paid out 3.4 Excess interest credited to accounts 3.5 Aggregate write-ins for other amounts deducted prior to determining amounts included in Lines 1 or 2 3.99 Total (Lines 3.1 through 3.5) Transfers: 4.1 Enter in Column 2, as a negative number, and Column 4, as a positive number, the total of all amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, that are included in Column 2, Lines 1, 2 and 3.99 4.2 Enter in Column 2, as a positive number, and Column 4, as a negative number, any amounts reported in Column 4, Lines 1, 2 and 3.99 that are allocated. (Note: amounts received to fund contracts established under Section 403(b) of the U.S. Internal Revenue Code, should not be included in line 4.2) 4.3 Enter in Column 4, as a positive number, and Column 2, as a negative number, any amounts reported in Column 2, Lines 1, 2 and 3.99 that are unallocated 4.99 Total (Lines 4.1 + 4.2 + 4.3) Total (Lines 1 + 2 + 3.99 + 4.99) 1 2 3 Life Insurance Premiums Annuity Considerations A & H Premiums 4 Deposit-Type Contract Funds and Other Considerations 139,369,939 0 53,446,560,672 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 139,369,939 0 53,446,560,672 DEVELOPMENT OF AMOUNTS INCLUDED IN LINES 1 THROUGH 5 THAT SHOULD BE DEDUCTED IN DETERMINING THE BASE Do not include any amount more than once in Lines 6 through 9 Aggregate write-ins for amounts where the insurer is not subject to risk. Premiums for portions of policies or contracts NOT guaranteed or under which the entire investment risk is borne by the policyholder. (Please specify such deductions and indicate where such amounts were reported in the Annual Statement) Amounts NOT allocated to individuals or individual certificate holders or amounts received for such contracts in excess of limits: 7.1 Unallocated funding obligations that do NOT fund government lotteries or employee, union, or association of natural persons benefit plans 7.2 Unallocated funding obligations that fund any employee, union, or association of natural persons benefit plans protected by the Federal Pension Benefit Guaranty Corporation 7.3 Unallocated funding obligations that fund governmental lotteries or employee, union, or association of natural persons benefit plans in excess of $5 million per contract which are NOT: (a) government retirement plans established under Sections 401, 403(b) or 457 of the U.S. Internal Revenue Code, or (b) protected by the Federal Pension Benefit Guaranty Corporation 7.4 Total (Lines 7.1 + 7.2 + 7.3) Dividends/Experience rating credits paid or credited, but only if NOT guaranteed in advance (include only amounts NOT already deducted in determining Lines 1 and 2) Aggregate write-ins for Other Deductions Total (Lines 6 + 7.4 + 8 + 9) Current Year DETAILS OF WRITE-INS 0 0 0 0 0 0 0 XXX XXX XXX 0 XXX XXX XXX 0 XXX XXX XXX XXX XXX XXX 0 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 139,369,939 0 0 0 0 17,052,231,941 17,052,231,941 0 0 0 0 36,394,328,731 0 Summary of remaining write-ins for Line 3.5 from overflow page Totals (Lines 3.501 thru 3.503 plus 3.598)(Line 3.5 above) 0 0 0 0 0 0 0 0 Summary of remaining write-ins for Line 6 from overflow page Totals (Lines 0601 thru 0603 plus 0698)(Line 6 above) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 659,294,996 14,737,389,597 1,655,547,348 0 17,052,231,941 0 0 0 0 0 0 0 Stop Loss Medicare Part C & D Medicaid Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.GT *79413201830100100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company LONG-TERM CARE EXPERIENCE REPORTING FORM 1 ACTUAL VS. EXPECTED CLAIMS AND PERSISTENCY NAIC Group Code REPORTING YEAR 2018 (To Be Filed By April 1) 4 Actual to Expected Incurred Claims 0707 1 Earned Premiums 301 A. Individual Comprehensive: 1. Current 2. Prior 3. 2nd Prior 4. 3rd Prior 5. 4th Prior 6. 5th Prior 7. Form Inception-to-Date 8. Total Inception-to-Date Institutional Only: 9. Current 10. Prior 11. 2nd Prior 12. 3rd Prior 13. 4th Prior 14. 5th Prior 15. Form Inception-to-Date 16. Total Inception-to-Date Non-Institutional Only: 17. Current 18. Prior 19. 2nd Prior 20. 3rd Prior 21. 4th Prior 22. 5th Prior 23. Form Inception-to-Date 24. Total Inception-to-Date B. Group Comprehensive: 1. Current 2. Prior 3. 2nd Prior 4. 3rd Prior 5. 4th Prior 6. 5th Prior 7. Form Inception-to-Date 8. Total Inception-to-Date Institutional Only: 9. Current 10. Prior 11. 2nd Prior 12. 3rd Prior 13. 4th Prior 14. 5th Prior 15. Form Inception-to-Date 16. Total Inception-to-Date Non-Institutional Only: 17. Current 18. Prior 19. 2nd Prior 20. 3rd Prior 21. 4th Prior 22. 5th Prior 23. Form Inception-to-Date 24. Total Inception-to-Date C. Summary 7. Form Inception-to-Date 8. Total Inception-to-Date 2 Incurred Claims 3 Valuation Expected Incurred Claims 13,963 14,078 14,078 16,238 14,171 15,547 142,406 123,209 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 142,406 123,209 0 0 0 0 0 0 0 0 0 XXX 0.0 0.0 0.0 0.0 0.0 0.0 0.0 XXX 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 0 0 0 0 XXX XXX 0.0 0.0 0.0 0.0 0.0 0.0 0.0 XXX 0 XXX XXX XXX 0 XXX XXX 0.0 0.0 0.0 0.0 0.0 0.0 0.0 XXX 0 0 0 0 0 0 0 XXX 111 XXX XXX XXX XXX 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.0 XXX XXX XXX XXX XXX 100.0 100.0 100.0 100.0 100.0 100.0 100.0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX 11 11 12 11 12 12 111 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 XXX XXX XXX 11 11 12 11 12 12 111 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0 0 0 0 0 0 0 XXX XXX 79413 NAIC Company Code 8 9 Expected Lives Actual to Expected Inforce End of Year Lives Inforce 7 Lives Inforce End of Year 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 XXX XXX XXX XXX XXX 0 0 0 0 0 0 0 6 New Claim Count 0 0 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0 0 0 0 0 0 0 XXX 5 Open Claim Count 0.0 0.0 0.0 0.0 0.0 0.0 0.0 XXX 111 XXX 100.0 XXX *79413201830200100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company LONG-TERM CARE EXPERIENCE REPORTING FORM 2 EXPERIENCE RESERVE VS. REPORTED RESERVE BY CALENDAR YEAR NAIC Group Code REPORTING YEAR 2018 (To Be Filed By April 1) 0707 Reporting Year A. Individual 1 2 3 4 5 6 Policy Form First Year Issue Last Year Issue Earned Premiums Incurred Claims Loss Ratio 7 Annual Net/ Annual Gross Premiums 8 9 Inforce Count Beginning of Year Current Year Net Premiums 10 New Issues Current Year 11 Inforce Count End of Year NAIC Company Code 79413 13 14 12 Persistency Rate Experience Policy Reserves Reported Policy Reserves 15 Experience/ Reported Ratio 1. 2. 3. Current Prior 2nd Prior LTC POL 1010 IL AND STC POL 1000 IL LTC POL 1010 IL AND STC POL 1000 IL LTC POL 1010 IL AND STC POL 1000 IL 2008 2008 2008 1,813 1,836 2,976 0 0 0 0.0 0.0 0.0 0.0 0.0 0.0 0 0 0 1 1 1 0 0 0 0 0 0 0.000 0.000 0.000 0 0 0 0 0 0 0.0 0.0 0.0 1. 2. 3. Current Prior 2nd Prior LTC POL 1010 OH AND STC POL 1000 OH LTC POL 1010 OH AND STC POL 1000 OH LTC POL 1010 OH AND STC POL 1000 OH 2008 2008 2008 5,907 6,737 7,298 0 0 0 0.0 0.0 0.0 0.0 0.0 0.0 0 0 0 5 6 6 0 0 0 0 0 0 0.000 0.000 0.000 0 0 0 0 0 0 0.0 0.0 0.0 1. 2. 3. Current Prior 2nd Prior LTC POL 1010 WI AND STC POL 1000 WI LTC POL 1010 WI AND STC POL 1000 WI LTC POL 1010 WI AND STC POL 1000 WI 2009 2009 2009 6,243 5,505 5,963 0 0 0 0.0 0.0 0.0 0.0 0.0 0.0 0 0 0 5 5 4 0 0 0 0 0 0 0.000 0.000 0.000 0 0 0 0 0 0 0.0 0.0 0.0 13,963 14,078 16,237 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 11 12 11 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 13,963 0 0 11 0 0 0 0 B. Group 302 1. 2. 3. Current Prior 2nd Prior 1. 2. 3. Current Prior 2nd Prior 1. 2. 3. Current Prior 2nd Prior C. Summary 1. 2. 3. 4. 5. 6. 7. Total Current - Individual Total Prior - Individual Total 2nd Prior - Individual Total Current - Group Total Prior - Group 2nd Prior - Group Current Year Total XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 0.0 0.0 XXX XXX XXX XXX XXX XXX 0.000 XXX XXX XXX XXX XXX XXX 0.0 *79413201830300000* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company LONG-TERM CARE EXPERIENCE REPORTING FORM 3 LTC EXPERIENCE DEVELOPMENT ($000 OMITTED) NAIC Group Code REPORTING YEAR 2018 (To Be Filed By April 1) 0707 Incurred Year 1 2011 2 2012 3 2013 4 2014 NONE A. Individual 5 2015 6 2016 NAIC Company Code 79413 7 8 2017 2018 XXX XXX XXX XXX XXX XXX PART 1 - Total (Direct and Transferred) Amount Paid Policyholders 1. 2. 3. 4. 5. 6. 7. 8. 9. Prior 2011 2012 2013 2014 2015 2016 2017 2018 1. 2. 3. 4. 5. 6. 7. 8. 9. Prior 2011 2012 2013 2014 2015 2016 2017 2018 1. 2. 3. 4. 5. 6. 7. 8. 9. Prior 2011 2012 2013 2014 2015 2016 2017 2018 1. 2. 3. 4. 5. 6. 7. 8. 9. Prior 2011 2012 2013 2014 2015 2016 2017 2018 XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX PART 2 - Sum of Total Amount Paid Policyholders and Claim Liability and Reserve Outstanding at End of Year 36 0 303-1 XXX XXX XXX XXX XXX XXX XXX 36 0 1 XXX XXX XXX XXX XXX XXX 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 0 0 XXX XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (1) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 PART 3 - Transferred Reserves NONE XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX PART 4 - Present Value of Incurred Claims 0 0 XXX XXX XXX XXX XXX XXX XXX 0 0 1 XXX XXX XXX XXX XXX XXX (36) 0 0 0 XXX XXX XXX XXX XXX (36) 0 0 0 0 XXX XXX XXX XXX (36) 0 0 0 0 0 XXX XXX XXX (35) 0 0 0 0 0 0 XXX XXX XXX SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company Long-Term Care Experience Reporting Form 3 - Group - Part 1 NONE Long-Term Care Experience Reporting Form 3 - Group - Part 2 NONE Long-Term Care Experience Reporting Form 3 - Group - Part 3 NONE Long-Term Care Experience Reporting Form 3 - Group - Part 4 NONE 303-2 SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company LONG-TERM CARE EXPERIENCE REPORTING FORM 3 (continued) LTC EXPERIENCE DEVELOPMENT ($000 OMITTED) Incurred Year 1 2011 2 2012 3 2013 4 2014 5 2015 6 2016 7 2017 XXX XXX XXX XXX XXX XXX 8 2018 C. Summary PART 1 - Total (Direct and Transferred) Amount Paid Policyholders 1. 2. 3. 4. 5. 6. 7. 8. 9. Prior 2011 2012 2013 2014 2015 2016 2017 2018 1. 2. 3. 4. 5. 6. 7. 8. 9. Prior 2011 2012 2013 2014 2015 2016 2017 2018 1. 2. 3. 4. 5. 6. 7. 8. 9. Prior 2011 2012 2013 2014 2015 2016 2017 2018 1. 2. 3. 4. 5. 6. 7. 8. 9. Prior 2011 2012 2013 2014 2015 2016 2017 2018 NONE XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX PART 2 - Sum of Total Amount Paid Policyholders and Claim Liability and Reserve Outstanding at End of Year 36 0 XXX XXX XXX XXX XXX XXX XXX 36 0 1 XXX XXX XXX XXX XXX XXX 0 0 0 0 XXX XXX XXX XXX XXX 0 0 0 0 0 XXX XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 303-3 XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (1) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 PART 3 - Transferred Reserves XXX XXX XXX XXX XXX XXX XXX NONE XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX PART 4 - Present Value of Incurred Claims 0 0 XXX XXX XXX XXX XXX XXX XXX 0 0 1 XXX XXX XXX XXX XXX XXX (36) 0 0 0 XXX XXX XXX XXX XXX (36) 0 0 0 0 XXX XXX XXX XXX (36) 0 0 0 0 0 XXX XXX XXX (35) 0 0 0 0 0 0 XXX XXX XXX *79413201830400000* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company LONG-TERM CARE EXPERIENCE REPORTING FORM 4 LIFE AND ANNUITY PRODUCTS WITH LTC ACCELERATED BENEFITS NAIC Group Code 0707 Incurred Year REPORTING YEAR 2018 (To Be Filed By April 1) 1 Number of Policies In Force 2 Number of Certificates NAIC Company Code 3 Death Claims A. Individual 1. Current 2. Prior 3. 2nd Prior B. Group 1. Current 2. Prior NONE 3. 2nd Prior C. Summary 1. Total Inception-to-Date Total Reserves are reserves for these particular life products with LTC accelerated benefits. Incurred claims are only the policies that claims have been triggered due to acceleration. 304 4 LTC Accelerated Claims 79413 5 Total Reserves *79413201830514100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company LONG-TERM CARE EXPERIENCE REPORTING FORM 5 EXPERIENCE IN THE STATE OF Illinois NAIC Group Code 0707 REPORTING YEAR 2018 (To Be Filed By April 1) NAIC Company Code 1 2 Earned Premiums Incurred Claims 3 Inforce Count End of Year 79413 4 Lives Inforce End of Year 1,813 0 1 1 0 0 0 0 1,813 0 1 1 Actual total reported experience through prior year 17,623 14,941 XXX XXX Actual total reported experience through statement year 19,436 14,941 XXX XXX 1. Individual 2. Group 3. Total 4. 5. 305.IL *79413201830536100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company LONG-TERM CARE EXPERIENCE REPORTING FORM 5 EXPERIENCE IN THE STATE OF Ohio NAIC Group Code 0707 REPORTING YEAR 2018 (To Be Filed By April 1) NAIC Company Code 1 2 Earned Premiums Incurred Claims 3 Inforce Count End of Year 79413 4 Lives Inforce End of Year 5,907 0 5 5 0 0 0 0 5,907 0 5 5 Actual total reported experience through prior year 48,593 38,079 XXX XXX Actual total reported experience through statement year 54,500 38,079 XXX XXX 1. Individual 2. Group 3. Total 4. 5. 305.OH *79413201830550100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company LONG-TERM CARE EXPERIENCE REPORTING FORM 5 EXPERIENCE IN THE STATE OF Wisconsin NAIC Group Code 0707 REPORTING YEAR 2018 (To Be Filed By April 1) NAIC Company Code 1 2 Earned Premiums Incurred Claims 3 Inforce Count End of Year 79413 4 Lives Inforce End of Year 6,243 0 5 5 0 0 0 0 6,243 0 5 5 Actual total reported experience through prior year 40,249 34,131 XXX XXX Actual total reported experience through statement year 46,492 34,131 XXX XXX 1. Individual 2. Group 3. Total 4. 5. 305.WI *79413201830559100* SUPPLEMENT FOR THE YEAR 2018 OF THE UnitedHealthcare Insurance Company LONG-TERM CARE EXPERIENCE REPORTING FORM 5 EXPERIENCE IN THE STATE OF Grand Total NAIC Group Code 0707 REPORTING YEAR 2018 (To Be Filed By April 1) NAIC Company Code 1 2 Earned Premiums Incurred Claims 3 Inforce Count End of Year 79413 4 Lives Inforce End of Year 13,963 0 11 0 0 0 0 13,963 0 11 11 Actual total reported experience through prior year 106,465 87,151 XXX XXX Actual total reported experience through statement year 120,428 87,151 XXX XXX 1. Individual 2. Group 3. Total 4. 5. 305.GT 11