*73288201820100100* HEALTH ANNUAL STATEMENT FOR THE YEAR ENDED DECEMBER 31, 2018 OF THE CONDITION AND AFFAIRS OF THE Humana Insurance Company NAIC Group Code 0119 0119 (Current) (Prior) Organized under the Laws of NAIC Company Code Wisconsin 73288 Employer's ID Number 39-1263473 , State of Domicile or Port of Entry Country of Domicile WI United States of America Licensed as business type: Life, Accident & Health Is HMO Federally Qualified? Yes [ ] No [ X ] 12/18/1968 Incorporated/Organized Statutory Home Office Commenced Business 1100 Employers Boulevard (Street and Number) , Main Administrative Office Mail Address P.O. Box 740036 (Street and Number or P.O. Box) , Primary Location of Books and Records 920-336-1100 (Area Code) (Telephone Number) Louisville, KY, US 40201-7436 (City or Town, State, Country and Zip Code) 500 West Main Street (Street and Number) , Louisville, KY, US 40202 (City or Town, State, Country and Zip Code) Internet Website Address Statutory Statement Contact DePere, WI, US 54115 (City or Town, State, Country and Zip Code) 1100 Employers Boulevard (Street and Number) , DePere, WI, US 54115 (City or Town, State, Country and Zip Code) 12/31/1968 502-580-1000 (Area Code) (Telephone Number) www.humana.com Elizabeth Lindsey (Name) DOIINQUIRIES@humana.com (E-mail Address) , , 502-580-8965 (Area Code) (Telephone Number) 502-580-2099 (FAX Number) OFFICERS Bruce Dale Broussard President & CEO SVP, Assoc Gen Counsel & Corp Sec Brian Andrew Kane Chief Financial Officer Joseph Christopher Ventura Vanessa Marie Olson SVP, Chief Actuary OTHER Alan James Bailey, VP & Treasurer Jeffrey Carl Fernandez, SVP, Medicare West and MarketPOINT Christopher Howal Hunter #, Segment President, Group Business Mark Matthew Matzke, SVP, Employer Group and Specialty Timothy Patrick O'Rourke, SVP, Medicare Divisional Leader Richard Donald Remmers, SVP, Employer Group Sales Charles Wilbur Dow Jr., Regional President William Kevin Fleming, Segment President, Healthcare Services Douglas Allen Edwards, Vice President Deborah Maureen Galloway, Regional President Brian Phillip LeClaire, Ph.D., Chief Information Officer Susan Lynn Mateja, Appointed Actuary Steven Edward McCulley, SVP, Medicare Sean Joseph O'Reilly #, VP, Chief Compliance Officer Bruno Roger Piquin, Regional President George Renaudin II, SVP, Medicare East & Provider Gilbert Alan Stewart #, SVP, Medicare Divisional Leader Daniel Andrew Tufto, SVP, Medicare Divisional Leader Timothy Alan Wheatley, Segment President, Retail Ralph Martin Wilson, Vice President William Mark Preston, VP, Investments Donald Hank Robinson, SVP, Tax Richard Andrew Vollmer Jr. #, SVP, Medicare Divisional Leader Cynthia Hillebrand Zipperle, SVP, Chief Accounting Officer & Controller DIRECTORS OR TRUSTEES Bruce Dale Broussard Kentucky Jefferson State of County of Brian Andrew Kane Timothy Alan Wheatley SS: The officers of this reporting entity being duly sworn, each depose and say that they are the described officers of said reporting entity, and that on the reporting period stated above, all of the herein described assets were the absolute property of the said reporting entity, free and clear from any liens or claims thereon, except as herein stated, and that this statement, together with related exhibits, schedules and explanations therein contained, annexed or referred to, is a full and true statement of all the assets and liabilities and of the condition and affairs of the said reporting entity as of the reporting period stated above, and of its income and deductions therefrom for the period ended, and have been completed in accordance with the NAIC Annual Statement Instructions and Accounting Practices and Procedures manual except to the extent that: (1) state law may differ; or, (2) that state rules or regulations require differences in reporting not related to accounting practices and procedures, according to the best of their information, knowledge and belief, respectively. Furthermore, the scope of this attestation by the described officers also includes the related corresponding electronic filing with the NAIC, when required, that is an exact copy (except for formatting differences due to electronic filing) of the enclosed statement. The electronic filing may be requested by various regulators in lieu of or in addition to the enclosed statement. Bruce Dale Broussard President & CEO Subscribed and sworn to before me this 22nd day of Julia Wentworth Notary Public January 10, 2021 Joseph Christopher Ventura SVP, Assoc Gen Counsel & Corp Sec February, 2019 a. Is this an original filing? b. If no, 1. State the amendment number 2. Date filed 3. Number of pages attached Alan James Bailey VP & Treasurer Yes [ X ] No [ ] *73288201821000100* SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company ACCIDENT AND HEALTH POLICY EXPERIENCE EXHIBIT FOR YEAR NAIC Group Code 0119 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 (24,425,438) 0 (24,425,438) 0 600 600 (28,829,222) 0 (28,829,222) 0 (149) (149) (3,396,558) 0 (3,396,558) 5 Number of Policies or Certificates as of Dec. 31 NAIC Company Code 73288 6 7 Number of Covered Lives Member Months as of Dec. 31 131.9 0.0 131.9 1 0 1 1 0 1 5,477 0 5,477 0 0 0 0.0 (24.8) (24.8) 0 0 0 0 0 0 0 0 0 0 0 0 0.0 0.0 0.0 0 0 0 0 0 0 0 0 0 32.7 0.0 32.7 0 0 0 0 0 0 107,756 0 107,756 0 0 0 0 0 0 3,305,736 0 3,305,736 1,189,169 0 1,189,169 0 28,471,391 28,471,391 0 7,132,989 7,132,989 0 0 0 0.0 25.1 25.1 0 128,354 128,354 0 160,527 160,527 0 1,891,626 1,891,626 0 0 0 0 0 0 0 0 0 0.0 0.0 0.0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.0 0.0 0.0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.0 0.0 0.0 0 0 0 0 0 0 0 0 0 (108,548) 0 (108,548) SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 0 426,178,821 0 426,178,821 327,726,824 0 327,726,824 2,201,867 0 2,201,867 77.4 0.0 77.4 201,493 0 201,493 201,493 0 201,493 2,397,496 0 2,397,496 0 93,106,629 93,106,629 0 45,750,168 45,750,168 0 0 0 0.0 49.1 49.1 0 245,953 245,953 0 305,726 305,726 0 3,716,827 3,716,827 0 0 0 0 0 0 0 0 0 0.0 0.0 0.0 0 0 0 0 0 0 0 0 0 0 13,310,999,952 13,310,999,952 0 10,902,567,550 10,902,567,550 0 0 0 0.0 81.9 81.9 0 1,299,200 1,299,200 0 1,299,200 1,299,200 0 15,473,777 15,473,777 0 0 0 0 0 0 0 0 0 0.0 0.0 0.0 0 0 0 0 0 0 0 0 0 0 3,404,717,205 3,404,717,205 0 2,172,285,245 2,172,285,245 0 0 0 0.0 63.8 63.8 0 4,844,372 4,844,372 0 4,844,372 4,844,372 0 58,395,582 58,395,582 1,193,317 0 1,193,317 929,999 0 929,999 278,387 0 278,387 101.3 0.0 101.3 0 0 0 0 0 0 29,137 0 29,137 406,252,436 16,837,295,777 17,243,548,213 301,016,770 13,127,735,803 13,428,752,573 73.8 78.0 77.9 201,494 6,517,879 6,719,373 201,494 6,609,825 6,811,319 2,539,866 79,477,812 82,017,678 (1,024,852) 0 (1,024,852) SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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)/1 691,707,700 489,428,992 1,181,136,692 81,456,733 226,112,665 0 1,488,706,090 521,401,918 407,746,704 929,148,622 74,825,829 173,368,657 0 1,177,343,108 19,069,650 80,787,642 0 2,702,463 352,069 825,272 0 0 29,449,185 0 285,572,071 5,465,150,006 28,114,716 2,896,044 7,403,625,208 13,131,090 51,038,029 0 931,359 111,825 715,168 0 0 20,431,150 0 205,562,009 4,775,294,007 21,572,374 404,137 6,266,534,256 0 218,298,885 0 208,919,427 XXX XXX XXX XXX 218,298,885 208,919,427 0 24,865,472,306 0 19,904,206,256 0 0 0 0 0 0 0 (965,999) 0 0 187,263 0 (500,886) 0 0 0 0 0 0 0 321,749 (957,873) 0 0 XXX XXX 5 Number of Policies or Certificates as of Dec. 31 0 (1,982,725) 7 Member Months 75.4 83.3 78.7 91.9 76.7 0.0 79.1 159,411 148,175 307,586 7,890 20,837 0 336,313 266,408 243,515 509,923 16,989 44,402 0 571,314 3,611,188 3,037,704 6,648,892 200,538 508,939 0 7,358,369 63.8 63.2 0.0 41.4 31.8 26.0 0.0 0.0 69.4 0.0 72.0 87.4 76.7 25.1 84.6 21,066 696,771 0 4,833 1,617 108 0 0 49,793 0 480,121 448,391 14,082 3,135 2,056,230 42,132 1,267,120 0 6,842 1,701 108 0 0 110,534 0 842,072 448,391 14,082 6,227 3,310,523 1,101,703 14,387,238 0 103,409 22,805 3,082 0 0 1,325,291 0 9,538,340 5,342,498 168,079 106,023 39,456,837 0.0 95.7 95.7 0 199,674 100,630 0 300,304 0 323,702 197,250 0 520,952 0 3,157,587 2,278,287 0 5,435,874 0.0 80.0 0 9,075,907 0 10,642,794 0 126,910,389 XXX XXX 0 6 Number of Covered Lives as of Dec. 31 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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. 17,243,548,213 0 17,243,548,213 0 4,605,155 17,238,943,058 U.S. Forms Direct Business Other Forms Direct Business Total Direct Business Reinsurance Assumed Less Reinsurance Ceded Total 2 Incurred Claims Amount 13,428,752,573 0 13,428,752,573 (44,092) 2,271,355 13,426,437,126 3 Change in Contract Reserves 4 Loss Ratio (2+3)/1 (1,024,852) 0 (1,024,852) 0 169,832 (1,194,684) 77.9 0.0 77.9 0.0 53.0 77.9 PART 2 – GROUP POLICIES SUMMARY 1 Description 1. 2. 3. 4. 5. 6. Premiums Earned 7,621,924,093 0 7,621,924,093 1,779,926 42,608,507 7,581,095,512 U.S. Forms Direct Business Other Forms Direct Business Total Direct Business Reinsurance Assumed Less Reinsurance Ceded Total 2 Incurred Claims Amount 6,475,453,683 0 6,475,453,683 1,601,600 30,573,313 6,446,481,970 3 Change in Contract Reserves 4 Loss Ratio (2+3)/1 (957,873) 0 (957,873) (941,135) (1,899,008) 0 84.9 0.0 84.9 37.1 67.3 85.0 210-4 PART 3 – CREDIT POLICIES (Individual and Group) 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 NONE Premiums Earned 2 Incurred Claims Amount 3 Change in Contract Reserves 4 Loss Ratio (2+3)/1 2 Incurred Claims Amount 3 Change in Contract Reserves 4 Loss Ratio (2+3)/1 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 24,865,472,306 0 24,865,472,306 1,779,926 47,213,662 24,820,038,570 19,904,206,256 0 19,904,206,256 1,557,508 32,844,668 19,872,919,096 (1,982,725) 0 (1,982,725) (941,135) (1,729,176) (1,194,684) 80.0 0.0 80.0 34.6 65.9 80.1 *73288201821601100* SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (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) Humana Insurance Company 2. 1100 Employers Boulevard DePere, WI 54115 (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 2 Small Group Employer 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 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) 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 73288 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 184,711 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 15,363,128 0 0 0 0 0 15,547,839 0 0 XXX XXX XXX 184,711 (222,842) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 15,363,128 726,785 0 0 15,547,839 503,943 XXX (34,552) 0 0 442,104 0 0 0 442,104 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 0 154,975 0 73,647 14,407,721 (667,761) 0 0 13,739,960 0 0 0 0 0 0 0 0 120,424 0 73,647 14,849,825 (667,761) 0 0 14,182,064 XXX XXX XXX XXX XXX 120,424 0 73,647 14,849,825 (667,761) 0 0 14,182,064 1,429,489 (15,944) 8,072 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 8,703,167 389 24 0 0 0 10,132,656 (15,556) 8,095 XXX XXX XXX 10,132,656 (15,556) 8,095 0 0 0 1,405,473 (494) 0 0 0 0 0 1,404,979 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8,703,532 (272,987) 0 XXX XXX XXX 0 8,430,545 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10,109,005 (273,482) 0 0 0 0 0 9,835,523 XXX XXX 0 0 0 10,109,005 (273,482) 0 0 0 0 0 9,835,523 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3.179 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 (3,589) (3,589) (0.008) 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 0 0 0 0 0 0 1,561 1 131 87,983 22,726 0 0 0 0 0 1,561 1 131 87,983 22,726 0 112,402 XXX 0 0.000 112,402 XXX 64,946 119,279 184,224 0.013 0 0 0 0.000 64,946 115,690 180,635 XXX XXX 0 0 0 0.000 15,547,839 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 1,561 1 131 87,983 22,726 0 112,402 XXX 0 0 0 64,946 115,690 180,635 XXX XXX XXX 15,547,839 503,943 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 57 (6,570) 9,790 0 3,278 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 0 129,345 1,156,090 144,738 (552,423) 0 877,751 0 0 0 0 0 0 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 129,345 1,156,148 138,169 (542,633) 0 881,029 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 3,172,476 XXX 3,172,476 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 (962,562) 0 0 0 0 0 0 0 0 0 4,135,038 0 3,172,476 XXX 129,345 1,156,148 138,169 (542,633) 0 881,029 XXX 3,172,476 0 0 0 OTHER INDICATORS: 216-2.AL 1. Number of certificates/policies 0 0 0 0 0 0 0 0 0 0 38,837 0 38,837 0 38,837 2. Number of Covered Lives 0 0 0 0 0 0 0 0 0 0 66,848 0 66,848 0 66,848 3. Number of Groups 0 0 0 0 0 0 0 0 280 0 280 0 280 4. Member Months 0 0 0 0 0 0 0 0 805,704 0 805,692 0 805,692 XXX (12) Is run off business reported in Columns 1 through 9 or 12? Yes [ XXX 0 ] No [ X ] 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 XXX 9,985,308 376,325 0 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 376,820 8,280 0 XXX (13,518,890) 2,382,627 0 0 9,409 0 0 XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF 1100 Employers Boulevard DePere, WI 54115 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 73288 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.AL Health Premiums Earned: 184,711 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) (8,280) 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 184,711 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 192,991 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 2,589,890 2.1 Paid claims during the year (733,776) 2.2 Direct claim liability current year 435,648 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 (8,280) 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 6,713 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 3,876 2.12a Healthcare receivables current year (2,837) 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 1,405,473 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 494 2.18 Ceded incurred claims to non-affiliates 0 2.19 Other adjustments due to MLR calculation - Claims 1,413,258 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) 4,858,864 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 15,362,535 41,004 40,411 593 0 0 0 0 0 0 15,363,128 0 (663,853) 3,908 0 14,695,367 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 15,547,246 41,004 40,411 593 (8,280) 0 0 0 0 0 15,547,839 0 (663,853) 3,908 0 14,888,358 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8,751,231 993,507 985,290 21,338 23,504 12,090 34,183 0 0 0 0 0 0 0 31,656 31,917 261 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 11,341,121 259,731 1,420,939 21,338 23,504 12,090 34,184 (8,280) 0 0 0 0 0 0 38,369 35,793 (2,576) 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 0 0 0 0 0 0 0 0 8,703,532 19,940 (266,213) 26,714 0 8,430,545 0 0 0 0 0 0 10,109,005 19,940 (266,213) 27,208 0 9,843,803 0 0 0 3,487,653 for stand-alone vision policies. 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF Alabama DURING THE YEAR All Expenses 1 2. 216-4.AL 3. Individual Comprehensive Coverage Expenses: 620 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 $ 6 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. 1100 Employers Boulevard DePere, WI 54115 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 (3,587) (1) 0 0 0 (1) (3,589) 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (3,589) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 73288 9 10 General Administrative Expenses Total Expenses (6 to 9) 9,783 3 1 0 0 60 9,847 0 (6,570) 3,278 0 6,196 2 0 0 0 60 6,258 0 (6,570) (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 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 Humana 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 *73288201821602100* SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (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) Humana Insurance Company 2. 1100 Employers Boulevard DePere, WI 54115 (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 2 Small Group Employer 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 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) 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 73288 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 1,836,624 0 0 0 0 0 1,836,624 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 1,836,624 (30,566) 0 0 1,836,624 (30,566) 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 36,096 0 890 1,830,204 (9,354) 0 0 1,820,850 0 0 0 0 0 0 0 0 36,096 0 890 1,830,204 (9,354) 0 0 1,820,850 XXX XXX XXX XXX XXX 36,096 0 890 1,830,204 (9,354) 0 0 1,820,850 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,231,352 0 0 0 0 0 1,231,352 0 0 XXX XXX XXX 1,231,352 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,231,352 0 0 0 0 0 0 1,231,352 XXX XXX 0 0 0 0 0 1,231,352 0 0 XXX XXX XXX 0 1,231,352 0 0 0 1,231,352 0 0 0 0 0 0 1,231,352 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 0 0 27,769 2,212 0 0 0 0 0 74 0 0 27,769 2,212 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 30,055 XXX 0 0.000 30,055 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 3,884 17,293 21,177 0.012 0 0 0 0.000 3,884 17,293 21,177 XXX XXX XXX XXX XXX 0 0 0 0.000 1,836,624 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 74 0 0 27,769 2,212 0 30,055 XXX 0 0 0 3,884 17,293 21,177 XXX XXX XXX 1,836,624 (30,566) SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 2,346 147,162 2,928 124,386 0 276,823 0 0 0 0 0 0 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 2,346 147,162 2,928 124,386 0 276,823 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 261,443 XXX 261,443 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 0 261,443 0 261,443 XXX 2,346 147,162 2,928 124,386 0 276,823 XXX 261,443 0 0 0 OTHER INDICATORS: 216-2.AK 1. Number of certificates/policies 0 0 0 0 0 0 0 0 0 0 1,129 0 1,129 0 1,129 2. Number of Covered Lives 0 0 0 0 0 0 0 0 0 0 1,216 0 1,216 0 1,216 3. Number of Groups 0 0 0 0 0 0 0 0 19 0 19 0 19 4. Member Months 0 0 0 0 0 0 0 0 14,070 0 14,070 0 14,070 XXX 0 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ X ] If yes, show the amount of premiums and claims included. Premiums $ XXX 0 0 Claims $ 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) 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 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 XXX XXX NONE XXX XXX 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF 1100 Employers Boulevard DePere, WI 54115 Alaska 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 73288 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.AK 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) 206,456 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 1,836,624 0 0 0 0 0 0 0 0 0 1,836,624 0 0 9,354 0 1,827,270 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,836,624 0 0 0 0 0 0 0 0 0 1,836,624 0 0 9,354 0 1,827,270 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,273,565 127,336 163,220 0 0 0 0 0 0 0 0 0 0 0 6,329 6,330 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,273,565 127,336 163,220 0 0 0 0 0 0 0 0 0 0 0 6,329 6,330 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,231,352 0 0 0 0 1,231,352 0 0 0 0 0 0 1,231,352 0 0 0 0 1,231,352 0 0 0 4,447 for stand-alone vision policies. 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF Alaska DURING THE YEAR All Expenses 1 2. 216-4.AK 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. 1100 Employers Boulevard DePere, WI 54115 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 73288 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 Humana 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 Humana 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 *73288201821603100* SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (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) Humana Insurance Company 2. 1100 Employers Boulevard DePere, WI 54115 (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 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) 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 73288 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 5,432 0 0 23,598,047 0 0 11,509,610 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 26,987,379 0 0 0 0 0 62,100,468 0 0 XXX XXX XXX 62,100,468 0 0 5,432 23,418 23,598,047 497,076 11,509,610 423,432 0 0 0 0 0 0 0 0 0 0 0 0 0 0 26,987,379 785,066 0 0 62,100,468 1,728,992 XXX (71,600) 62,100,468 1,657,392 3,541 0 11 (21,538) 0 0 0 (21,538) 461,654 0 17,410 22,621,906 0 0 0 22,621,906 229,444 0 7,158 10,849,576 0 0 0 10,849,576 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 0 0 0 0 0 0 0 0 555,318 0 48,640 25,598,356 (2,225) 0 0 25,596,130 0 0 0 0 0 0 0 0 1,249,957 0 73,220 59,048,299 (2,225) 0 0 59,046,074 (10,844) 0 1,904 XXX XXX XXX XXX XXX 1,239,114 0 75,124 59,128,839 (2,225) 0 0 59,126,613 149,829 (3,669) 3,352 18,060,249 2,070,905 422,991 9,022,142 546,483 102,011 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 18,391,377 (17) 250 0 0 0 45,623,597 2,613,702 528,605 XXX XXX XXX 45,623,597 2,613,702 528,605 0 0 0 142,808 (571) 0 0 0 0 0 142,236 0 0 0 19,708,163 0 (857,594) 954,044 866,368 769,918 0 19,708,163 0 0 0 9,466,614 0 35 0 0 0 0 9,466,649 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 18,391,110 (22,340) 0 XXX XXX XXX 0 18,368,770 0 0 0 0 0 0 0 0 0 0 0 0 0 0 47,708,694 (22,911) (857,559) 954,044 866,368 769,918 0 47,685,818 XXX XXX 0 0 0 47,708,694 (22,911) (857,559) 954,044 866,368 769,918 0 47,685,818 0 0 0 (239,519) 0 91,436 37,205 23,426 283,856 47,437 53,879 22,340 13,213 200,018 27,696 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (239,519) 4.490 483,361 0.893 317,147 0.902 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 12 (46,120) (46,108) 2.141 136,754 112,162 248,916 0.011 73,809 66,214 140,022 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 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 2,333 1 108 207,587 36,252 0 0 0 0 0 147,648 59,546 36,748 451,942 111,385 2,138 103 499 10,249 2,307 149,786 59,650 37,246 462,191 113,692 0 246,281 XXX 0 0.000 807,269 XXX 15,295 XXX 822,564 XXX 0 0 0 0.000 136,460 169,272 305,732 0.012 0 0 0 0.000 347,035 301,528 648,563 XXX 9,746 16,846 26,592 XXX 356,781 318,374 675,154 XXX XXX SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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) 0 212 414 (6,051) 0 (5,424) 3 Large Group Employer 80,398 431,919 54,758 1,605,591 0 2,172,667 4 5 Small Group Employer Individual 50,918 114,313 32,333 965,560 0 1,163,124 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 0 142,738 1,910,889 121,680 992,209 0 3,167,515 0 0 0 0 0 0 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 274,054 2,457,334 209,184 3,557,309 0 6,497,882 55,769 98,507 9,007 216,968 0 380,251 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 3,406,543 XXX 3,562,311 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 0 127,277 8,799 (237,366) 0 0 0 0 0 0 0 3,507,833 0 3,406,543 XXX XXX 329,823 2,555,841 218,191 3,774,277 0 6,878,132 3,064,944 497,367 497,367 0 OTHER INDICATORS: 216-2.AZ 1. Number of certificates/policies 0 8,591 5,366 0 0 0 0 0 0 0 48,509 0 62,466 179 62,645 2. Number of Covered Lives 0 13,836 9,057 0 0 0 0 0 0 0 81,813 0 104,706 309 105,015 3. Number of Groups 202 18 0 0 0 0 0 0 3,670 0 3,890 14 3,904 4. Member Months 0 186,501 104,383 0 0 0 0 0 0 907,032 0 1,197,916 3,765 1,201,681 XXX Is run off business reported in Columns 1 through 9 or 12? Yes [ XXX 0 ] No [ X ] 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 5,102 85,842 XXX 1,442,714 434,945 0 0 653,802 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 16 435,516 0 0 (296,497) XXX (1,303,801) 2,412,473 0 0 0 0 (1,016,266) XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF 1100 Employers Boulevard DePere, WI 54115 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 73288 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.AZ Health Premiums Earned: 5,432 23,598,047 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) 0 954,044 1.5 Paid rate credits 0 769,918 1.6 Reserve for rate credits current year 0 866,368 1.7 Reserve for rate credits prior year 0 (96,450) 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 5,432 23,598,047 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 5,432 22,740,453 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 442,440 18,157,064 2.1 Paid claims during the year 46,391 1,909,015 2.2 Direct claim liability current year 343,706 1,322,282 2.3 Direct claim liability prior year 0 35,874 2.4 Direct claim reserves current year 0 44,650 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 0 954,044 2.8 Paid rate credits 0 769,918 2.9 Reserve for rate credits current year 0 866,368 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 2,318 (115,548) 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 8,520 153,770 2.12a Healthcare receivables current year 6,201 269,318 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 + 2.9 142,808 19,708,163 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 571 0 2.18 Ceded incurred claims to non-affiliates 0 0 2.19 Other adjustments due to MLR calculation - Claims 142,236 18,850,569 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) 14,196,198 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 11,509,610 0 0 0 0 0 0 0 0 0 11,509,610 0 0 0 0 11,509,610 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 26,996,884 80,045 89,549 (9,504) 0 0 0 0 0 0 26,987,379 313 (2,539) 0 0 26,985,154 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 62,109,973 80,045 89,549 (9,504) 954,044 769,918 866,368 (96,450) 0 0 62,100,468 313 (2,539) 0 0 61,240,649 9,743,888 1,530,451 1,710,541 0 0 0 0 0 0 0 0 0 0 0 97,184 52,581 (44,604) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 17,746,464 2,344,859 1,668,030 40,716 46,637 455,832 449,352 0 0 0 0 0 0 0 32,743 32,934 192 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 46,089,856 5,830,715 5,044,558 76,590 91,287 455,832 449,351 954,044 769,918 866,368 0 0 0 0 16,697 247,805 231,108 0 0 9,466,614 0 0 0 35 9,466,649 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 18,391,110 49,365 (29,299) 42,405 0 18,368,770 0 0 0 0 0 0 47,708,694 49,365 (29,299) 42,977 35 46,828,224 0 0 0 1,963,153 for stand-alone vision policies. 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF Arizona DURING THE YEAR All Expenses 1 Individual Comprehensive Coverage Expenses: (17,169) for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services (1,077) for affiliated services) 1.3 EDP Equipment and Software (incl $ (29) for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 0 for affiliated services) 1.5 Accreditation and Certification (incl $ (5,669) 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 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 (1) 0 0 XXX Small Group Comprehensive Coverage Expenses: 126,136 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 9,197 for affiliated services) 2.3 EDP Equipment and Software (incl $ 227 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 77 for affiliated services) 2.5 Accreditation and Certification (incl $ 92,707 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 XXX XXX 0 0 27,895 48,532 2,354 59 0 12,597 91,436 0 1,244 35,298 102 2 9,132 9,570 660 16 XXX 558 37,205 0 XXX XXX 161,099 63,372 10,554 223 XXX 4,048 23,426 0 XXX (121,686) (51,475) (10,819) (271) 0 (55,267) (239,519) 0 0 0 0 (239,519) 0 XXX XXX 20 21 2 0 0 (30) 12 0 XXX (46,093) (12) (3) 0 0 (13) (46,120) 0 XXX 0 0 (239,519) 0 12 0 (46,120) 0 24,100 10,194 2,144 54 223,470 166,966 15,812 354 0 76,757 483,361 0 56,834 49,560 4,295 107 44 25,913 136,754 0 58,511 23,150 4,719 115 47 25,619 112,162 0 XXX 48,608 283,856 0 Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses Total (1 to 5) XXX (LOCATION) NAIC Company Code 2018 6 0 0 0 0 (55,266) (239,519) 0 XXX 0 0 XXX (121,687) (51,475) (10,819) (271) 0 0 0 0 0 XXX Large Group Comprehensive Coverage Expenses: 76,449 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 5,718 for affiliated services) 3.3 EDP Equipment and Software (incl $ 142 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 47 for affiliated services) 3.5 Accreditation and Certification (incl $ 41,922 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. 1100 Employers Boulevard DePere, WI 54115 10,945 47,437 0 XXX XXX XXX XXX 91,436 0 37,205 0 23,426 0 283,856 0 47,437 0 483,361 0 136,754 28,249 112,162 0 16,168 28,966 1,394 35 0 7,317 53,879 0 720 21,240 60 1 4,982 5,608 390 10 106,627 47,298 7,884 180 14,080 5,954 1,252 30 142,577 109,066 10,980 256 0 54,267 317,147 0 32,053 24,368 2,588 64 26 14,710 73,809 0 33,175 14,322 2,964 73 29 15,650 66,214 0 XXX XXX XXX 319 22,340 0 XXX 53,879 0 XXX 2,224 13,213 0 XXX 22,340 0 XXX 38,028 200,018 0 XXX 13,213 0 6,379 27,696 0 XXX 200,018 0 XXX 27,696 0 XXX 317,147 0 XXX 73,809 16,958 66,214 0 73288 9 10 General Administrative Expenses Total Expenses (6 to 9) (3,931) (565) 55 (19) 1 (1,379) (5,839) 0 414 (5,424) 0 (171,690) (52,031) (10,765) (290) 1 (56,689) (291,465) 0 414 (291,051) 0 922,543 327,065 67,142 1,693 683 798,783 2,117,909 0 54,758 2,172,667 0 1,261,359 566,741 91,969 2,270 774 927,072 2,850,186 0 54,758 2,904,943 28,249 556,680 197,429 40,647 1,028 413 334,595 1,130,791 0 32,333 1,163,124 0 764,486 345,185 57,179 1,421 469 419,222 1,587,961 0 32,333 1,620,293 16,958 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 Humana 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 *73288201821604100* SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (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) Humana Insurance Company 2. 1100 Employers Boulevard DePere, WI 54115 (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 2 Small Group Employer 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 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) 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 73288 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8,919,755 0 0 0 0 0 8,919,756 0 0 XXX XXX XXX 1 1,057 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8,919,755 (133,259) 0 0 8,919,756 (132,202) XXX 161 0 0 (1,218) 0 0 0 (1,218) 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16,300 0 12,414 9,024,300 (6,522) 0 0 9,017,778 0 0 0 0 0 0 0 0 16,461 0 12,414 9,023,082 (6,522) 0 0 9,016,561 XXX XXX XXX XXX XXX 16,461 0 12,414 9,023,086 (6,522) 0 0 9,016,565 (5,496) (1,064) 130 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7,027,662 175 19 0 0 0 7,022,165 (889) 149 XXX XXX XXX 7,022,165 (889) 149 0 0 0 (6,691) 0 0 0 0 0 0 (6,691) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7,021,128 9,330 0 0 0 0 0 7,030,458 XXX XXX 0 0 0 0 0 7,027,819 9,330 0 XXX XXX XXX 0 7,037,148 0 0 0 7,021,128 9,330 0 0 0 0 0 7,030,458 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 769 0 7 109,282 11,812 0 0 0 0 0 769 0 7 109,282 11,812 0 5.495 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 121,870 XXX 0 0.000 121,870 XXX 0 172 172 (0.142) 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 19,634 78,767 98,402 0.011 0 0 0 0.000 19,634 78,940 98,574 XXX XXX XXX XXX XXX 0 0 0 0.000 8,919,756 0 0 (4) (1) 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 769 0 7 109,282 11,812 0 121,870 XXX 0 0 0 19,634 78,940 98,574 XXX XXX XXX 8,919,756 (132,205) SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 31 10 0 41 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 30,190 948,791 28,657 (349,728) 0 657,910 0 0 0 0 0 0 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 30,190 948,792 28,688 (349,718) 0 657,951 0 0 0 19 0 20 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 1,107,708 XXX 1,107,691 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 5,260 0 0 0 0 0 0 0 0 0 1,102,448 0 1,107,708 XXX 30,190 948,792 28,689 (349,699) 0 657,971 XXX 1,107,691 0 0 0 OTHER INDICATORS: 216-2.AR 1. Number of certificates/policies 0 0 0 0 0 0 0 0 0 0 9,381 0 9,381 0 9,381 2. Number of Covered Lives 0 0 0 0 0 0 0 0 0 0 11,706 0 11,706 0 11,706 3. Number of Groups 0 0 0 0 0 0 0 0 38 0 38 0 38 4. Member Months 0 0 0 0 0 0 0 0 135,504 0 135,504 0 135,504 XXX 0 Is run off business reported in Columns 1 through 9 or 12? Yes [ XXX 0 ] No [ X ] 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 XXX 148,686 0 0 XXX 0 0 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 (106,659) 17,143 0 0 0 0 0 XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF 1100 Employers Boulevard DePere, WI 54115 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 73288 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.AR Health Premiums Earned: 1 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 1 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 1 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: (472) 2.1 Paid claims during the year 139 2.2 Direct claim liability current year 6,152 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 205 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) (16) 2.12a Healthcare receivables current year (221) 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 (6,691) 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 (6,691) 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) 1,258,089 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 8,922,636 18,700 21,580 (2,880) 0 0 0 0 0 0 8,919,755 0 (6,522) 0 0 8,913,233 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8,922,636 18,700 21,580 (2,880) 0 0 0 0 0 0 8,919,756 0 (6,522) 0 0 8,913,234 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7,010,717 822,358 766,330 0 0 (58) 12,047 0 0 0 0 0 0 0 26,822 26,801 (21) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7,010,245 822,497 772,482 0 0 (58) 12,048 0 0 0 0 0 0 0 27,027 26,785 (242) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7,027,819 0 6,744 (2,586) 0 7,037,148 0 0 0 0 0 0 7,021,128 0 6,744 (2,586) 0 7,030,458 0 0 0 406,719 for stand-alone vision policies. 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF DURING THE YEAR Arkansas All Expenses 1 2. 216-4.AR 3. Individual Comprehensive Coverage Expenses: 6 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 1 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 $ 6 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. 1100 Employers Boulevard DePere, WI 54115 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 60 49 10 0 0 53 172 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 172 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 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 73288 9 10 General Administrative Expenses Total Expenses (6 to 9) 4 2 0 0 0 3 10 0 31 41 0 64 51 11 0 0 56 182 0 31 213 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 0 0 0 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 Humana 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 *73288201821605100* SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (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) Humana Insurance Company 2. 1100 Employers Boulevard DePere, WI 54115 (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 2 Small Group Employer 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 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) 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 73288 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 84,651,507 0 0 0 0 0 84,651,507 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 84,651,507 (643,234) 0 0 84,651,507 (643,234) 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 1,631,730 0 47,377 83,615,635 (83,453) 0 0 83,532,181 0 0 0 0 0 0 0 0 1,631,730 0 47,377 83,615,635 (83,453) 0 0 83,532,181 XXX XXX XXX XXX XXX 1,631,730 0 47,377 83,615,635 (83,453) 0 0 83,532,181 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 63,522,321 73 431 0 0 0 63,522,321 73 431 XXX XXX XXX 63,522,321 73 431 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 63,521,964 (61,231) 0 XXX XXX XXX 0 63,460,733 0 0 0 0 0 0 0 0 0 0 0 0 0 0 63,521,964 (61,231) 0 0 0 0 0 63,460,733 XXX XXX 0 0 0 63,521,964 (61,231) 0 0 0 0 0 63,460,733 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 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 0 0 0 0 0 0 0 4,876 3 303 509,254 94,263 0 0 0 0 0 4,876 3 303 509,254 94,263 0 608,699 XXX 0 0.000 608,699 XXX 403,866 614,175 1,018,041 0.012 0 0 0 0.000 403,866 614,175 1,018,041 XXX XXX 0 0 0 0.000 84,651,507 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 4,876 3 303 509,254 94,263 0 608,699 XXX 0 0 0 403,866 614,175 1,018,041 XXX XXX XXX 84,651,507 (643,234) SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 0 296,954 8,633,486 166,608 6,458,424 0 15,555,472 0 0 0 0 0 0 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 296,954 8,633,486 166,608 6,458,424 0 15,555,472 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 2,889,236 XXX 2,889,236 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 2,889,236 0 2,889,236 XXX 296,954 8,633,486 166,608 6,458,424 0 15,555,472 XXX 2,889,236 0 0 0 OTHER INDICATORS: 216-2.CA 1. Number of certificates/policies 0 0 0 0 0 0 0 0 0 0 119,813 0 119,813 0 119,813 2. Number of Covered Lives 0 0 0 0 0 0 0 0 0 0 178,185 0 178,185 0 178,185 3. Number of Groups 0 0 0 0 0 0 0 0 4,425 0 4,425 0 4,425 4. Member Months 0 0 0 0 0 0 0 0 1,924,257 0 1,924,257 0 1,924,257 XXX 0 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ X ] If yes, show the amount of premiums and claims included. Premiums $ XXX 0 0 Claims $ 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) 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 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 XXX XXX NONE XXX XXX 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF 1100 Employers Boulevard DePere, WI 54115 California 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 73288 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.CA 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) 38,972,957 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 84,697,148 126,194 171,834 (45,641) 0 0 0 0 0 0 84,651,507 (490) (413) 82,550 0 84,568,054 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 84,697,148 126,194 171,834 (45,641) 0 0 0 0 0 0 84,651,507 (490) (413) 82,550 0 84,568,054 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 62,814,328 6,396,395 5,527,059 569,021 617,445 0 2,169 0 0 0 0 0 0 0 111,108 111,496 388 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 62,814,328 6,396,395 5,527,059 569,021 617,445 0 2,169 0 0 0 0 0 0 0 111,108 111,496 388 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 0 0 0 0 0 0 0 0 63,521,964 (95,377) (27,635) (61,781) 0 63,460,733 0 0 0 0 0 0 63,521,964 (95,377) (27,635) (61,781) 0 63,460,733 0 0 0 5,571,248 for stand-alone vision policies. 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF California DURING THE YEAR All Expenses 1 2. 216-4.CA 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. 1100 Employers Boulevard DePere, WI 54115 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 73288 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 Humana 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 Humana 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 *73288201821606100* SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (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) Humana Insurance Company 2. 1100 Employers Boulevard DePere, WI 54115 (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 2 Small Group Employer 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 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) 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 73288 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 (6,994) 0 0 14,386,762 0 0 3,243,382 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 45,211,099 0 0 0 0 0 62,834,249 0 0 XXX XXX XXX 62,834,249 0 0 (6,994) 2,355 14,386,761 589,816 3,243,382 (15,460) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 45,211,099 (626,857) 0 0 62,834,249 (50,147) XXX (74,884) 62,834,249 (125,031) 195 0 0 (9,544) 0 0 0 (9,544) 319,580 0 10,198 13,467,167 0 0 0 13,467,167 49,371 0 2,172 3,207,300 0 0 0 3,207,300 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 739,820 0 26,631 45,071,504 (87,022) 0 0 44,984,483 0 0 0 0 0 0 0 0 1,108,966 0 39,002 61,736,428 (87,022) 0 0 61,649,406 (11,331) 0 1,314 XXX XXX XXX XXX XXX 1,097,634 0 40,315 61,821,330 (87,022) 0 0 61,734,308 (11,938) (8,523) 405 10,125,717 806,727 110,979 3,082,076 103,521 22,428 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 42,150,559 78 0 0 0 0 55,346,414 901,804 133,812 XXX XXX XXX 55,346,414 901,804 133,812 0 0 0 (20,866) (35) 0 0 0 0 0 (20,901) 0 0 0 10,821,465 0 0 0 0 0 0 10,821,465 0 0 0 3,163,169 0 57,754 0 0 0 0 3,220,923 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 42,150,637 (28,993) 0 XXX XXX XXX 0 42,121,644 0 0 0 0 0 0 0 0 0 0 0 0 0 0 56,114,406 (29,028) 57,754 0 0 0 0 56,143,131 XXX XXX 0 0 0 56,114,406 (29,028) 57,754 0 0 0 0 56,143,131 0 0 0 0 (1) 47,189 19,240 11,551 65,281 25,661 12,174 5,028 3,048 34,585 6,271 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 (1) 2.186 168,922 0.816 61,105 1.005 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 (108) (108) 0.011 58,862 52,104 110,966 0.008 16,870 21,520 38,390 0.012 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 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 1,238 1 123 349,405 68,619 0 0 0 0 0 60,602 24,268 14,721 449,271 100,550 4,269 198 1,194 21,555 4,434 64,871 24,466 15,915 470,826 104,984 0 419,387 XXX 0 0.000 649,413 XXX 31,650 XXX 681,062 XXX 0 0 0 0.000 85,115 143,552 228,667 0.005 0 0 0 0.000 160,847 217,067 377,914 XXX 18,454 20,129 38,583 XXX 179,300 237,197 416,497 XXX XXX SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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) (69) 69 (80) 0 (81) 3 Large Group Employer 42,780 210,190 35,845 833,364 0 1,122,179 4 5 Small Group Employer Individual 14,501 40,939 7,266 285,718 0 348,423 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 87,294 1,912,664 82,526 931,540 0 3,014,023 0 0 0 0 0 0 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 144,574 2,163,723 125,705 2,050,542 0 4,484,544 20,925 154,472 5,412 179,480 0 360,289 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 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 11,548 1,243,635 (461,541) 0 0 0 0 0 0 0 (799,238) 0 (5,596) XXX XXX 165,499 2,318,195 131,117 2,230,022 0 4,844,832 (351,215) 305,803 (5,596) 305,803 0 0 XXX (45,412) OTHER INDICATORS: 216-2.CO 1. Number of certificates/policies 0 5,291 1,657 0 0 0 0 0 0 0 50,949 0 57,897 636 58,533 2. Number of Covered Lives 0 9,094 2,351 0 0 0 0 0 0 0 78,741 0 90,186 860 91,046 3. Number of Groups 109 3 0 0 0 0 0 0 4,131 0 4,243 38 4,281 4. Member Months 0 121,014 24,241 0 0 0 0 0 0 877,977 0 1,023,232 7,287 1,030,519 XXX Is run off business reported in Columns 1 through 9 or 12? Yes [ XXX 0 ] No [ X ] 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 1,722 614,474 781,605 621,087 (141,771) XXX (713,249) 26,894 133,171 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 26,929 0 0 XXX 302,282 0 0 0 0 XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF 1100 Employers Boulevard DePere, WI 54115 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 73288 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.CO Health Premiums Earned: (6,994) 14,386,762 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 (6,994) 14,386,762 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 (6,994) 14,386,762 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 86,845 11,574,197 2.1 Paid claims during the year 427 1,563,353 2.2 Direct claim liability current year 40,503 2,456,310 2.3 Direct claim liability prior year 0 569 2.4 Direct claim reserves current year 0 1,045 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 67,635 (140,701) 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) (2,576) 36,072 2.12a Healthcare receivables current year (70,211) 176,773 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 (20,866) 10,821,465 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 35 0 2.18 Ceded incurred claims to non-affiliates 0 0 2.19 Other adjustments due to MLR calculation - Claims (20,901) 10,821,465 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) 5,748,181 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 3,243,382 0 0 0 0 0 0 0 0 0 3,243,382 0 0 0 0 3,243,382 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 45,212,936 10,713 12,550 (1,837) 0 0 0 0 0 0 45,211,099 10,193 (65,418) 31,796 0 45,124,077 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 62,836,086 10,713 12,550 (1,837) 0 0 0 0 0 0 62,834,249 10,193 (65,418) 31,796 0 62,747,227 2,820,011 123,409 (273,448) 0 0 0 0 0 0 0 0 0 0 0 53,698 24,888 (28,810) 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 41,466,399 4,671,355 3,926,375 1,541 3,935 8,034 4,013 0 0 0 0 0 0 0 62,368 62,407 39 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 55,947,452 6,358,544 6,149,740 2,110 4,980 8,034 4,013 0 0 0 0 0 0 0 43,000 120,791 77,790 0 0 3,163,169 0 0 0 57,754 3,220,923 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 42,150,637 (37,843) 8,283 (566) 0 42,121,644 0 0 0 0 0 0 56,114,406 (37,843) 8,283 (531) 57,754 56,143,131 0 0 0 1,589,670 for stand-alone vision policies. 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF Colorado DURING THE YEAR All Expenses 1 Individual Comprehensive Coverage Expenses: (24) for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 1 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 $ (2) 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 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: 59,883 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 4,465 for affiliated services) 2.3 EDP Equipment and Software (incl $ 111 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 40 for affiliated services) 2.5 Accreditation and Certification (incl $ 45,087 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 XXX 0 0 0 0 14,306 25,132 1,238 31 0 6,482 47,189 0 600 18,313 53 1 4,367 4,873 346 9 34,099 19,448 2,123 43 XXX XXX 272 19,240 0 XXX XXX 1,956 11,551 0 XXX 0 0 0 0 0 0 (1) 0 0 (1) 0 XXX 0 0 XXX (1) 0 13,038 5,514 1,161 29 XXX 9,568 65,281 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses Total (1 to 5) XXX 5,919 25,661 0 XXX (LOCATION) NAIC Company Code 2018 6 0 0 0 0 0 0 0 0 0 XXX Large Group Comprehensive Coverage Expenses: 21,825 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 1,521 for affiliated services) 3.3 EDP Equipment and Software (incl $ 37 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 14 for affiliated services) 3.5 Accreditation and Certification (incl $ 12,110 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. 1100 Employers Boulevard DePere, WI 54115 0 0 0 0 0 0 0 0 XXX (221) 49 10 0 0 53 (108) 0 XXX (1) 0 0 0 (108) 0 66,411 73,280 4,922 113 0 24,197 168,922 0 27,869 15,822 2,257 57 23 12,834 58,862 0 25,730 11,435 2,360 58 24 12,497 52,104 0 XXX XXX XXX 47,189 0 19,240 0 11,551 0 65,281 0 25,661 0 168,922 0 58,862 14,864 52,104 0 3,658 6,544 312 8 0 1,653 12,174 0 153 4,793 14 0 1,165 1,276 87 2 25,281 4,857 1,011 12 3,187 1,347 284 7 33,444 18,817 1,708 29 0 7,108 61,105 0 7,916 4,678 622 15 6 3,632 16,870 0 12,368 3,959 821 20 8 4,343 21,520 0 XXX XXX XXX 69 5,028 0 XXX 12,174 0 XXX 517 3,048 0 XXX 5,028 0 XXX 3,424 34,585 0 XXX 3,048 0 1,446 6,271 0 XXX 34,585 0 XXX 6,271 0 XXX 61,105 0 XXX 16,870 4,015 21,520 0 73288 9 10 General Administrative Expenses Total Expenses (6 to 9) (20) (52) (1) 0 0 (77) (150) 0 69 (81) 0 (241) (3) 9 0 0 (24) (259) 0 69 (190) 0 478,816 169,824 35,112 880 358 401,344 1,086,334 0 35,845 1,122,179 0 598,826 270,361 44,650 1,108 404 450,873 1,366,222 0 35,845 1,402,067 14,864 164,527 58,136 12,054 302 123 106,015 341,157 0 7,266 348,423 0 218,255 85,590 15,205 366 137 121,099 440,652 0 7,266 447,918 4,015 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 Humana 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 *73288201821607100* SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (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) Humana Insurance Company 2. 1100 Employers Boulevard DePere, WI 54115 (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 2 Small Group Employer 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 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) 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 73288 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 4,793,574 0 (37,849) 0 0 0 4,793,574 0 (37,849) XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4,755,725 29,992 0 0 4,755,725 29,992 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 77,910 0 3,343 4,644,480 0 0 0 4,644,480 0 0 0 0 0 0 0 0 77,910 0 3,343 4,644,480 0 0 0 4,644,480 XXX XXX XXX XXX XXX 77,910 0 3,343 4,644,480 0 0 0 4,644,480 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,895,440 530 0 0 0 0 2,895,440 530 0 XXX XXX XXX 2,895,440 530 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,895,970 (9,164) 0 XXX XXX XXX 0 2,886,806 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,895,970 (9,164) 0 0 0 0 0 2,886,806 XXX XXX 0 0 0 2,895,970 (9,164) 0 0 0 0 0 2,886,806 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 0.000 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 0 0 0 0 0 0 0 91 0 9 53,660 6,044 0 0 0 0 0 91 0 9 53,660 6,044 0 59,803 XXX 0 0.000 59,803 XXX 13,878 38,554 52,433 0.011 0 0 0 0.000 13,878 38,554 52,433 XXX XXX 0 0 0 0.000 4,793,574 0 (37,849) 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 91 0 9 53,660 6,044 0 59,803 XXX 0 0 0 13,878 38,554 52,433 XXX XXX XXX 4,755,725 29,992 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 19,137 418,138 14,733 460,372 0 912,380 0 0 0 0 0 0 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 19,137 418,138 14,733 460,372 0 912,380 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 733,058 XXX 733,058 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 0 733,058 0 733,058 XXX 19,137 418,138 14,733 460,372 0 912,380 XXX 733,058 0 0 0 OTHER INDICATORS: 216-2.CT 1. Number of certificates/policies 0 0 0 0 0 0 0 0 0 0 6,240 0 6,240 0 6,240 2. Number of Covered Lives 0 0 0 0 0 0 0 0 0 0 8,397 0 8,397 0 8,397 3. Number of Groups 0 0 0 0 0 0 0 0 138 0 138 0 138 4. Member Months 0 0 0 0 0 0 0 0 105,764 0 105,764 0 105,764 XXX 0 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ X ] If yes, show the amount of premiums and claims included. Premiums $ XXX 0 0 Claims $ 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) 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 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 XXX XXX NONE XXX XXX 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF 1100 Employers Boulevard DePere, WI 54115 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 73288 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.CT 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) 1,498,615 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 4,790,249 28,980 25,655 3,326 0 0 0 0 0 0 4,793,574 0 0 0 0 4,793,574 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4,790,249 28,980 25,655 3,326 0 0 0 0 0 0 4,793,574 0 0 0 0 4,793,574 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,952,801 317,268 370,613 0 0 0 0 0 0 0 0 0 0 0 3,485 3,393 (92) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,952,801 317,268 370,613 0 0 0 0 0 0 0 0 0 0 0 3,485 3,393 (92) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,895,970 354,197 (352,513) 10,848 0 2,886,806 0 0 0 0 0 0 2,895,970 354,197 (352,513) 10,848 0 2,886,806 0 0 0 310,072 for stand-alone vision policies. 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF Connecticut DURING THE YEAR All Expenses 1 2. 216-4.CT 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. 1100 Employers Boulevard DePere, WI 54115 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 73288 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 Humana 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 Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 7. 8. 216-6.CT 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 *73288201821608100* SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (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) Humana Insurance Company 2. 1100 Employers Boulevard DePere, WI 54115 (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 2 Small Group Employer 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 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) 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 73288 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 4,542,589 0 0 0 0 0 4,542,589 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 4,542,589 11,523 0 0 4,542,589 11,523 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 86,465 0 6,131 4,438,470 0 0 0 4,438,470 0 0 0 0 0 0 0 0 86,465 0 6,131 4,438,470 0 0 0 4,438,470 XXX XXX XXX XXX XXX 86,465 0 6,131 4,438,470 0 0 0 4,438,470 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,842,438 250 (6) 0 0 0 2,842,438 250 (6) XXX XXX XXX 2,842,438 250 (6) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,842,694 0 0 0 0 0 0 2,842,694 XXX XXX 0 0 0 0 0 2,842,694 0 0 XXX XXX XXX 0 2,842,694 0 0 0 2,842,694 0 0 0 0 0 0 2,842,694 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 0 1 22,837 6,524 0 0 0 0 0 192 0 1 22,837 6,524 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 29,554 XXX 0 0.000 29,554 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 11,736 43,305 55,042 0.012 0 0 0 0.000 11,736 43,305 55,042 XXX XXX XXX XXX XXX 0 0 0 0.000 4,542,589 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 192 0 1 22,837 6,524 0 29,554 XXX 0 0 0 11,736 43,305 55,042 XXX XXX XXX 4,542,589 11,523 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 16,112 471,140 9,445 170,035 0 666,731 0 0 0 0 0 0 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 16,112 471,140 9,445 170,035 0 666,731 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 844,448 XXX 844,448 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 0 844,448 0 844,448 XXX 16,112 471,140 9,445 170,035 0 666,731 XXX 844,448 0 0 0 OTHER INDICATORS: 216-2.DE 1. Number of certificates/policies 0 0 0 0 0 0 0 0 0 0 5,406 0 5,406 0 5,406 2. Number of Covered Lives 0 0 0 0 0 0 0 0 0 0 5,628 0 5,628 0 5,628 3. Number of Groups 0 0 0 0 0 0 0 0 1 0 1 0 1 4. Member Months 0 0 0 0 0 0 0 0 69,872 0 69,872 0 69,872 XXX 0 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ X ] If yes, show the amount of premiums and claims included. Premiums $ XXX 0 0 Claims $ 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) 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 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 XXX XXX NONE XXX XXX 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF 1100 Employers Boulevard DePere, WI 54115 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 73288 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.DE 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) 977,364 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 4,543,193 14,848 15,452 (604) 0 0 0 0 0 0 4,542,589 0 0 0 0 4,542,589 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4,543,193 14,848 15,452 (604) 0 0 0 0 0 0 4,542,589 0 0 0 0 4,542,589 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,863,000 287,270 285,480 0 0 0 0 0 0 0 0 0 0 0 22,095 22,141 46 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,863,000 287,270 285,480 0 0 0 0 0 0 0 0 0 0 0 22,095 22,141 46 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,842,694 0 0 0 0 2,842,694 0 0 0 0 0 0 2,842,694 0 0 0 0 2,842,694 0 0 0 101,329 for stand-alone vision policies. 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF Delaware DURING THE YEAR All Expenses 1 2. 216-4.DE 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. 1100 Employers Boulevard DePere, WI 54115 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 73288 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 Humana 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 Humana 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 *73288201821609100* SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (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) Humana Insurance Company 2. 1100 Employers Boulevard DePere, WI 54115 (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 2 Small Group Employer 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 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) 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 73288 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 2,472,648 0 0 0 0 0 2,472,648 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 2,472,648 85,312 0 0 2,472,648 85,312 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 40,352 0 1,725 2,345,258 0 0 0 2,345,258 0 0 0 0 0 0 0 0 40,352 0 1,725 2,345,258 0 0 0 2,345,258 XXX XXX XXX XXX XXX 40,352 0 1,725 2,345,258 0 0 0 2,345,258 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,572,932 0 0 0 0 0 1,572,932 0 0 XXX XXX XXX 1,572,932 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,572,932 26,328 0 0 0 0 0 1,599,260 XXX XXX 0 0 0 0 0 1,572,932 26,328 0 XXX XXX XXX 0 1,599,260 0 0 0 1,572,932 26,328 0 0 0 0 0 1,599,260 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 0 345 0 2 900 2,898 0 0 0 0 0 345 0 2 900 2,898 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 4,144 0 0.000 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 0 0 0 0.000 31,161 18,797 49,958 XXX XXX XXX XXX 0 XXX XXX 0 0 0 0.000 31,161 18,797 49,958 0.021 2,472,648 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 2,472,648 85,312 0 0 0 0 0 4,144 345 0 2 900 2,898 0 XXX 0 0 0 XXX 4,144 XXX 31,161 18,797 49,958 XXX SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 14,921 188,298 8,942 230,273 0 442,434 0 0 0 0 0 0 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 14,921 188,298 8,942 230,273 0 442,434 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 249,463 XXX 249,463 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 0 249,463 0 249,463 XXX 14,921 188,298 8,942 230,273 0 442,434 XXX 249,463 0 0 0 OTHER INDICATORS: 216-2.DC 1. Number of certificates/policies 0 0 0 0 0 0 0 0 0 0 4,385 0 4,385 0 4,385 2. Number of Covered Lives 0 0 0 0 0 0 0 0 0 0 7,290 0 7,290 0 7,290 3. Number of Groups 0 0 0 0 0 0 0 0 144 0 144 0 144 4. Member Months 0 0 0 0 0 0 0 0 84,337 0 84,337 0 84,337 XXX 0 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ X ] If yes, show the amount of premiums and claims included. Premiums $ XXX 0 0 Claims $ 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) 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 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 XXX XXX NONE XXX XXX 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF 1100 Employers Boulevard DePere, WI 54115 District of Columbia 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 73288 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.DC 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) 2,107,544 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,472,956 5,962 6,270 (308) 0 0 0 0 0 0 2,472,648 106 (106) 0 0 2,472,648 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,472,956 5,962 6,270 (308) 0 0 0 0 0 0 2,472,648 106 (106) 0 0 2,472,648 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,579,741 192,371 174,788 156,884 181,193 0 0 0 0 0 0 0 0 0 84 114 30 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,579,741 192,371 174,788 156,884 181,193 0 0 0 0 0 0 0 0 0 84 114 30 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,572,932 (4,315) (899) (31,542) 0 1,599,260 0 0 0 0 0 0 1,572,932 (4,315) (899) (31,542) 0 1,599,260 0 0 0 63,301 for stand-alone vision policies. 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF District of Columbia DURING THE YEAR All Expenses 1 2. 216-4.DC 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. 1100 Employers Boulevard DePere, WI 54115 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 73288 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 Humana 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 Humana 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 *73288201821610100* SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (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) Humana Insurance Company 2. 1100 Employers Boulevard DePere, WI 54115 (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 2 Small Group Employer 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 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) 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 73288 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 0 124,732,732 0 0 0 0 0 124,732,732 0 0 XXX XXX XXX 124,732,732 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 124,732,732 3,854,898 0 0 124,732,732 3,854,898 XXX (186,763) 124,732,732 3,668,135 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,044,314 0 183,052 119,650,468 (163,761) 0 0 119,486,706 0 0 0 0 0 0 0 0 1,044,314 0 183,052 119,650,468 (163,761) 0 0 119,486,706 (28,137) 0 3,541 XXX XXX XXX XXX XXX 1,016,177 0 186,593 119,861,827 (163,761) 0 0 119,698,065 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 87,695,802 0 (1) 0 0 0 87,695,802 0 (1) XXX XXX XXX 87,695,802 0 (1) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 87,695,802 (66,770) 0 XXX XXX XXX 0 87,629,033 0 0 0 0 0 0 0 0 0 0 0 0 0 0 87,695,802 (66,770) 0 0 0 0 0 87,629,033 XXX XXX 0 0 0 87,695,802 (66,770) 0 0 0 0 0 87,629,033 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 0.000 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 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 17,431 13 1,393 354,873 180,508 0 0 0 0 0 17,431 13 1,393 354,873 180,508 10,612 495 3,602 77,902 11,411 28,043 507 4,995 432,775 191,919 0 554,217 XXX 0 0.000 554,217 XXX 104,022 XXX 658,239 XXX 0 0 0 0.000 859,642 872,400 1,732,042 0.014 0 0 0 0.000 859,642 872,400 1,732,042 XXX 52,023 51,898 103,921 XXX 911,665 924,298 1,835,963 XXX XXX SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 1,215,980 9,939,758 703,997 10,906,719 0 22,766,455 0 0 0 0 0 0 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 1,215,980 9,939,758 703,997 10,906,719 0 22,766,455 50,120 363,459 16,623 481,236 0 911,437 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 6,804,960 XXX 7,050,091 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 6,804,960 0 6,804,960 XXX XXX 1,266,101 10,303,217 720,619 11,387,955 0 23,677,892 5,896,939 1,153,152 1,153,152 0 OTHER INDICATORS: 216-2.FL 1. Number of certificates/policies 0 0 0 0 0 0 0 0 0 0 429,123 0 429,123 1,929 431,052 2. Number of Covered Lives 0 0 0 0 0 0 0 0 0 0 741,389 0 741,389 2,537 743,926 3. Number of Groups 0 0 0 0 0 0 0 0 11,547 0 11,547 106 11,653 4. Member Months 0 0 0 0 0 0 0 0 8,642,163 0 8,642,163 17,308 8,659,471 XXX 0 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ X ] If yes, show the amount of premiums and claims included. Premiums $ XXX 0 0 Claims $ 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) 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 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 XXX XXX NONE XXX XXX 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF 1100 Employers Boulevard DePere, WI 54115 Florida 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 73288 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.FL 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) 88,062,957 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 0 124,784,782 460,414 512,464 (52,050) 0 0 0 0 0 0 124,732,732 (4,940) (76,456) 82,365 0 124,568,970 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 124,784,782 460,414 512,464 (52,050) 0 0 0 0 0 0 124,732,732 (4,940) (76,456) 82,365 0 124,568,970 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 85,400,198 8,471,803 6,137,688 99,504 126,281 (1,386) 1,082 0 0 0 0 0 0 0 9,265 9,348 84 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 85,400,198 8,471,803 6,137,688 99,504 126,281 (1,386) 1,082 0 0 0 0 0 0 0 9,265 9,348 84 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 87,695,802 (114,535) (1,489) (49,254) 0 87,629,033 0 0 0 0 0 0 87,695,802 (114,535) (1,489) (49,254) 0 87,629,033 0 0 0 30,927,417 for stand-alone vision policies. 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF Florida DURING THE YEAR All Expenses 1 2. 216-4.FL 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. 1100 Employers Boulevard DePere, WI 54115 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 73288 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 Humana 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 Humana 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 *73288201821611100* SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (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) Humana Insurance Company 2. 1100 Employers Boulevard DePere, WI 54115 (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 2 Small Group Employer 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 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) 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 73288 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 90,279,199 0 0 42,806,501 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 108,875,623 0 0 0 0 0 241,961,325 0 0 XXX XXX XXX 241,961,325 0 0 2 (68,417) 90,279,199 5,090,550 42,806,501 760,642 0 0 0 0 0 0 0 0 0 0 0 0 0 0 108,875,623 2,567,724 0 0 241,961,325 8,350,499 XXX (48,680) 241,961,325 8,301,819 (10,428) 0 0 78,846 0 0 0 78,846 2,253,585 0 57,787 82,877,277 0 0 0 82,877,277 750,141 0 21,569 41,274,149 0 0 0 41,274,149 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 2,283,741 0 148,348 103,875,809 (310,843) 0 0 103,564,967 0 0 0 0 0 0 0 0 5,277,039 0 227,704 228,106,082 (310,843) 0 0 227,795,239 (7,339) 0 865 XXX XXX XXX XXX XXX 5,269,701 0 228,569 228,161,236 (310,843) 0 0 227,850,393 354,538 (1,677) 180 58,887,255 1,333,670 250,852 41,357,499 260,069 63,404 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 79,553,430 (44) 0 0 0 0 180,152,721 1,592,019 314,436 XXX XXX XXX 180,152,721 1,592,019 314,436 0 0 0 352,681 0 0 0 0 0 0 352,681 0 0 0 59,970,074 0 (1,332,963) 425,965 0 906,998 0 59,970,074 0 0 0 41,554,164 0 18 0 0 0 0 41,554,182 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 79,553,386 (157,375) 0 XXX XXX XXX 0 79,396,011 0 0 0 0 0 0 0 0 0 0 0 0 0 0 181,430,304 (157,375) (1,332,945) 425,965 0 906,998 0 181,272,948 XXX XXX 0 0 0 181,430,304 (157,375) (1,332,945) 425,965 0 906,998 0 181,272,948 2 0 0 0 0 0 0 0 284,231 118,342 67,173 336,308 155,067 157,108 66,150 36,476 184,178 84,156 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4.473 961,121 0.735 528,068 1.020 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 (6,812) (6,812) (0.086) 341,447 280,957 622,404 0.008 186,251 126,412 312,663 0.008 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 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 6,233 4 433 305,277 159,389 0 0 0 0 0 447,572 184,496 104,082 825,763 398,612 2,557 116 827 14,071 2,855 450,129 184,612 104,909 839,835 401,467 0 471,336 XXX 0 0.000 1,960,525 XXX 20,426 XXX 1,980,951 XXX 0 0 0 0.000 356,250 491,125 847,375 0.008 0 0 0 0.000 883,948 891,682 1,775,630 XXX 14,734 11,646 26,380 XXX 898,682 903,327 1,802,010 XXX XXX SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 (1,980) (2) 0 (1,982) 3 Large Group Employer 259,968 208,765 267,678 5,019,751 0 5,756,162 4 5 Small Group Employer Individual 156,973 (411,183) 74,798 2,785,359 0 2,605,948 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 0 624,445 6,690,017 369,200 5,135,118 0 12,818,780 0 0 0 0 0 0 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 1,041,386 6,487,600 709,697 12,940,226 0 21,178,908 12,427 111,945 4,256 115,853 0 244,481 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) 15,567,516 (3,726,710) 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 21,607,229 XXX 21,710,954 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 (265,041) 0 0 0 0 0 0 0 10,031,464 0 21,607,229 XXX XXX 1,053,813 6,599,545 713,953 13,056,079 0 21,423,389 21,371,095 339,859 339,859 0 OTHER INDICATORS: 216-2.GA 1. Number of certificates/policies 0 51,699 28,082 0 0 0 0 0 0 0 182,970 0 262,751 291 263,042 2. Number of Covered Lives 0 86,761 44,830 0 0 0 0 0 0 0 302,895 0 434,486 508 434,994 3. Number of Groups 178 19 0 0 0 0 0 0 17,299 0 17,496 28 17,524 4. Member Months 1,116,320 577,202 0 0 0 0 0 0 3,328,651 0 5,022,176 4,267 5,026,443 XXX 3 Is run off business reported in Columns 1 through 9 or 12? Yes [ XXX 0 ] No [ X ] 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 0 504,230 53,617 XXX 157,498 0 (62,445) XXX 0 0 0 0 ACA Receipts and Payments 4. Permanent ACA Risk Adjustment Program 4.0 Premium adjustments receipts/(payments) 2 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 (131,961) 159,738 0 0 0 0 603,834 XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF 1100 Employers Boulevard DePere, WI 54115 Georgia 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 73288 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.GA Health Premiums Earned: 2 90,279,199 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) 0 425,965 1.5 Paid rate credits 0 906,998 1.6 Reserve for rate credits current year 0 0 1.7 Reserve for rate credits prior year 0 906,998 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 2 90,279,199 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 2 88,946,236 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 1,064,874 58,724,938 2.1 Paid claims during the year 27,781 6,162,017 2.2 Direct claim liability current year 741,190 6,125,707 2.3 Direct claim liability prior year 0 33,106 2.4 Direct claim reserves current year 0 27,006 2.5 Direct claim reserves prior year 0 0 2.6 Direct contract reserves current year 1 0 2.7 Direct contract reserves prior year 0 425,965 2.8 Paid rate credits 0 906,998 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 (1,216) 130,237 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 3,565 281,550 2.12a Healthcare receivables current year 4,780 151,312 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 + 2.9 352,681 59,970,074 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 352,681 58,637,111 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) 35,224,188 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 42,806,501 0 0 0 0 0 0 0 0 0 42,806,501 0 0 0 0 42,806,501 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 108,898,193 70,190 92,759 (22,569) 0 0 0 0 0 0 108,875,623 13,304 (245,320) 78,827 0 108,564,781 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 241,983,894 70,190 92,759 (22,569) 425,965 906,998 0 906,998 0 0 241,961,325 13,304 (245,320) 78,827 0 240,317,519 41,470,297 4,331,797 4,226,829 4 0 0 0 0 0 0 0 0 0 0 21,105 49,478 28,373 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 72,579,113 11,714,597 5,887,447 39,425 49,650 6,518,492 5,221,299 0 0 0 0 0 0 0 139,844 139,443 (401) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 173,839,222 22,236,192 16,981,173 72,535 76,657 6,518,492 5,221,301 425,965 906,998 0 0 0 0 0 289,970 474,034 184,064 0 0 41,554,164 0 0 0 18 41,554,182 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 79,553,386 182,903 (109,369) 230,909 0 79,396,011 0 0 0 0 0 0 181,430,304 182,903 (109,369) 230,909 18 179,939,985 0 0 0 9,027,706 for stand-alone vision policies. 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF Georgia DURING THE YEAR All Expenses 1 2. Individual Comprehensive Coverage Expenses: (681) 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.GA 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: 351,250 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 26,822 for affiliated services) 2.3 EDP Equipment and Software (incl $ 670 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 244 for affiliated services) 2.5 Accreditation and Certification (incl $ 164,271 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 (6,808) (2) 0 0 0 (1) (6,812) 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (6,812) 0 84,771 153,352 7,448 187 0 38,473 284,231 0 3,636 112,725 322 8 24,627 29,298 2,082 52 149,395 120,967 11,227 259 78,774 33,321 7,005 176 341,203 449,662 28,084 681 0 141,492 961,121 0 159,425 94,191 13,605 341 139 73,747 341,447 0 125,372 67,729 14,109 352 143 73,251 280,957 0 XXX Large Group Comprehensive Coverage Expenses: 191,512 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 15,015 for affiliated services) 3.3 EDP Equipment and Software (incl $ 374 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 137 for affiliated services) 3.5 Accreditation and Certification (incl $ 38,474 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. 1100 Employers Boulevard DePere, WI 54115 XXX XXX 1,651 118,342 0 XXX XXX 11,115 67,173 0 XXX XXX 54,460 336,308 0 XXX 35,793 155,067 0 XXX XXX XXX XXX 284,231 0 118,342 0 67,173 0 336,308 0 155,067 0 961,121 0 341,447 89,604 280,957 0 46,421 85,394 4,110 103 0 21,081 157,108 0 2,005 63,062 178 4 13,154 16,193 1,148 29 78,807 70,745 5,902 136 42,769 18,088 3,803 93 183,156 253,482 15,141 364 0 75,925 528,068 0 88,037 49,504 7,709 193 78 40,731 186,251 0 32,994 40,743 8,534 213 87 43,840 126,412 0 XXX XXX XXX 902 66,150 0 XXX 157,108 0 XXX 5,952 36,476 0 XXX 66,150 0 XXX 28,588 184,178 0 XXX 36,476 0 19,403 84,156 0 XXX 184,178 0 XXX 84,156 0 XXX 528,068 0 XXX 186,251 50,443 126,412 0 73288 9 10 General Administrative Expenses Total Expenses (6 to 9) (5) 1 0 0 0 1 (2) 0 (1,980) (1,982) 0 (6,813) 0 0 0 0 0 (6,814) 0 (1,980) (8,793) 0 2,886,498 1,027,863 212,423 5,322 2,161 1,354,216 5,488,484 0 267,678 5,756,162 0 3,512,498 1,639,445 268,221 6,695 2,443 1,642,706 7,072,009 0 267,678 7,339,687 89,604 1,610,933 573,027 118,767 2,974 1,208 224,241 2,531,150 0 74,798 2,605,948 0 1,915,120 916,755 150,151 3,744 1,372 384,738 3,371,880 0 74,798 3,446,678 50,443 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 Humana 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 *73288201821612100* SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (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) Humana Insurance Company 2. 1100 Employers Boulevard DePere, WI 54115 (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 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) 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 73288 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 2,187,071 0 0 0 0 0 2,187,071 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 2,187,071 (180,758) 0 0 2,187,071 (180,758) 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 61,872 0 3,411 2,302,547 0 0 0 2,302,547 0 0 0 0 0 0 0 0 61,872 0 3,411 2,302,547 0 0 0 2,302,547 XXX XXX XXX XXX XXX 61,872 0 3,411 2,302,547 0 0 0 2,302,547 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,509,443 0 0 0 0 0 2,509,443 0 0 XXX XXX XXX 2,509,443 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,509,443 0 0 0 0 0 0 2,509,443 XXX XXX 0 0 0 0 0 2,509,443 0 0 XXX XXX XXX 0 2,509,443 0 0 0 2,509,443 0 0 0 0 0 0 2,509,443 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 0 0 35,350 2,923 0 0 0 0 0 10 0 0 35,350 2,923 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 38,283 XXX 0 0.000 38,283 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 3,401 24,332 27,733 0.012 0 0 0 0.000 3,401 24,332 27,733 XXX XXX XXX XXX XXX 0 0 0 0.000 2,187,071 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 10 0 0 35,350 2,923 0 38,283 XXX 0 0 0 3,401 24,332 27,733 XXX XXX XXX 2,187,071 (180,758) SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 4,670 193,800 (29,906) (182,321) 0 (13,757) 0 0 0 0 0 0 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 4,670 193,800 (29,906) (182,321) 0 (13,757) 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 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 0 0 0 0 0 0 0 0 0 0 (259,154) 0 (259,154) XXX 4,670 193,800 (29,906) (182,321) 0 (13,757) XXX (259,154) 0 (259,154) 0 0 0 XXX (259,154) OTHER INDICATORS: 216-2.HI 1. Number of certificates/policies 0 0 0 0 0 0 0 0 0 0 1,266 0 1,266 0 1,266 2. Number of Covered Lives 0 0 0 0 0 0 0 0 0 0 1,266 0 1,266 0 1,266 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 15,179 0 15,179 0 15,179 XXX 0 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ X ] If yes, show the amount of premiums and claims included. Premiums $ XXX 0 0 Claims $ 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) 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 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 XXX XXX NONE XXX XXX 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF 1100 Employers Boulevard DePere, WI 54115 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 73288 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) 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 2,187,071 0 0 0 0 0 0 0 0 0 2,187,071 0 0 0 0 2,187,071 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,187,071 0 0 0 0 0 0 0 0 0 2,187,071 0 0 0 0 2,187,071 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,524,103 292,703 303,917 0 0 0 0 0 0 0 0 0 0 0 3,446 3,446 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,524,103 292,703 303,917 0 0 0 0 0 0 0 0 0 0 0 3,446 3,446 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,509,443 0 0 0 0 2,509,443 0 0 0 0 0 0 2,509,443 0 0 0 0 2,509,443 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 Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF Hawaii DURING THE YEAR All Expenses 1 2. 216-4.HI 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. 1100 Employers Boulevard DePere, WI 54115 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 73288 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 Humana 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 Humana 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 *73288201821613100* SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (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) Humana Insurance Company 2. 1100 Employers Boulevard DePere, WI 54115 (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 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) 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 73288 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 2,604,158 0 0 0 0 0 2,604,158 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 2,604,158 210,933 0 0 2,604,158 210,933 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 69,979 0 10,938 2,312,308 0 0 0 2,312,308 0 0 0 0 0 0 0 0 69,979 0 10,938 2,312,308 0 0 0 2,312,308 XXX XXX XXX XXX XXX 69,979 0 10,938 2,312,308 0 0 0 2,312,308 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 1,874,511 3 0 0 0 0 1,874,511 3 0 XXX XXX XXX 1,874,511 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,874,514 0 0 0 0 0 0 1,874,514 XXX XXX 0 0 0 0 0 1,874,514 0 0 XXX XXX XXX 0 1,874,514 0 0 0 1,874,514 0 0 0 0 0 0 1,874,514 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 1 74,858 3,331 0 0 0 0 0 4 0 1 74,858 3,331 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 78,194 XXX 0 0.000 78,194 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 3,548 23,243 26,791 0.012 0 0 0 0.000 3,548 23,243 26,791 XXX XXX XXX XXX XXX 0 0 0 0.000 2,604,158 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 4 0 1 74,858 3,331 0 78,194 XXX 0 0 0 3,548 23,243 26,791 XXX XXX XXX 2,604,158 210,933 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 13,035 223,820 50,909 (1,266,352) 0 (978,588) 0 0 0 0 0 0 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 13,035 223,820 50,909 (1,266,352) 0 (978,588) 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 1,311,397 XXX 1,311,397 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 1,311,397 0 1,311,397 XXX 13,035 223,820 50,909 (1,266,352) 0 (978,588) XXX 1,311,397 0 0 0 OTHER INDICATORS: 216-2.ID 1. Number of certificates/policies 0 0 0 0 0 0 0 0 0 0 1,653 0 1,653 0 1,653 2. Number of Covered Lives 0 0 0 0 0 0 0 0 0 0 1,738 0 1,738 0 1,738 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 20,842 0 20,842 0 20,842 XXX 0 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ X ] If yes, show the amount of premiums and claims included. Premiums $ XXX 0 0 Claims $ 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) 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 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 XXX XXX NONE XXX XXX 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF 1100 Employers Boulevard DePere, WI 54115 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 73288 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.ID 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 2,604,496 1,413 1,752 (338) 0 0 0 0 0 0 2,604,158 0 0 0 0 2,604,158 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,604,496 1,413 1,752 (338) 0 0 0 0 0 0 2,604,158 0 0 0 0 2,604,158 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,729,403 234,768 216,923 0 0 696,417 558,339 0 0 0 0 0 0 0 10,812 10,843 31 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,729,403 234,768 216,923 0 0 696,417 558,339 0 0 0 0 0 0 0 10,812 10,843 31 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,874,514 0 0 0 0 1,874,514 0 0 0 0 0 0 1,874,514 0 0 0 0 1,874,514 0 0 0 85,244 for stand-alone vision policies. 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF Idaho DURING THE YEAR All Expenses 1 2. 216-4.ID 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. 1100 Employers Boulevard DePere, WI 54115 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 73288 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 Humana 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 Humana 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 *73288201821614100* SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (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) Humana Insurance Company 2. 1100 Employers Boulevard DePere, WI 54115 (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 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) 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 73288 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 176,459 0 0 106,729,203 0 0 96,558,889 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 36,216,528 0 0 0 0 0 239,681,079 0 0 XXX XXX XXX 239,681,079 0 0 176,459 (52,270) 106,729,203 3,600,559 96,558,889 2,224,460 0 0 0 0 0 0 0 0 0 0 0 0 0 0 36,216,528 (3,763,187) 0 0 239,681,079 2,009,562 XXX (4,136,651) 239,681,079 (2,127,089) (9,233) 0 1,448 236,514 0 0 0 236,514 736,842 0 49,637 102,342,165 0 0 0 102,342,165 310,173 0 44,416 93,979,840 0 0 0 93,979,840 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (495,387) 0 130,305 40,344,798 (386,969) 0 0 39,957,829 0 0 0 0 0 0 0 0 542,394 0 225,807 236,903,317 (386,969) 0 0 236,516,348 (620,338) 0 117,697 XXX XXX XXX XXX XXX (77,944) 0 343,503 241,542,609 (386,969) 0 0 241,155,640 (842,041) (32,349) 109 68,363,661 14,442,479 3,047,199 73,749,763 14,259,420 2,951,802 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 25,682,320 604 135 0 0 0 166,953,703 28,670,154 5,999,244 XXX XXX XXX 166,953,703 28,670,154 5,999,244 0 0 0 (874,498) (137,162) 284,307 1,041,976 1,326,283 0 0 (1,011,661) 0 0 0 79,758,941 0 0 0 0 0 0 79,758,941 0 0 0 85,057,382 0 483,198 0 0 0 0 85,540,580 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 25,682,789 (69,669) 0 XXX XXX XXX 0 25,613,120 0 0 0 0 0 0 0 0 0 0 0 0 0 0 189,624,613 (206,831) 767,505 1,041,976 1,326,283 0 0 189,900,980 XXX XXX 0 0 0 189,624,613 (206,831) 767,505 1,041,976 1,326,283 0 0 189,900,980 (16) 0 (3) 0 478 337,250 134,598 97,036 821,109 174,020 344,045 137,901 97,851 838,360 176,202 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 459 (3.695) 1,564,013 0.795 1,594,359 0.922 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 64,308 64,308 0.272 593,249 510,925 1,104,174 0.011 598,640 536,489 1,135,129 0.012 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 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 3,332 2 250 163,275 49,138 0 0 0 0 0 684,611 272,501 195,134 1,822,744 399,838 528,518 24,568 157,320 134,857 528,772 1,213,129 297,069 352,454 1,957,601 928,610 0 215,997 XXX 0 0.000 3,374,829 XXX 1,374,035 XXX 4,748,864 XXX 0 0 0 0.000 183,918 227,824 411,742 0.010 0 0 0 0.000 1,375,807 1,339,545 2,715,353 XXX 2,351,785 2,279,511 4,631,296 XXX 3,727,593 3,619,056 7,346,649 XXX XXX SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 (12,060) 6,253 206,206 0 200,400 3 Large Group Employer 307,191 3,583,340 260,303 6,018,167 0 10,169,000 4 5 Small Group Employer Individual 321,202 3,555,363 187,776 6,154,318 0 10,218,658 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 0 232,411 2,516,411 86,106 27,363,994 0 30,198,922 0 (16,481,952) 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 0 0 0 0 0 0 860,803 9,643,053 540,438 39,742,685 0 50,786,980 1,185,539 211,363 546,169 16,463,229 0 18,406,300 0 (10,261,794) XXX XXX 24,190,387 2,046,342 9,854,416 1,086,607 56,205,914 0 69,193,280 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 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 0 983,008 9,746,037 (4,508,887) 0 0 0 0 0 0 (10,261,794) (30,034,132) 24,190,387 0 0 XXX (5,843,745) OTHER INDICATORS: 216-2.IL 1. Number of certificates/policies 0 8,779 10,468 0 0 0 0 0 0 0 80,678 0 99,925 33,373 133,298 2. Number of Covered Lives 0 15,219 18,246 0 0 0 0 0 0 0 139,314 0 172,779 73,770 246,549 3. Number of Groups 1,261 202 0 0 0 0 0 0 2,511 0 3,974 17 3,991 4. Member Months 209,345 236,061 0 0 0 0 0 0 1,633,185 0 2,079,004 886,482 2,965,486 XXX 413 Is run off business reported in Columns 1 through 9 or 12? Yes [ XXX 0 ] No [ X ] 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 0 133,536 46,569 1,467,833 1,150,599 1,597,046 XXX 0 0 (1,678,585) 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 0 41,973 0 XXX 434,153 0 0 47,697 0 XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF 1100 Employers Boulevard DePere, WI 54115 Illinois 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 73288 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.IL Health Premiums Earned: 115,603 106,729,203 1.1 Direct premiums written 60,856 0 1.2 Unearned premium prior year 0 0 1.3 Unearned premium current year 60,856 0 1.4 Change in unearned premium (Lines 1.2 - 1.3) 1,000,003 0 1.5 Paid rate credits 0 0 1.6 Reserve for rate credits current year 1,326,283 0 1.7 Reserve for rate credits prior year (1,326,283) 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 176,459 106,729,203 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 502,739 106,729,203 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 1,265,934 80,686,213 2.1 Paid claims during the year 32,795 (4,807,557) 2.2 Direct claim liability current year 1,501,450 (3,489,565) 2.3 Direct claim liability prior year 0 311,670 2.4 Direct claim reserves current year 0 328,590 2.5 Direct claim reserves prior year 0 0 2.6 Direct contract reserves current year 412,495 0 2.7 Direct contract reserves prior year 1,000,003 0 2.8 Paid rate credits 0 0 2.9 Reserve for rate credits current year 1,326,283 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 (66,998) (407,640) 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) (2,425) 913,910 2.12a Healthcare receivables current year 64,573 1,321,549 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 (874,498) 79,758,941 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 137,162 0 2.18 Ceded incurred claims to non-affiliates 0 0 2.19 Other adjustments due to MLR calculation - Claims (685,381) 79,758,941 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) 15,190,105 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 96,558,889 0 0 0 0 0 0 0 0 0 96,558,889 0 0 0 0 96,558,889 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 36,243,680 67,161 94,313 (27,152) 0 0 0 0 0 0 36,216,528 901 (284,058) 103,812 0 35,829,560 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 239,647,375 128,017 94,313 33,704 1,000,003 0 1,326,283 (1,326,283) 0 0 239,681,079 901 (284,058) 103,812 0 239,620,390 84,929,664 21,812,111 21,442,029 426,127 479,464 0 0 0 0 0 0 0 0 0 189,029 773,281 584,252 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 25,057,832 2,958,791 2,263,583 234,932 247,092 10,978 28,882 0 0 0 0 0 0 0 40,186 39,023 (1,163) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 191,939,643 19,996,140 21,717,497 972,729 1,055,145 10,978 441,376 1,000,003 0 1,326,283 0 0 0 0 (245,422) 1,723,790 1,969,212 0 0 85,057,382 0 0 0 483,198 85,540,580 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 25,682,789 (54,824) (13,590) 1,255 0 25,613,120 0 0 0 0 0 0 189,624,613 (54,824) (13,590) 138,417 483,198 190,227,260 0 0 0 5,961,957 for stand-alone vision policies. 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF Illinois DURING THE YEAR All Expenses 1 Individual Comprehensive Coverage Expenses: 14,048 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 1,168 for affiliated services) 1.3 EDP Equipment and Software (incl $ 29 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 12 for affiliated services) 1.5 Accreditation and Certification (incl $ 5,069 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. (1) (16) 0 0 0 1 (16) 0 XXX XXX XXX 0 (3) 0 0 XXX 0 0 0 XXX 105,265 176,303 8,308 208 0 47,167 337,250 0 Large Group Comprehensive Coverage Expenses: 492,760 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 33,297 for affiliated services) 3.3 EDP Equipment and Software (incl $ 796 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 294 for affiliated services) 3.5 Accreditation and Certification (incl $ 537,558 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) 0 0 0 0 (16) 0 Small Group Comprehensive Coverage Expenses: 480,985 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 32,479 for affiliated services) 2.3 EDP Equipment and Software (incl $ 777 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 287 for affiliated services) 2.5 Accreditation and Certification (incl $ 536,641 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. 1100 Employers Boulevard DePere, WI 54115 XXX 0 (3) 0 XXX 0 0 40,584 36,452 2,339 58 XXX 2,226 134,598 0 XXX XXX 242 84 22 0 0 111 459 0 110 478 0 XXX XXX (43) (18) (4) 0 0 65 0 0 XXX 27,662 15,994 3,362 84 34 17,172 64,308 0 XXX 0 0 478 0 459 0 0 0 64,308 0 602,408 119,469 23,177 250 88,407 37,396 7,862 196 841,696 496,589 42,047 720 0 182,961 1,564,013 0 246,070 220,966 15,566 387 158 110,102 593,249 0 280,877 98,225 19,401 462 188 111,770 510,925 0 XXX 17,603 97,036 0 Total (1 to 5) XXX XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 243 103 22 0 0 0 0 (3) 0 5,032 126,970 362 9 XXX 0 0 0 0 (LOCATION) NAIC Company Code 2018 XXX 75,806 821,109 0 XXX 40,159 174,020 0 XXX XXX XXX XXX 337,250 0 134,598 0 97,036 0 821,109 0 174,020 0 1,564,013 0 593,249 101,467 510,925 0 107,013 180,336 8,501 212 0 47,983 344,045 0 5,162 130,074 370 9 40,649 37,087 2,392 59 619,754 119,388 23,465 243 89,511 37,864 7,958 199 862,089 504,749 42,685 723 0 184,113 1,594,359 0 248,751 221,781 16,059 400 163 111,486 598,640 0 296,868 102,425 20,381 487 198 116,130 536,489 0 XXX XXX XXX 2,286 137,901 0 XXX 344,045 0 XXX 17,664 97,851 0 XXX 137,901 0 XXX 75,510 838,360 0 XXX 97,851 0 40,669 176,202 0 XXX 838,360 0 XXX 176,202 0 XXX 1,594,359 0 XXX 598,640 104,520 536,489 0 73288 9 10 General Administrative Expenses Total Expenses (6 to 9) 112,623 39,586 8,304 208 85 33,340 194,146 0 6,253 200,400 0 140,485 55,646 11,683 293 119 50,688 258,913 0 6,253 265,167 0 3,441,206 1,249,420 247,774 6,202 2,520 4,961,575 9,908,698 0 260,303 10,169,000 0 4,809,849 2,065,199 324,789 7,772 2,866 5,366,409 12,576,885 0 260,303 12,837,187 101,467 3,519,889 1,284,363 253,843 6,353 2,581 4,963,853 10,030,882 0 187,776 10,218,658 0 4,927,597 2,113,319 332,968 7,962 2,942 5,375,582 12,760,371 0 187,776 12,948,147 104,520 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 Humana 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 *73288201821615100* SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (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) Humana Insurance Company 2. 1100 Employers Boulevard DePere, WI 54115 (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 2 Small Group Employer 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 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) 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 73288 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 (756) 0 0 35,856,193 0 0 23,298,302 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 32,611,502 0 0 0 0 0 91,765,242 0 0 XXX XXX XXX 91,765,242 0 0 (756) (2,250) 35,856,193 1,190,789 23,298,302 1,871,132 0 0 0 0 0 0 0 0 0 0 0 0 0 0 32,611,502 (913,484) 0 0 91,765,242 2,146,188 XXX (734,956) 91,765,242 1,411,232 (341) 0 0 1,835 0 0 0 1,835 634,937 0 24,662 34,005,805 0 0 0 34,005,805 508,704 0 12,064 20,906,403 0 0 0 20,906,403 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 298,196 0 37,911 33,188,880 (96,152) 0 0 33,092,728 0 0 0 0 0 0 0 0 1,441,496 0 74,637 88,102,922 (96,152) 0 0 88,006,770 (110,627) 0 19,410 XXX XXX XXX XXX XXX 1,330,869 0 94,046 88,929,095 (96,152) 0 0 88,832,943 17,701 (9,493) 349 21,445,460 5,760,662 1,288,933 10,197,161 4,020,181 1,015,407 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 26,343,806 707 298 0 0 0 58,004,128 9,772,058 2,304,987 XXX XXX XXX 58,004,128 9,772,058 2,304,987 0 0 0 7,860 (1) 0 0 0 0 0 7,858 0 0 0 25,917,190 0 0 0 0 0 0 25,917,190 0 0 0 13,201,935 0 150,454 76,185 1,165,677 1,036,766 0 13,299,663 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 65,471,199 40,278 150,454 76,185 1,165,677 1,036,766 0 65,609,205 XXX XXX 0 0 0 0 0 26,344,215 40,279 0 XXX XXX XXX 0 26,384,494 0 0 0 65,471,199 40,278 150,454 76,185 1,165,677 1,036,766 0 65,609,205 0 0 0 0 0 136,724 53,838 41,082 390,195 68,187 94,308 37,349 27,998 303,888 46,780 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 1,139 1 72 353,464 44,725 0 0 0 0 0 232,172 91,188 69,151 1,047,548 159,691 84,438 3,646 33,830 107,166 80,617 316,610 94,834 102,982 1,154,713 240,308 0 4.284 690,026 0.782 510,324 0.656 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 399,400 XXX 0 0.000 1,599,750 XXX 309,697 XXX 1,909,447 XXX 0 (537) (537) (0.292) 245,993 182,834 428,827 0.013 168,825 125,362 294,187 0.014 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 71,711 189,508 261,219 0.008 0 0 0 0.000 486,528 497,167 983,695 XXX 402,387 333,358 735,746 XXX 888,915 830,525 1,719,441 XXX XXX XXX XXX XXX 0 XXX XXX XXX XXX XXX XXX XXX XXX SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 (10) (65) 1 0 (73) 3 Large Group Employer 115,751 902,393 98,171 2,307,215 0 3,423,530 4 5 Small Group Employer Individual 85,001 441,239 86,066 1,645,410 0 2,257,716 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 0 104,029 3,044,484 95,132 3,099,294 0 6,342,939 0 0 0 0 0 0 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 304,781 4,388,107 279,304 7,051,920 0 12,024,111 206,123 259,832 100,513 2,743,600 0 3,310,068 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 7,790,009 XXX 10,176,919 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 (5,414) 3,546,232 4,544,514 0 0 0 0 0 0 0 (295,323) 0 7,790,009 XXX XXX 510,904 4,647,938 379,817 9,795,519 0 15,334,178 4,260,673 5,916,247 5,916,247 0 OTHER INDICATORS: 216-2.IN 1. Number of certificates/policies 0 5,714 6,638 0 0 0 0 0 0 0 46,477 0 58,829 5,355 64,184 2. Number of Covered Lives 0 9,735 11,423 0 0 0 0 0 0 0 70,855 0 92,013 11,097 103,110 3. Number of Groups 480 54 0 0 0 0 0 0 1,463 0 1,997 32 2,029 4. Member Months 0 110,437 134,193 0 0 0 0 0 0 792,413 0 1,037,043 131,962 1,169,005 XXX Is run off business reported in Columns 1 through 9 or 12? Yes [ XXX 0 ] No [ X ] 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 0 302,083 122,434 1,156,928 729,983 XXX 0 1,042 (1,945,583) 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 1,043 0 0 XXX 1,108,338 0 0 0 0 XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF 1100 Employers Boulevard DePere, WI 54115 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 73288 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.IN Health Premiums Earned: (756) 35,856,193 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 (756) 35,856,193 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 (756) 35,856,193 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 80,550 27,505,182 2.1 Paid claims during the year 498 3,188,597 2.2 Direct claim liability current year 58,711 4,821,704 2.3 Direct claim liability prior year 0 31,576 2.4 Direct claim reserves current year 0 24,586 2.5 Direct claim reserves prior year 0 0 2.6 Direct contract reserves current year 333 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 14,144 (38,126) 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 1,649 380,659 2.12a Healthcare receivables current year (12,495) 418,785 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 7,860 25,917,190 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 1 0 2.18 Ceded incurred claims to non-affiliates 0 0 2.19 Other adjustments due to MLR calculation - Claims 7,858 25,917,190 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) 4,443,531 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 23,298,302 0 0 0 76,185 1,036,766 1,165,677 (128,911) 0 0 23,298,302 0 0 0 0 23,351,028 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 32,632,484 46,005 66,986 (20,981) 0 0 (46) 46 0 0 32,611,502 4,533 (45,760) 54,925 0 32,515,305 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 91,786,223 46,005 66,986 (20,981) 76,185 1,036,766 1,165,631 (128,865) 0 0 91,765,242 4,533 (45,760) 54,925 0 91,721,770 15,157,839 (235,144) 1,769,870 5 6 0 0 76,185 1,036,766 1,165,677 0 0 0 0 (101,838) 273,957 375,794 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 25,970,587 3,303,824 2,799,852 336,782 404,376 0 0 0 0 (46) 0 0 0 0 62,795 63,567 772 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 68,714,158 6,257,774 9,450,138 368,363 428,968 0 333 76,185 1,036,766 1,165,631 0 0 0 0 (63,024) 719,832 782,856 0 0 13,201,935 0 0 0 97,728 13,352,389 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 26,344,215 31,583 (33,115) (41,811) 0 26,384,448 0 0 0 0 0 0 65,471,199 31,583 (33,115) (41,809) 97,728 65,661,885 0 0 0 2,182,257 for stand-alone vision policies. 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF Indiana DURING THE YEAR All Expenses 1 Individual Comprehensive Coverage Expenses: (54) 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 $ (1) 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 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: 191,511 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 12,639 for affiliated services) 2.3 EDP Equipment and Software (incl $ 299 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 109 for affiliated services) 2.5 Accreditation and Certification (incl $ 159,985 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 (536) 0 0 0 0 0 (537) 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (537) 0 43,284 70,686 3,331 83 0 19,339 136,724 0 2,090 50,678 145 4 17,597 14,938 940 23 292,212 50,542 11,153 118 34,642 14,653 3,081 77 389,826 201,497 18,649 305 0 79,750 690,026 0 103,977 89,569 6,117 152 62 46,116 245,993 0 96,902 36,577 6,966 165 67 42,156 182,834 0 XXX Large Group Comprehensive Coverage Expenses: 137,971 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 9,067 for affiliated services) 3.3 EDP Equipment and Software (incl $ 213 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 78 for affiliated services) 3.5 Accreditation and Certification (incl $ 93,508 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. 1100 Employers Boulevard DePere, WI 54115 XXX XXX 922 53,838 0 XXX XXX 7,585 41,082 0 XXX XXX 36,171 390,195 0 XXX 15,734 68,187 0 XXX XXX XXX XXX 136,724 0 53,838 0 41,082 0 390,195 0 68,187 0 690,026 0 245,993 39,984 182,834 0 29,729 48,930 2,304 57 0 13,289 94,308 0 1,444 35,169 100 2 11,913 10,279 649 16 233,834 34,835 8,563 81 23,768 10,053 2,114 52 300,687 139,266 13,729 209 0 56,432 510,324 0 71,258 61,472 4,296 107 43 31,648 168,825 0 64,199 26,081 5,017 119 49 29,897 125,362 0 XXX XXX XXX 634 37,349 0 XXX 94,308 0 XXX 5,141 27,998 0 XXX 37,349 0 XXX 26,575 303,888 0 XXX 27,998 0 10,793 46,780 0 XXX 303,888 0 XXX 46,780 0 XXX 510,324 0 XXX 168,825 27,989 125,362 0 73288 9 10 General Administrative Expenses Total Expenses (6 to 9) 0 0 0 0 0 (9) (9) 0 (65) (73) 0 (536) 0 0 0 0 (9) (545) 0 (65) (610) 0 1,324,401 471,137 94,660 2,371 963 1,431,827 3,325,359 0 98,171 3,423,530 0 1,915,106 798,780 126,393 2,993 1,092 1,599,849 4,444,212 0 98,171 4,542,382 39,984 943,570 340,971 67,624 1,693 687 817,105 2,171,650 0 86,066 2,257,716 0 1,379,714 567,791 90,666 2,128 779 935,082 2,976,160 0 86,066 3,062,226 27,989 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 Humana 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 *73288201821616100* SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (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) Humana Insurance Company 2. 1100 Employers Boulevard DePere, WI 54115 (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 2 Small Group Employer 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 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) 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 73288 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 2,714,630 0 0 0 0 0 2,714,630 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 2,714,630 184,956 0 0 2,714,630 184,956 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 47,904 0 9,851 2,471,920 (50,991) 0 0 2,420,929 0 0 0 0 0 0 0 0 47,904 0 9,851 2,471,920 (50,991) 0 0 2,420,929 XXX XXX XXX XXX XXX 47,904 0 9,851 2,471,920 (50,991) 0 0 2,420,929 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,671,411 0 0 0 0 0 1,671,411 0 0 XXX XXX XXX 1,671,411 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,671,411 12,121 0 0 0 0 0 1,683,532 XXX XXX 0 0 0 0 0 1,671,411 12,121 0 XXX XXX XXX 0 1,683,532 0 0 0 1,671,411 12,121 0 0 0 0 0 1,683,532 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 0 2 19,695 4,096 0 0 0 0 0 124 0 2 19,695 4,096 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 23,918 XXX 0 0.000 23,918 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 8,722 24,365 33,086 0.013 0 0 0 0.000 8,722 24,365 33,086 XXX XXX XXX XXX XXX 0 0 0 0.000 2,714,630 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 124 0 2 19,695 4,096 0 23,918 XXX 0 0 0 8,722 24,365 33,086 XXX XXX XXX 2,714,630 184,956 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 17,891 173,387 9,167 (679,997) 0 (479,552) 0 0 0 0 0 0 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 17,891 173,387 9,167 (679,997) 0 (479,552) 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 1,159,945 XXX 1,159,945 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 1,159,945 0 1,159,945 XXX 17,891 173,387 9,167 (679,997) 0 (479,552) XXX 1,159,945 0 0 0 OTHER INDICATORS: 216-2.IA 1. Number of certificates/policies 0 0 0 0 0 0 0 0 0 0 4,456 0 4,456 0 4,456 2. Number of Covered Lives 0 0 0 0 0 0 0 0 0 0 5,201 0 5,201 0 5,201 3. Number of Groups 0 0 0 0 0 0 0 0 14 0 14 0 14 4. Member Months 0 0 0 0 0 0 0 0 63,101 0 63,101 0 63,101 XXX 0 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ X ] If yes, show the amount of premiums and claims included. Premiums $ XXX 0 0 Claims $ 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) 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 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 XXX XXX NONE XXX XXX 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF 1100 Employers Boulevard DePere, WI 54115 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 73288 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.IA 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) 863,482 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 2,718,152 32,993 36,515 (3,522) 0 0 0 0 0 0 2,714,630 0 (25,835) 25,156 0 2,663,639 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,718,152 32,993 36,515 (3,522) 0 0 0 0 0 0 2,714,630 0 (25,835) 25,156 0 2,663,639 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,708,772 203,122 172,909 35,849 45,213 0 54,595 0 0 0 0 0 0 0 3,615 3,643 28 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,708,772 203,122 172,909 35,849 45,213 0 54,595 0 0 0 0 0 0 0 3,615 3,643 28 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,671,411 (111) (16,230) (28,461) 0 1,683,532 0 0 0 0 0 0 1,671,411 (111) (16,230) (28,461) 0 1,683,532 0 0 0 188,357 for stand-alone vision policies. 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF Iowa DURING THE YEAR All Expenses 1 2. 216-4.IA 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. 1100 Employers Boulevard DePere, WI 54115 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 73288 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 Humana 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 Humana 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 *73288201821617100* SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (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) Humana Insurance Company 2. 1100 Employers Boulevard DePere, WI 54115 (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 2 Small Group Employer 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 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) 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 73288 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 1,520 0 0 97,135,598 0 0 40,809,978 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 24,969,023 0 0 0 0 0 162,916,119 0 0 XXX XXX XXX 162,916,119 0 0 1,520 (12,993) 97,135,598 2,223,239 40,809,978 819,264 0 0 0 0 0 0 0 0 0 0 0 0 0 0 24,969,023 545,374 0 0 162,916,119 3,574,883 XXX (816,003) 162,916,119 2,758,880 (1,972) 0 1 16,483 0 0 0 16,483 1,026,404 0 67,338 93,818,617 0 0 0 93,818,617 341,099 0 22,875 39,626,741 0 0 0 39,626,741 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 302,623 0 23,725 24,097,301 (245,551) 0 0 23,851,750 0 0 0 0 0 0 0 0 1,668,154 0 113,939 157,559,142 (245,551) 0 0 157,313,592 (123,513) 0 16,086 XXX XXX XXX XXX XXX 1,544,641 0 130,025 158,482,573 (245,551) 0 0 158,237,022 61,156 (8,141) 294 61,939,178 20,218,259 4,499,498 30,064,724 7,845,763 2,082,830 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 17,561,728 6 0 0 0 0 109,626,786 28,055,887 6,582,622 XXX XXX XXX 109,626,786 28,055,887 6,582,622 0 0 0 52,721 0 0 0 0 0 0 52,721 0 0 0 77,657,939 0 0 0 0 0 0 77,657,939 0 0 0 35,827,656 0 186,492 0 0 0 0 36,014,148 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 17,561,735 (13,191) 0 XXX XXX XXX 0 17,548,543 0 0 0 0 0 0 0 0 0 0 0 0 0 0 131,100,050 (13,191) 186,492 0 0 0 0 131,273,351 XXX XXX 0 0 0 131,100,050 (13,191) 186,492 0 0 0 0 131,273,351 4 2 1 11 2 365,963 145,669 107,276 1,055,282 183,147 181,353 72,805 52,081 641,630 89,347 0 0 0 0 0 0 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 3.200 1,857,337 0.848 1,037,216 0.930 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 7 (155) (149) (0.009) 566,504 531,444 1,097,948 0.012 280,509 272,052 552,561 0.014 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 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 1,170 1 70 60,172 38,469 0 0 0 0 0 548,491 218,476 159,427 1,757,094 310,965 47,432 2,127 16,506 350,376 49,964 595,924 220,603 175,933 2,107,470 360,929 0 99,881 XXX 0 0.000 2,994,454 XXX 466,404 XXX 3,460,859 XXX 0 0 0 0.000 59,957 88,619 148,576 0.006 0 0 0 0.000 906,977 891,960 1,798,936 XXX 212,913 218,071 430,984 XXX 1,119,890 1,110,030 2,229,920 XXX XXX SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 24 (374) 30,251 0 29,905 3 Large Group Employer 310,773 4,386,174 218,989 6,094,922 0 11,010,858 4 5 Small Group Employer Individual 168,131 1,558,927 89,787 3,054,787 0 4,871,632 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 80,073 1,276,758 104,939 1,515,923 0 2,977,693 0 0 0 0 0 0 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 558,981 7,221,883 413,340 10,695,883 0 18,890,088 286,734 1,502,537 74,696 2,100,600 0 3,964,567 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 2,356,762 XXX 3,256,427 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 (66,014) 2,194,536 (2,848,816) 0 0 0 0 0 0 0 3,077,056 0 2,356,762 XXX XXX 845,716 8,724,420 488,037 12,796,483 0 22,854,656 (1,581,764) 4,838,191 4,838,191 0 OTHER INDICATORS: 216-2.KS 1. Number of certificates/policies 0 9,578 5,531 0 0 0 0 0 0 0 34,432 0 49,541 4,728 54,269 2. Number of Covered Lives 0 16,842 9,967 0 0 0 0 0 0 0 58,859 0 85,668 8,496 94,164 3. Number of Groups 1,445 92 0 0 0 0 0 0 3,207 0 4,744 280 5,024 4. Member Months 3 220,640 119,475 0 0 0 0 0 0 658,243 0 998,361 76,947 1,075,308 XXX Is run off business reported in Columns 1 through 9 or 12? Yes [ XXX 0 ] No [ X ] 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) 4 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 1,304,929 1,652 2,067,705 1,286,720 XXX 0 0 (3,431,415) 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 73,479 0 0 0 0 XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF 1100 Employers Boulevard DePere, WI 54115 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 73288 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.KS Health Premiums Earned: 1,520 97,135,598 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 1,520 97,135,598 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 1,520 97,135,598 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: (56,908) 77,249,286 2.1 Paid claims during the year 116,099 6,653,254 2.2 Direct claim liability current year 18,138 5,738,966 2.3 Direct claim liability prior year 0 208,990 2.4 Direct claim reserves current year 0 101,253 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 (11,668) 613,372 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 1,854 1,332,341 2.12a Healthcare receivables current year 13,522 718,969 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 52,721 77,657,939 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 52,721 77,657,939 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) 4,394,462 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 40,809,978 0 0 0 1,490,129 0 (524,180) 524,180 0 0 40,809,978 0 0 0 0 38,795,669 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 24,977,586 32,592 41,155 (8,563) 0 0 0 0 0 0 24,969,023 79 (162,822) 82,807 0 24,723,472 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 162,924,682 32,592 41,155 (8,563) 1,490,129 0 (524,180) 524,180 0 0 162,916,119 79 (162,822) 82,807 0 160,656,259 33,211,029 4,290,514 4,226,657 0 0 0 0 1,490,129 0 (524,180) 0 0 0 0 (538,461) 534,867 1,073,327 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16,623,082 2,878,184 1,734,150 0 0 171,054 329,977 0 0 0 0 0 0 0 46,459 46,055 (404) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 127,026,490 13,938,051 11,717,911 208,990 101,253 171,054 329,978 1,490,129 0 (524,180) 0 0 0 0 109,703 1,915,117 1,805,414 0 0 35,827,656 0 0 0 186,492 33,999,839 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 17,561,735 5,770 (5,515) 13,446 0 17,548,543 0 0 0 0 0 0 131,100,050 5,770 (5,515) 13,446 186,492 129,259,042 0 0 0 1,868,038 for stand-alone vision policies. 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF Kansas DURING THE YEAR All Expenses 1 2. Individual Comprehensive Coverage Expenses: 3,007 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 $ 5 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.KS 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. 2 2 0 0 0 0 4 0 XXX Small Group Comprehensive Coverage Expenses: 511,746 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 33,680 for affiliated services) 2.3 EDP Equipment and Software (incl $ 796 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 291 for affiliated services) 2.5 Accreditation and Certification (incl $ 623,987 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 2 0 0 XXX 1 1 0 0 XXX 0 2 0 XXX 8 2 0 0 XXX 0 1 0 XXX Total (1 to 5) 12 7 1 0 0 1 20 0 XXX 1 11 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 1 0 0 0 0 2 0 XXX (LOCATION) NAIC Company Code 2018 XXX 3 2 0 0 0 1 7 0 XXX (158) 1 0 0 0 1 (155) 0 XXX 4 0 2 0 1 0 11 0 2 0 20 0 7 1 (155) 0 114,784 190,633 8,956 224 0 51,366 365,963 0 5,607 137,189 389 10 45,317 39,774 2,522 63 796,661 133,117 29,891 303 93,037 39,355 8,273 207 1,055,406 540,069 50,031 806 0 211,025 1,857,337 0 269,124 160,289 16,458 409 166 120,057 566,504 0 295,411 100,650 19,534 465 189 115,195 531,444 0 XXX Large Group Comprehensive Coverage Expenses: 268,019 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 17,295 for affiliated services) 3.3 EDP Equipment and Software (incl $ 401 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 147 for affiliated services) 3.5 Accreditation and Certification (incl $ 248,965 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. 1100 Employers Boulevard DePere, WI 54115 XXX XXX 2,474 145,669 0 XXX XXX XXX 19,600 107,276 0 95,310 1,055,282 0 365,963 0 145,669 0 107,276 0 XXX 1,055,282 0 56,443 95,056 4,455 111 0 25,288 181,353 0 2,739 68,657 194 5 21,735 19,634 1,254 31 511,998 61,325 17,580 136 XXX XXX XXX XXX 1,210 72,805 0 XXX 181,353 0 XXX 9,426 52,081 0 XXX 72,805 0 XXX XXX XXX 1,857,337 0 566,504 107,704 531,444 0 45,391 19,201 4,036 101 638,305 263,874 27,519 384 0 107,134 1,037,216 0 132,466 80,118 8,418 209 85 59,212 280,509 0 148,939 52,615 10,368 248 101 59,783 272,052 0 20,619 89,347 0 XXX 641,630 0 XXX 183,147 0 XXX 50,591 641,630 0 XXX 52,081 0 42,275 183,147 0 XXX 89,347 0 XXX 1,037,216 0 XXX 280,509 54,757 272,052 0 73288 9 10 General Administrative Expenses Total Expenses (6 to 9) 30,217 17 4 0 0 42 30,279 0 (374) 29,905 0 30,074 27 4 0 0 46 30,151 0 (374) 29,777 1 3,497,524 1,241,146 250,779 6,279 2,550 5,793,592 10,791,870 0 218,989 11,010,858 0 5,117,465 2,042,154 336,802 7,959 2,905 6,239,869 13,747,154 0 218,989 13,966,143 107,704 1,760,485 626,735 126,646 3,170 1,287 2,263,522 4,781,845 0 89,787 4,871,632 0 2,680,195 1,023,341 172,951 4,011 1,473 2,489,651 6,371,622 0 89,787 6,461,409 54,757 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 Humana 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 *73288201821618100* SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (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) Humana Insurance Company 2. 1100 Employers Boulevard DePere, WI 54115 (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 2 Small Group Employer 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 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) 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 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 0 0 0 0 0 0 0 0 0 0 995,561 (2,764,198) 0 0 995,561 (2,764,198) XXX (3,156,085) 995,561 (5,920,283) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (342,271) 0 26,233 4,075,797 (132,682) 0 0 3,943,115 0 0 0 0 0 0 0 0 (342,271) 0 26,233 4,075,797 (132,682) 0 0 3,943,115 (478,316) 0 82,950 XXX XXX XXX XXX XXX (820,587) 0 109,183 7,627,248 (132,682) 0 0 7,494,566 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 674,593 0 0 0 0 0 674,593 0 0 XXX XXX XXX 674,593 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 674,593 6,030 0 0 0 0 0 680,623 XXX XXX 0 0 0 0 0 674,593 6,030 0 XXX XXX XXX 0 680,623 0 0 0 674,593 6,030 0 0 0 0 0 680,623 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 0 4 31 2,134 0 0 0 0 0 9 0 4 31 2,134 331,409 15,667 104,153 834,140 335,808 331,418 15,667 104,157 834,172 337,942 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 2,179 0 0.000 2,179 1,621,177 XXX 1,623,356 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 1,527,135 1,797,131 3,324,266 XXX 1,527,656 1,797,112 3,324,768 XXX 0 XXX 0 0 0 0.000 521 (19) 502 0.000 0 0 0 0.000 995,561 0 0 XXX XXX XXX 0 0 0 XXX 0 0 0 73288 13 0 0 0 XXX XXX XXX 995,561 0 0 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA XXX 521 (19) 502 XXX 995,561 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 25,241 70,704 16,024 15,866,770 0 15,978,739 0 (12,718,928) 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 0 0 0 0 0 0 25,241 70,704 16,024 15,866,770 0 15,978,739 825,504 1,734,934 404,886 11,562,352 0 14,527,677 0 (12,718,928) XXX XXX 23,188,057 850,746 1,805,638 420,911 27,429,122 0 30,506,416 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 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 0 0 0 0 0 0 0 0 0 (12,718,928) (28,640,598) 23,188,057 0 0 XXX (5,452,540) OTHER INDICATORS: 216-2.KY 1. Number of certificates/policies 0 0 0 0 0 0 0 0 0 0 1,987 0 1,987 22,821 24,808 2. Number of Covered Lives 0 0 0 0 0 0 0 0 0 0 2,685 0 2,685 40,364 43,049 3. Number of Groups 0 0 0 0 0 0 0 0 29 0 29 180 209 4. Member Months 0 0 0 0 0 0 0 0 41,442 0 41,442 548,514 589,956 XXX 0 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ X ] If yes, show the amount of premiums and claims included. Premiums $ XXX 0 0 Claims $ 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) 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 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 XXX XXX NONE XXX XXX 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF 1100 Employers Boulevard DePere, WI 54115 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 73288 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.KY 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 0 991,692 16,332 12,462 3,870 0 0 0 0 0 0 995,561 4,715 (107,011) 30,386 0 862,879 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 991,692 16,332 12,462 3,870 0 0 0 0 0 0 995,561 4,715 (107,011) 30,386 0 862,879 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 710,144 188,973 175,170 78,676 128,030 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 710,144 188,973 175,170 78,676 128,030 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 674,593 8,445 (4,661) (2,247) 0 680,623 0 0 0 0 0 0 674,593 8,445 (4,661) (2,247) 0 680,623 0 0 0 447,852 for stand-alone vision policies. 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF Kentucky 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.KY 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) 1100 Employers Boulevard DePere, WI 54115 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 73288 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 Humana 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 Humana 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 *73288201821619100* SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (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) Humana Insurance Company 2. 1100 Employers Boulevard DePere, WI 54115 (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 2 Small Group Employer 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 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) 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 73288 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 5,146,655 0 0 0 0 0 5,146,655 0 0 XXX XXX XXX 5,146,655 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5,146,655 94,666 0 0 5,146,655 94,666 XXX (828,594) 5,146,655 (733,928) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 130,134 0 25,432 4,896,424 (510,899) 0 0 4,385,525 0 0 0 0 0 0 0 0 130,134 0 25,432 4,896,424 (510,899) 0 0 4,385,525 (124,987) 0 18,646 XXX XXX XXX XXX XXX 5,146 0 44,078 5,831,360 (510,899) 0 0 5,320,461 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 3,565,884 0 0 0 0 0 3,565,884 0 0 XXX XXX XXX 3,565,884 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3,565,884 (123,522) 0 XXX XXX XXX 0 3,442,362 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3,565,884 (123,522) 0 0 0 0 0 3,442,362 XXX XXX 0 0 0 3,565,884 (123,522) 0 0 0 0 0 3,442,362 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 0.000 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 0 0 0 0 0 0 0 0 XXX 443 0 3 1,188 8,203 0 0 0 0 0 9,837 0 0.000 0 0 0 0.000 XXX 0 0 0 0.000 19,585 27,042 46,626 0.010 0 XXX XXX XXX XXX XXX XXX XXX XXX 443 0 3 1,188 8,203 77,574 3,385 29,889 269,860 75,684 78,017 3,385 29,892 271,048 83,887 9,837 XXX 456,392 XXX 466,229 XXX 19,585 27,042 46,626 XXX 358,844 331,126 689,970 XXX 378,429 358,168 736,596 XXX SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 46,034 154,782 67,003 441,184 0 709,002 0 0 0 0 0 0 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 46,034 154,782 67,003 441,184 0 709,002 216,331 855,872 95,096 2,603,912 0 3,771,211 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 177,697 XXX 2,426,651 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 0 177,697 0 177,697 XXX XXX 262,365 1,010,654 162,099 3,045,096 0 4,480,213 (3,804,939) 6,231,591 6,231,591 0 OTHER INDICATORS: 216-2.LA 1. Number of certificates/policies 0 0 0 0 0 0 0 0 0 0 9,820 0 9,820 6,344 16,164 2. Number of Covered Lives 0 0 0 0 0 0 0 0 0 0 15,308 0 15,308 12,758 28,066 3. Number of Groups 0 0 0 0 0 0 0 0 305 0 305 182 487 4. Member Months 0 0 0 0 0 0 0 0 179,916 0 179,916 122,560 302,476 XXX 0 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ X ] If yes, show the amount of premiums and claims included. Premiums $ XXX 0 0 Claims $ 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) 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 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 XXX XXX NONE XXX XXX 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF 1100 Employers Boulevard DePere, WI 54115 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 73288 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.LA 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) 2,479,490 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 5,137,534 52,629 43,507 9,122 0 0 0 0 0 0 5,146,655 5,638 (468,473) 48,064 0 4,635,757 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5,137,534 52,629 43,507 9,122 0 0 0 0 0 0 5,146,655 5,638 (468,473) 48,064 0 4,635,757 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3,492,173 587,807 366,659 51,494 91,656 19,763 127,038 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 3,492,173 587,807 366,659 51,494 91,656 19,763 127,038 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3,565,884 4,774 (176,570) (48,274) 0 3,442,362 0 0 0 0 0 0 3,565,884 4,774 (176,570) (48,274) 0 3,442,362 0 0 0 305,361 for stand-alone vision policies. 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF Louisiana DURING THE YEAR All Expenses 1 2. 216-4.LA 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. 1100 Employers Boulevard DePere, WI 54115 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 73288 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 Humana 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 Humana 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 *73288201821620100* SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (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) Humana Insurance Company 2. 1100 Employers Boulevard DePere, WI 54115 (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 2 Small Group Employer 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 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) 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 73288 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 0 800,293 0 0 0 0 0 800,293 0 0 XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 800,293 (24,895) 0 0 800,293 (24,895) 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 11,090 0 552 813,546 (5,867) 0 0 807,679 0 0 0 0 0 0 0 0 11,090 0 552 813,546 (5,867) 0 0 807,679 XXX XXX XXX XXX XXX 11,090 0 552 813,546 (5,867) 0 0 807,679 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 0 560,870 390 0 0 0 0 560,870 390 0 XXX XXX XXX 560,870 390 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 561,260 (622) 0 0 0 0 0 560,638 XXX XXX 0 0 0 561,260 (622) 0 0 0 0 0 560,638 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 0 0 0 0 0 561,260 (622) 0 XXX XXX XXX 0 560,638 0 0 0 0 0 2 0 0 14,799 1,066 0 0 0 0 0 2 0 0 14,799 1,066 0 15,867 XXX 0 0.000 15,867 XXX 1,293 8,510 9,803 0.012 0 0 0 0.000 1,293 8,510 9,803 XXX 0 0 0 0.000 XXX 800,293 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 2 0 0 14,799 1,066 0 15,867 XXX 0 0 0 1,293 8,510 9,803 XXX XXX 800,293 (24,895) XXX SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 1,708 34,223 1,700 113,710 0 151,341 0 0 0 0 0 0 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 1,708 34,223 1,700 113,710 0 151,341 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 70,030 XXX 70,030 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 70,030 0 70,030 XXX 1,708 34,223 1,700 113,710 0 151,341 XXX 70,030 0 0 0 OTHER INDICATORS: 216-2.ME 1. Number of certificates/policies 0 0 0 0 0 0 0 0 0 0 603 0 603 0 603 2. Number of Covered Lives 0 0 0 0 0 0 0 0 0 0 657 0 657 0 657 3. Number of Groups 0 0 0 0 0 0 0 0 5 0 5 0 5 4. Member Months 0 0 0 0 0 0 0 0 8,289 0 8,289 0 8,289 XXX 0 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ X ] If yes, show the amount of premiums and claims included. Premiums $ XXX 0 0 Claims $ 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) 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 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 XXX XXX NONE XXX XXX 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF 1100 Employers Boulevard DePere, WI 54115 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 73288 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.ME 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) 20,848 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 0 800,268 1,125 1,100 25 0 0 0 0 0 0 800,293 0 (366) 5,501 0 794,426 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 800,268 1,125 1,100 25 0 0 0 0 0 0 800,293 0 (366) 5,501 0 794,426 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 547,144 74,414 59,899 0 0 118 0 0 0 0 0 0 0 0 517 550 32 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 547,144 74,414 59,899 0 0 118 0 0 0 0 0 0 0 0 517 550 32 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 561,260 0 (504) 118 0 560,638 0 0 0 0 0 0 561,260 0 (504) 118 0 560,638 0 0 0 38,629 for stand-alone vision policies. 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF Maine DURING THE YEAR All Expenses 1 2. 216-4.ME 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. 1100 Employers Boulevard DePere, WI 54115 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 73288 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 Humana 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 Humana 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 *73288201821621100* SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (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) Humana Insurance Company 2. 1100 Employers Boulevard DePere, WI 54115 (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 2 Small Group Employer 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 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) 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 73288 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 17,849,129 0 0 0 0 0 17,849,129 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 17,849,129 129,651 0 0 17,849,129 129,651 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 0 236,084 0 12,522 17,470,871 (25,953) 0 0 17,444,918 0 0 0 0 0 0 0 0 236,084 0 12,522 17,470,871 (25,953) 0 0 17,444,918 XXX XXX XXX XXX XXX 236,084 0 12,522 17,470,871 (25,953) 0 0 17,444,918 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 12,660,340 (602) 0 0 0 0 12,660,340 (602) 0 XXX XXX XXX 12,660,340 (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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 12,659,738 0 0 0 0 0 0 12,659,738 XXX XXX 0 0 0 0 0 12,659,738 0 0 XXX XXX XXX 0 12,659,738 0 0 0 12,659,738 0 0 0 0 0 0 12,659,738 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,174 1 28 20,712 22,224 0 0 0 0 0 2,174 1 28 20,712 22,224 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 45,139 XXX 0 0.000 45,139 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 0.000 275,769 146,751 422,519 0.024 0 0 0 0.000 275,769 146,751 422,519 XXX XXX XXX XXX XXX 0 0 0 0.000 17,849,129 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 2,174 1 28 20,712 22,224 0 45,139 XXX 0 0 0 275,769 146,751 422,519 XXX XXX XXX 17,849,129 129,651 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 94,713 1,171,824 53,539 1,669,297 0 2,989,373 0 0 0 0 0 0 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 94,713 1,171,824 53,539 1,669,297 0 2,989,373 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 1,328,149 XXX 1,328,149 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 1,328,149 0 1,328,149 XXX 94,713 1,171,824 53,539 1,669,297 0 2,989,373 XXX 1,328,149 0 0 0 OTHER INDICATORS: 216-2.MD 1. Number of certificates/policies 0 0 0 0 0 0 0 0 0 0 26,120 0 26,120 0 26,120 2. Number of Covered Lives 0 0 0 0 0 0 0 0 0 0 46,744 0 46,744 0 46,744 3. Number of Groups 0 0 0 0 0 0 0 0 525 0 525 0 525 4. Member Months 0 0 0 0 0 0 0 0 553,983 0 553,983 0 553,983 XXX 0 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ X ] If yes, show the amount of premiums and claims included. Premiums $ XXX 0 0 Claims $ 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) 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 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 XXX XXX NONE XXX XXX 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF 1100 Employers Boulevard DePere, WI 54115 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 73288 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.MD 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) 9,913,400 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 17,849,628 11,930 12,429 (499) 0 0 0 0 0 0 17,849,129 (2,659) 1,608 24,902 0 17,823,176 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 17,849,628 11,930 12,429 (499) 0 0 0 0 0 0 17,849,129 (2,659) 1,608 24,902 0 17,823,176 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 12,574,773 1,531,591 1,418,877 0 0 0 0 0 0 0 0 0 0 0 27,749 27,880 131 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 12,574,773 1,531,591 1,418,877 0 0 0 0 0 0 0 0 0 0 0 27,749 27,880 131 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 12,659,738 3,202 (3,202) 0 0 12,659,738 0 0 0 0 0 0 12,659,738 3,202 (3,202) 0 0 12,659,738 0 0 0 852,407 for stand-alone vision policies. 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF Maryland DURING THE YEAR All Expenses 1 2. 216-4.MD 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. 1100 Employers Boulevard DePere, WI 54115 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 73288 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 Humana 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 Humana 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 *73288201821622100* SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (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) Humana Insurance Company 2. 1100 Employers Boulevard DePere, WI 54115 (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 2 Small Group Employer 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 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) 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 73288 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 11,677,458 0 0 0 0 0 11,677,458 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 11,677,458 (124,340) 0 0 11,677,458 (124,340) 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 0 227,273 0 7,059 11,567,467 0 0 0 11,567,467 0 0 0 0 0 0 0 0 227,273 0 7,059 11,567,467 0 0 0 11,567,467 XXX XXX XXX XXX XXX 227,273 0 7,059 11,567,467 0 0 0 11,567,467 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 8,168,660 190 271 0 0 0 8,168,660 190 271 XXX XXX XXX 8,168,660 190 271 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8,168,579 (5,325) 0 XXX XXX XXX 0 8,163,254 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8,168,579 (5,325) 0 0 0 0 0 8,163,254 XXX XXX 0 0 0 8,168,579 (5,325) 0 0 0 0 0 8,163,254 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 0.000 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 0 0 0 0 0 0 0 350 0 19 15,373 12,329 0 0 0 0 0 350 0 19 15,373 12,329 0 28,071 XXX 0 0.000 28,071 XXX 25,125 88,519 113,645 0.010 0 0 0 0.000 25,125 88,519 113,645 XXX XXX 0 0 0 0.000 11,677,458 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 350 0 19 15,373 12,329 0 28,071 XXX 0 0 0 25,125 88,519 113,645 XXX XXX XXX 11,677,458 (124,340) SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 36,567 842,620 26,057 967,242 0 1,872,487 0 0 0 0 0 0 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 36,567 842,620 26,057 967,242 0 1,872,487 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 1,390,011 XXX 1,390,011 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 1,390,011 0 1,390,011 XXX 36,567 842,620 26,057 967,242 0 1,872,487 XXX 1,390,011 0 0 0 OTHER INDICATORS: 216-2.MA 1. Number of certificates/policies 0 0 0 0 0 0 0 0 0 0 11,540 0 11,540 0 11,540 2. Number of Covered Lives 0 0 0 0 0 0 0 0 0 0 15,361 0 15,361 0 15,361 3. Number of Groups 0 0 0 0 0 0 0 0 133 0 133 0 133 4. Member Months 0 0 0 0 0 0 0 0 189,050 0 189,050 0 189,050 XXX 0 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ X ] If yes, show the amount of premiums and claims included. Premiums $ XXX 0 0 Claims $ 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) 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 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 XXX XXX NONE XXX XXX 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF 1100 Employers Boulevard DePere, WI 54115 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 73288 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.MA 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) 2,376,214 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 11,676,814 53,787 53,143 644 0 0 0 0 0 0 11,677,458 0 0 0 0 11,677,458 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 11,676,814 53,787 53,143 644 0 0 0 0 0 0 11,677,458 0 0 0 0 11,677,458 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8,267,307 829,111 894,474 16,670 17,471 0 0 0 0 0 0 0 0 0 32,565 32,800 235 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8,267,307 829,111 894,474 16,670 17,471 0 0 0 0 0 0 0 0 0 32,565 32,800 235 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8,168,579 15,584 (17,422) 3,487 0 8,163,254 0 0 0 0 0 0 8,168,579 15,584 (17,422) 3,487 0 8,163,254 0 0 0 615,491 for stand-alone vision policies. 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF Massachusetts DURING THE YEAR All Expenses 1 2. 216-4.MA 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. 1100 Employers Boulevard DePere, WI 54115 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 73288 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 Humana 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 Humana 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 *73288201821623100* SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (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) Humana Insurance Company 2. 1100 Employers Boulevard DePere, WI 54115 (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 2 Small Group Employer 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 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) 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 73288 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 3,371 0 0 11,539,717 0 0 3,768,753 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 17,528,030 0 0 0 0 0 32,839,872 0 0 XXX XXX XXX 32,839,872 0 0 3,371 (42,113) 11,539,717 481,459 3,768,753 128,006 0 0 0 0 0 0 0 0 0 0 0 0 0 0 17,528,030 582,010 0 0 32,839,872 1,149,361 XXX (35,630) 32,839,872 1,113,731 (6,269) 0 363 51,390 0 0 0 51,390 256,498 0 7,021 10,794,739 0 0 0 10,794,739 64,770 0 2,519 3,573,458 0 0 0 3,573,458 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 385,202 0 45,545 16,515,273 (1,046,826) 0 0 15,468,447 0 0 0 0 0 0 0 0 700,201 0 55,449 30,934,861 (1,046,826) 0 0 29,888,035 (5,580) 0 877 XXX XXX XXX XXX XXX 694,621 0 56,326 30,975,194 (1,046,826) 0 0 29,928,368 (17,555) (7,413) 303 6,539,045 1,322,868 167,858 3,349,002 359,291 85,318 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10,769,307 576 0 0 0 0 20,639,799 1,675,321 253,479 XXX XXX XXX 20,639,799 1,675,321 253,479 0 0 0 (25,272) (128) (36,655) 45,126 8,471 0 0 (25,400) 0 0 0 7,694,054 0 (188,094) 506,868 797,345 478,571 0 7,694,054 0 0 0 3,622,976 0 (447,051) 432,256 112,416 127,211 0 3,622,976 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10,769,883 (317,282) 0 XXX XXX XXX 0 10,452,601 0 0 0 0 0 0 0 0 0 0 0 0 0 0 22,061,641 (317,410) (671,800) 984,250 918,232 605,782 0 21,744,231 XXX XXX 0 0 0 22,061,641 (317,410) (671,800) 984,250 918,232 605,782 0 21,744,231 (4) 0 0 0 98 44,417 17,860 12,164 95,375 22,513 16,557 6,662 4,525 35,652 8,400 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 94 (0.490) 192,329 0.731 71,797 1.034 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 1 13,654 13,654 0.266 65,930 56,224 122,154 0.011 24,566 21,018 45,583 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 0 0 0 0 0 0 0 1,157 1 35 82,560 21,386 0 0 0 0 0 62,128 24,523 16,724 213,587 52,398 0 105,139 XXX 0 0.000 369,359 XXX 97,325 114,191 211,516 0.013 0 0 0 0.000 187,821 205,087 392,908 XXX XXX 0 0 0 0.000 0 XXX XXX XXX XXX XXX XXX XXX XXX 3,590 152 1,531 772 3,561 65,717 24,674 18,254 214,359 55,959 9,604 XXX 378,963 XXX 17,290 15,484 32,774 XXX 205,111 220,571 425,682 XXX SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 1,060 267 54,056 0 55,383 3 Large Group Employer 37,380 380,950 37,360 972,204 0 1,427,893 4 5 Small Group Employer Individual 13,945 141,897 7,669 364,958 0 528,468 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 90,547 1,105,505 84,934 146,832 0 1,427,817 0 0 0 0 0 0 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 141,871 1,629,411 130,229 1,538,050 0 3,439,562 12,139 15,587 8,002 139,657 0 175,384 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 3,941,976 XXX 4,736,002 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 7,659 1,358,309 (695,365) 0 0 0 0 0 0 0 3,271,373 0 3,941,976 XXX XXX 154,010 1,644,998 138,231 1,677,707 0 3,614,946 3,764,547 971,455 971,455 0 OTHER INDICATORS: 216-2.MI 1. Number of certificates/policies 0 1,076 448 0 0 0 0 0 0 0 26,183 0 27,707 233 27,940 2. Number of Covered Lives 0 2,021 757 0 0 0 0 0 0 0 37,559 0 40,337 444 40,781 3. Number of Groups 146 23 0 0 0 0 0 0 946 0 1,115 3 1,118 4. Member Months 66 27,039 10,082 0 0 0 0 0 0 510,523 0 547,710 5,458 553,168 XXX Is run off business reported in Columns 1 through 9 or 12? Yes [ XXX 0 ] No [ X ] 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 0 114,957 XXX (292,119) 97,789 0 0 441,713 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 6. Temporary ACA Risk Corridors Program 6.1 Retrospective premium received 6.2 Rate credits or policy experience refunds paid 0 97,917 0 0 (208,113) XXX 282,977 637,520 0 0 0 0 (399,256) XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF 1100 Employers Boulevard DePere, WI 54115 Michigan 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 73288 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.MI Health Premiums Earned: (2,786) 11,539,717 1.1 Direct premiums written 6,157 0 1.2 Unearned premium prior year 0 0 1.3 Unearned premium current year 6,157 0 1.4 Change in unearned premium (Lines 1.2 - 1.3) 45,126 506,868 1.5 Paid rate credits 0 478,571 1.6 Reserve for rate credits current year 8,471 797,345 1.7 Reserve for rate credits prior year (8,471) (318,774) 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 3,371 11,539,717 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 (33,284) 11,351,623 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 331,336 7,827,887 2.1 Paid claims during the year 7,226 46,292 2.2 Direct claim liability current year 317,862 420,732 2.3 Direct claim liability prior year 0 187,513 2.4 Direct claim reserves current year 0 190,588 2.5 Direct claim reserves prior year 0 0 2.6 Direct contract reserves current year 97,483 0 2.7 Direct contract reserves prior year 45,126 506,868 2.8 Paid rate credits 0 478,571 2.9 Reserve for rate credits current year 8,471 797,345 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 (14,855) (55,588) 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) (2,461) 92,236 2.12a Healthcare receivables current year 12,394 147,824 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 (25,272) 7,694,054 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 128 0 2.18 Ceded incurred claims to non-affiliates 0 0 2.19 Other adjustments due to MLR calculation - Claims (62,056) 7,505,961 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) 8,656,767 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 3,768,753 0 0 0 432,256 127,211 112,416 14,795 0 0 3,768,753 0 0 0 0 3,321,701 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 17,534,954 99,405 106,328 (6,923) 0 0 0 0 0 0 17,528,030 3,250 (1,025,865) 24,211 0 16,481,205 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 32,840,638 105,562 106,328 (766) 984,250 605,782 918,232 (312,450) 0 0 32,839,872 3,250 (1,025,865) 24,211 0 31,121,245 3,240,212 901,013 945,602 0 8 0 0 432,256 127,211 112,416 0 0 0 0 19,691 21,810 2,119 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10,895,315 1,215,935 1,282,696 227,843 239,213 13,721 53,830 0 0 0 0 0 0 0 7,193 7,279 86 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 22,294,750 2,170,467 2,966,891 415,356 429,809 13,721 151,313 984,250 605,782 918,232 0 0 0 0 (43,559) 118,863 162,422 0 0 3,622,976 0 0 0 0 3,175,924 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 10,769,883 334,602 (282,363) 369,521 0 10,452,601 0 0 0 0 0 0 22,061,641 334,602 (282,363) 369,649 0 21,072,430 0 0 0 1,131,545 for stand-alone vision policies. 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF Michigan DURING THE YEAR All Expenses 1 Individual Comprehensive Coverage Expenses: 3,407 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 281 for affiliated services) 1.3 EDP Equipment and Software (incl $ 7 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 3 for affiliated services) 1.5 Accreditation and Certification (incl $ 1,616 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 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 (4) 0 0 0 0 (4) 0 XXX XXX XXX 0 0 0 0 XXX 0 0 0 XXX 13,711 23,399 1,114 28 0 6,165 44,417 0 Large Group Comprehensive Coverage Expenses: 24,453 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 1,710 for affiliated services) 3.3 EDP Equipment and Software (incl $ 41 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 15 for affiliated services) 3.5 Accreditation and Certification (incl $ 23,495 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 (4) 0 Small Group Comprehensive Coverage Expenses: 65,166 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 4,555 for affiliated services) 2.3 EDP Equipment and Software (incl $ 111 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 41 for affiliated services) 2.5 Accreditation and Certification (incl $ 62,904 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. 1100 Employers Boulevard DePere, WI 54115 0 0 0 0 XXX 0 0 0 XXX Total (1 to 5) 50 17 4 0 0 22 94 0 XXX 0 0 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 51 21 4 0 22 98 0 XXX (LOCATION) NAIC Company Code 2018 XXX (10) (4) (1) 0 0 16 1 0 XXX 5,762 3,444 724 18 7 3,698 13,654 0 XXX 0 0 0 0 0 0 98 0 94 0 1 0 13,654 0 619 16,914 48 1 4,949 4,729 313 8 65,133 17,059 2,831 39 11,436 4,838 1,016 25 95,848 66,939 5,323 101 0 24,118 192,329 0 29,920 20,408 2,026 51 21 13,505 65,930 0 30,084 11,145 2,249 53 22 12,671 56,224 0 XXX XXX 277 17,860 0 XXX XXX 2,165 12,164 0 XXX XXX 10,313 95,375 0 XXX 5,198 22,513 0 XXX XXX XXX XXX 44,417 0 17,860 0 12,164 0 95,375 0 22,513 0 192,329 0 65,930 13,318 56,224 0 5,110 8,724 415 10 0 2,297 16,557 0 234 6,307 18 0 1,840 1,762 117 3 24,362 6,365 1,058 14 4,269 1,805 380 9 35,813 24,963 1,989 38 0 8,994 71,797 0 11,115 7,649 756 19 8 5,019 24,566 0 11,272 4,156 840 20 8 4,722 21,018 0 XXX XXX XXX 104 6,662 0 XXX 16,557 0 XXX 804 4,525 0 XXX 6,662 0 XXX 3,853 35,652 0 XXX 4,525 0 1,937 8,400 0 XXX 35,652 0 XXX 8,400 0 XXX 71,797 0 XXX 24,566 4,966 21,018 0 73288 9 10 General Administrative Expenses Total Expenses (6 to 9) 28,271 12,261 2,084 52 21 12,427 55,116 0 267 55,383 0 34,073 15,718 2,811 70 29 16,163 68,864 0 267 69,132 0 495,809 278,768 35,950 900 366 578,742 1,390,534 0 37,360 1,427,893 0 651,660 377,260 45,547 1,105 408 629,036 1,705,017 0 37,360 1,742,376 13,318 186,332 104,263 13,515 339 138 216,213 520,799 0 7,669 528,468 0 244,533 141,031 17,099 415 153 234,948 638,179 0 7,669 645,848 4,966 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 Humana 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 *73288201821624100* SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (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) Humana Insurance Company 2. 1100 Employers Boulevard DePere, WI 54115 (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 2 Small Group Employer 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 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) 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 73288 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 3,655 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,277,244 0 0 0 0 0 2,280,899 0 0 XXX XXX XXX 3,655 (5,686) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,277,244 147,743 0 0 2,280,899 142,058 XXX (810) 0 2 10,148 0 0 0 10,148 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 62,723 0 8,552 2,058,226 (360) 0 0 2,057,866 0 0 0 0 0 0 0 0 61,913 0 8,555 2,068,374 (360) 0 0 2,068,014 XXX XXX XXX XXX XXX 61,913 0 8,555 2,068,374 (360) 0 0 2,068,014 35,449 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,732,697 0 68 0 0 0 1,768,146 0 68 XXX XXX XXX 1,768,146 0 68 0 0 0 35,449 0 0 0 0 0 0 35,449 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,732,629 (1,104) 0 XXX XXX XXX 0 1,731,525 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,768,077 (1,104) 0 0 0 0 0 1,766,973 XXX XXX 0 0 0 1,768,077 (1,104) 0 0 0 0 0 1,766,973 10 0 2 14 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 33 3.497 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 19 26 45 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 0 0 0 0.000 0 0 0 0.000 XXX XXX XXX 0 0 0 0 0 0 0 280 0 12 11,303 2,903 0 0 0 0 0 291 0 14 11,317 2,909 0 14,497 XXX 0 0.000 14,531 XXX 7,633 26,147 33,779 0.016 0 0 0 0.000 7,652 26,172 33,824 XXX XXX 0 0 0 0.000 2,280,899 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 291 0 14 11,317 2,909 0 14,531 XXX 0 0 0 7,652 26,172 33,824 XXX XXX XXX 2,280,899 142,058 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 19 (155) 347 0 226 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 14,606 164,226 20,127 (886,595) 0 (687,635) 0 0 0 0 0 0 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 14,622 164,245 19,972 (886,248) 0 (687,409) 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 940,095 XXX 940,095 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 (25,605) 0 0 0 0 0 0 0 0 0 965,700 0 940,095 XXX 14,622 164,245 19,972 (886,248) 0 (687,409) XXX 940,095 0 0 0 OTHER INDICATORS: 216-2.MN 1. Number of certificates/policies 1 0 0 0 0 0 0 0 0 0 3,899 0 3,900 0 3,900 2. Number of Covered Lives 1 0 0 0 0 0 0 0 0 0 5,999 0 6,000 0 6,000 3. Number of Groups 0 0 0 0 0 0 0 0 76 0 76 0 76 4. Member Months 0 0 0 0 0 0 0 0 71,463 0 71,475 0 71,475 XXX 12 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ X ] If yes, show the amount of premiums and claims included. Premiums $ XXX 0 0 Claims $ 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) 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 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 XXX XXX NONE XXX XXX 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF 1100 Employers Boulevard DePere, WI 54115 Minnesota 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 73288 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.MN Health Premiums Earned: 3,655 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 3,655 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 3,655 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 34,304 2.1 Paid claims during the year 1,667 2.2 Direct claim liability current year 522 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 35,449 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 35,449 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) 348,103 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 2,278,514 9,297 10,567 (1,270) 0 0 0 0 0 0 2,277,244 0 (360) 0 0 2,276,884 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,282,169 9,297 10,567 (1,270) 0 0 0 0 0 0 2,280,899 0 (360) 0 0 2,280,539 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,761,085 240,409 237,631 38,881 52,965 0 0 0 0 0 0 0 0 0 17,151 17,227 76 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,795,389 242,077 238,153 38,881 52,965 0 0 0 0 0 0 0 0 0 17,151 17,227 76 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,732,629 (14,524) 14,131 711 0 1,731,525 0 0 0 0 0 0 1,768,077 (14,524) 14,131 711 0 1,766,973 0 0 0 495,347 for stand-alone vision policies. 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF Minnesota DURING THE YEAR All Expenses 1 2. 216-4.MN 3. Individual Comprehensive Coverage Expenses: 24 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 2 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 $ 12 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. 1100 Employers Boulevard DePere, WI 54115 5 2 0 0 0 2 10 0 XXX 0 0 0 0 XXX 1 1 0 0 XXX 0 0 0 XXX 7 3 1 0 XXX 0 2 0 XXX Total (1 to 5) 18 7 2 0 0 7 33 0 XXX 3 14 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 3 1 0 0 1 6 0 XXX (LOCATION) NAIC Company Code 2018 XXX 10 4 1 0 0 4 19 0 XXX 16 4 1 0 0 4 26 0 XXX 10 0 0 0 2 0 14 0 6 0 33 0 19 6 26 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 73288 9 10 General Administrative Expenses Total Expenses (6 to 9) 197 69 15 0 0 101 381 0 (155) 226 0 241 85 18 0 0 116 459 0 (155) 304 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 Humana 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 Humana 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 *73288201821625100* SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (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) Humana Insurance Company 2. 1100 Employers Boulevard DePere, WI 54115 (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 2 Small Group Employer 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 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) 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 73288 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 712,845 0 0 10,977,471 0 0 10,315,976 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 17,267,205 0 0 0 0 0 39,273,498 0 0 XXX XXX XXX 39,273,498 0 0 712,845 586,896 10,977,471 281,342 10,315,976 28,178 0 0 0 0 0 0 0 0 0 0 0 0 0 0 17,267,205 482,091 0 0 39,273,498 1,378,506 XXX (117,438) 39,273,498 1,261,068 87,368 0 8,281 30,301 0 0 0 30,301 251,350 0 8,189 10,436,590 0 0 0 10,436,590 161,563 0 5,189 10,121,046 0 0 0 10,121,046 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 0 390,506 0 34,989 16,359,620 (3,477,817) 0 0 12,881,803 0 0 0 0 0 0 0 0 890,787 0 56,648 36,947,557 (3,477,817) 0 0 33,469,740 (17,686) 0 2,707 XXX XXX XXX XXX XXX 873,100 0 59,356 37,079,974 (3,477,817) 0 0 33,602,157 (2,406,185) (265,742) (1,651) 6,516,315 1,790,840 382,645 8,991,574 1,814,191 354,425 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 11,466,861 521 0 0 0 0 24,568,565 3,339,810 735,419 XXX XXX XXX 24,568,565 3,339,810 735,419 0 (262,477) 0 (2,932,753) (1,502) 0 0 0 0 0 (2,934,254) 0 0 0 7,924,510 0 0 0 0 0 0 7,924,510 0 0 0 10,451,340 0 134,802 0 0 0 0 10,586,142 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 11,467,381 (2,580,019) 0 XXX XXX XXX 0 8,887,363 0 0 0 0 0 0 0 0 0 0 0 0 (262,477) 0 26,910,479 (2,581,520) 134,802 0 0 0 0 24,463,760 XXX XXX 0 (262,477) 0 26,910,479 (2,581,520) 134,802 0 0 0 0 24,463,760 42,487 16,630 12,807 91,284 20,909 40,720 16,005 12,250 97,171 20,146 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 (96.788) 184,117 0.777 186,292 1.051 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 1 (41,757) (41,757) (1.378) 67,510 59,073 126,583 0.012 65,375 63,845 129,220 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 XXX XXX XXX 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 1,102 0 27 56,896 19,471 0 0 0 0 0 84,309 32,635 25,084 245,351 60,526 11,059 482 4,323 12,583 10,690 95,369 33,117 29,406 257,934 71,216 0 77,497 XXX 0 0.000 447,905 XXX 39,137 XXX 487,042 XXX 0 0 0 0.000 73,668 95,087 168,755 0.010 0 0 0 0.000 206,554 176,248 382,802 XXX 51,366 45,417 96,783 XXX 257,919 221,666 479,585 XXX XXX SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 2,751 16,552 21,517 0 40,819 3 Large Group Employer 34,920 412,865 29,189 723,451 0 1,200,425 4 5 Small Group Employer Individual 36,023 213,581 13,860 883,171 0 1,146,635 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 80,053 1,008,717 109,433 (385,015) 0 813,188 0 0 0 0 0 0 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 150,996 1,637,914 169,033 1,243,124 0 3,201,067 31,089 117,522 12,888 380,680 0 542,178 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 4,974,205 XXX 5,114,095 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 2,965,492 1,000,956 (1,927,243) 0 0 0 0 0 0 0 2,935,000 0 4,974,205 XXX XXX 182,085 1,755,436 181,921 1,623,804 0 3,743,246 4,428,524 685,572 685,572 0 OTHER INDICATORS: 216-2.MS 1. Number of certificates/policies 0 1,122 1,206 0 0 0 0 0 0 0 28,234 0 30,562 787 31,349 2. Number of Covered Lives 0 1,920 1,654 0 0 0 0 0 0 0 43,969 0 47,543 1,544 49,087 3. Number of Groups 225 38 0 0 0 0 0 0 397 0 660 13 673 4. Member Months 1,173 24,931 24,050 0 0 0 0 0 0 562,333 0 612,487 17,493 629,980 XXX Is run off business reported in Columns 1 through 9 or 12? Yes [ XXX 0 ] No [ X ] 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 (6,476,040) (55,892) XXX (4,715,938) 1,142,938 0 0 (298,505) XXX 0 0 0 0 ACA Receipts and Payments 4. Permanent ACA Risk Adjustment Program 4.0 Premium adjustments receipts/(payments) 6,306,648 5. Transitional ACA Reinsurance Program 5.0 Amounts received for claims 1,144,439 6. Temporary ACA Risk Corridors Program 6.1 Retrospective premium received 6.2 Rate credits or policy experience refunds paid 0 0 (115,838) XXX 9,062,011 7,961,026 0 0 0 0 (198,413) XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF 1100 Employers Boulevard DePere, WI 54115 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 73288 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.MS Health Premiums Earned: 712,845 10,977,471 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 712,845 10,977,471 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 712,845 10,977,471 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 1,972,563 7,881,538 2.1 Paid claims during the year 165,943 1,049,635 2.2 Direct claim liability current year 5,235,810 1,224,589 2.3 Direct claim liability prior year 0 2,530 2.4 Direct claim reserves current year 0 2,010 2.5 Direct claim reserves prior year 0 0 2.6 Direct contract reserves current year (1) 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 (262,477) 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 381,363 0 2.11b Accrued medical incentive pools and bonuses current year 643,840 0 2.11c Accrued medical incentive pools and bonuses prior year (427,028) (217,405) 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 13,083 129,389 2.12a Healthcare receivables current year 440,110 346,794 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 (2,932,753) 7,924,510 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 1,502 0 2.18 Ceded incurred claims to non-affiliates 0 0 2.19 Other adjustments due to MLR calculation - Claims (2,934,254) 7,924,510 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) 5,520,496 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 10,315,976 0 0 0 0 0 0 0 0 0 10,315,976 0 0 0 0 10,315,976 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 17,273,635 33,328 39,758 (6,430) 0 0 0 0 0 0 17,267,205 0 (3,215,588) 262,229 0 13,789,388 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 39,279,928 33,328 39,758 (6,430) 0 0 0 0 0 0 39,273,498 0 (3,215,588) 262,229 0 35,795,681 10,508,000 881,470 720,965 633 184 0 0 0 0 0 0 0 0 0 217,615 95,067 (122,547) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 11,003,407 2,278,983 1,876,246 0 0 532,205 439,274 0 0 0 0 0 0 0 31,693 31,694 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 31,365,508 4,376,032 9,057,610 3,164 2,194 532,205 439,273 0 0 0 (262,477) 0 381,363 643,840 (395,125) 269,233 664,358 0 0 10,451,340 0 0 0 134,802 10,586,142 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 11,467,381 21,771 (2,315,039) 286,751 0 8,887,363 0 0 0 0 0 0 26,910,479 21,771 (2,315,039) 288,253 134,802 24,463,760 0 0 0 1,254,497 for stand-alone vision policies. 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF Mississippi DURING THE YEAR All Expenses 1 Individual Comprehensive Coverage Expenses: (2,027) 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 $ 280 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 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: 56,087 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 3,788 for affiliated services) 2.3 EDP Equipment and Software (incl $ 91 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 33 for affiliated services) 2.5 Accreditation and Certification (incl $ 62,580 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 (1) 0 0 0 0 2 1 0 XXX (41,730) (12) (3) 0 0 (12) (41,757) 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 1 0 (41,757) 0 13,386 22,072 1,026 25 0 5,978 42,487 0 626 15,685 44 1 5,496 4,648 290 7 63,150 15,759 2,691 36 10,625 4,494 945 23 93,283 62,658 4,997 92 0 23,087 184,117 0 32,455 18,726 1,876 46 19 14,387 67,510 0 31,639 11,674 2,222 53 21 13,464 59,073 0 XXX Large Group Comprehensive Coverage Expenses: 57,332 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 3,844 for affiliated services) 3.3 EDP Equipment and Software (incl $ 92 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 34 for affiliated services) 3.5 Accreditation and Certification (incl $ 42,762 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. 1100 Employers Boulevard DePere, WI 54115 XXX XXX 274 16,630 0 XXX XXX 2,366 12,807 0 XXX XXX 9,648 91,284 0 XXX 4,821 20,909 0 XXX XXX XXX XXX 42,487 0 16,630 0 12,807 0 91,284 0 20,909 0 184,117 0 67,510 12,275 59,073 0 12,855 21,112 987 25 0 5,741 40,720 0 562 15,149 43 1 5,246 4,461 278 7 69,187 15,188 2,850 35 10,235 4,329 910 23 98,085 60,238 5,068 91 0 22,808 186,292 0 31,196 18,428 1,837 46 18 13,851 65,375 0 35,613 12,036 2,320 55 22 13,799 63,845 0 XXX XXX XXX 251 16,005 0 XXX 40,720 0 XXX 2,258 12,250 0 XXX 16,005 0 XXX 9,911 97,171 0 XXX 12,250 0 4,648 20,146 0 XXX 97,171 0 XXX 20,146 0 XXX 186,292 0 XXX 65,375 11,979 63,845 0 73288 9 10 General Administrative Expenses Total Expenses (6 to 9) 21,457 (1) 0 0 0 2,812 24,267 0 16,552 40,819 0 (20,274) (13) (3) 0 0 2,801 (17,489) 0 16,552 (937) 0 403,494 163,083 28,785 721 293 574,859 1,171,236 0 29,189 1,200,425 0 560,872 256,141 37,880 912 333 625,798 1,481,936 0 29,189 1,511,125 12,275 408,429 316,936 29,218 731 297 377,165 1,132,775 0 13,860 1,146,635 0 573,322 407,638 38,443 924 338 427,623 1,448,287 0 13,860 1,462,147 11,979 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 Humana 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 *73288201821626100* SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (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) Humana Insurance Company 2. 1100 Employers Boulevard DePere, WI 54115 (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 2 Small Group Employer 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 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) 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 73288 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 (1,197,932) 0 0 59,686,162 0 0 36,191,956 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 38,547,016 0 0 0 0 0 133,227,202 0 0 XXX XXX XXX 133,227,202 0 0 (1,197,932) 527,556 59,686,162 1,012,509 36,191,956 771,190 0 0 0 0 0 0 0 0 0 0 0 0 0 0 38,547,016 263,323 0 0 133,227,202 2,574,578 XXX (802,728) 133,227,202 1,771,850 83,913 0 9,820 (1,819,221) 0 0 0 (1,819,221) 686,819 0 37,284 57,949,550 0 0 0 57,949,550 398,384 0 19,091 35,003,290 0 0 0 35,003,290 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 430,743 0 61,793 37,791,158 (658,101) 0 0 37,133,057 0 0 0 0 0 0 0 0 1,599,859 0 127,988 128,924,777 (658,101) 0 0 128,266,676 (121,286) 0 15,889 XXX XXX XXX XXX XXX 1,478,573 0 143,877 129,832,902 (658,101) 0 0 129,174,801 (4,454,051) (431,452) (15,607) 40,583,618 10,903,547 2,049,919 25,065,951 7,639,229 1,606,513 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 28,664,715 370 (6) 0 0 0 89,860,234 18,111,694 3,640,819 XXX XXX XXX 89,860,234 18,111,694 3,640,819 0 0 0 (4,869,896) (459) 0 0 0 0 0 (4,870,355) 0 0 0 49,437,246 0 0 0 0 0 0 49,437,246 0 0 0 31,098,667 0 364,711 0 0 0 0 31,463,378 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 28,665,091 (66,489) 0 XXX XXX XXX 0 28,598,602 0 0 0 0 0 0 0 0 0 0 0 0 0 0 104,331,109 (66,948) 364,711 0 0 0 0 104,628,872 XXX XXX 0 0 0 104,331,109 (66,948) 364,711 0 0 0 0 104,628,872 0 0 0 0 0 210,277 83,495 62,013 577,919 106,015 147,326 58,826 42,819 471,580 73,489 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2.677 1,039,719 0.871 794,040 0.911 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 329,613 317,505 647,118 0.011 231,088 225,803 456,891 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 (56,968) (56,968) 0.031 XXX XXX XXX 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 2,284 1 81 229,996 53,005 0 0 0 0 0 359,888 142,322 104,912 1,279,494 232,509 53,623 2,498 15,741 243,294 58,252 413,510 144,820 120,654 1,522,789 290,761 0 285,366 XXX 0 0.000 2,119,126 XXX 373,408 XXX 2,492,534 XXX 0 0 0 0.000 126,828 216,475 343,303 0.009 0 0 0 0.000 687,529 702,814 1,390,343 XXX 234,812 229,818 464,630 XXX 922,341 932,632 1,854,973 XXX XXX SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 (23,074) 16,000 19 0 (7,054) 3 Large Group Employer 184,259 2,685,385 121,351 3,582,981 0 6,573,976 4 5 Small Group Employer Individual 140,051 1,934,255 76,159 2,548,433 0 4,698,898 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 0 152,220 2,838,433 139,896 2,938,559 0 6,069,109 0 0 0 0 0 0 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 476,531 7,434,999 353,405 9,069,993 0 17,334,928 203,190 1,419,604 77,133 2,162,196 0 3,862,122 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 2,793,407 XXX 4,449,960 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 3,115,157 251,490 (2,409,917) 0 0 0 0 0 0 0 1,836,678 0 2,793,407 XXX XXX 679,721 8,854,603 430,538 11,232,188 0 21,197,050 (998,628) 5,448,588 5,448,588 0 OTHER INDICATORS: 216-2.MO 1. Number of certificates/policies 0 5,668 4,850 0 0 0 0 0 0 0 56,365 0 66,883 5,445 72,328 2. Number of Covered Lives 0 9,006 7,635 0 0 0 0 0 0 0 89,390 0 106,031 8,827 114,858 3. Number of Groups 910 77 0 0 0 0 0 0 3,588 0 4,575 264 4,839 4. Member Months 743 124,932 87,882 0 0 0 0 0 0 1,016,625 0 1,230,182 90,494 1,320,676 XXX Is run off business reported in Columns 1 through 9 or 12? Yes [ XXX 0 ] No [ X ] 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 (1,458,221) 1,166,316 XXX 8,974,901 349,381 0 0 3,528,957 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 (938,682) 349,840 0 0 (2,420,233) XXX (10,432,561) 2,337,996 0 0 0 0 (6,145,095) XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF 1100 Employers Boulevard DePere, WI 54115 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 73288 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.MO Health Premiums Earned: (1,197,932) 59,686,162 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 (1,197,932) 59,686,162 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 (1,197,932) 59,686,162 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 2,794,221 49,927,907 2.1 Paid claims during the year 108,365 2,939,187 2.2 Direct claim liability current year 8,505,373 3,434,671 2.3 Direct claim liability prior year 0 147,682 2.4 Direct claim reserves current year 0 117,776 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 (732,891) 25,082 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 1,050 652,050 2.12a Healthcare receivables current year 733,941 626,968 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 (4,869,896) 49,437,246 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 459 0 2.18 Ceded incurred claims to non-affiliates 0 0 2.19 Other adjustments due to MLR calculation - Claims (4,870,355) 49,437,246 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) 11,420,817 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 36,191,956 0 0 0 0 0 0 0 0 0 36,191,956 0 0 0 0 36,191,956 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 38,559,721 61,731 74,437 (12,705) 0 0 0 0 0 0 38,547,016 (109,805) (522,087) 26,210 0 37,888,915 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 133,239,907 61,731 74,437 (12,705) 0 0 0 0 0 0 133,227,202 (109,805) (522,087) 26,210 0 132,569,101 30,117,042 4,588,495 3,791,132 2,662 183 0 0 0 0 0 0 0 0 0 (181,783) 471,863 653,646 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 27,265,717 3,654,401 2,789,747 6,128 6,815 3,167,307 2,514,314 0 0 0 0 0 0 0 117,586 117,661 75 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 110,104,887 11,290,448 18,520,924 156,472 124,775 3,167,307 2,514,313 0 0 0 0 0 0 0 (772,006) 1,242,624 2,014,631 0 0 31,098,667 0 0 0 364,711 31,463,378 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 28,665,091 (383,248) 286,102 (30,657) 0 28,598,602 0 0 0 0 0 0 104,331,109 (383,248) 286,102 (30,198) 364,711 104,628,872 0 0 0 2,479,463 for stand-alone vision policies. 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF Missouri DURING THE YEAR All Expenses 1 Individual Comprehensive Coverage Expenses: (5,691) 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 $ (2,313) 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 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: 296,862 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 19,686 for affiliated services) 2.3 EDP Equipment and Software (incl $ 468 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 171 for affiliated services) 2.5 Accreditation and Certification (incl $ 377,448 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 1 0 0 0 0 (2) 0 0 XXX (56,929) (17) (4) 0 0 (18) (56,968) 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (56,968) 0 66,089 109,357 5,138 129 0 29,564 210,277 0 3,233 78,608 223 5 26,293 22,876 1,447 36 428,914 78,191 16,523 178 53,856 22,781 4,789 119 578,385 311,813 28,122 467 0 120,932 1,039,719 0 156,574 93,373 9,489 236 96 69,845 329,613 0 175,818 60,432 11,744 280 114 69,118 317,505 0 XXX Large Group Comprehensive Coverage Expenses: 216,849 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 14,203 for affiliated services) 3.3 EDP Equipment and Software (incl $ 334 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 122 for affiliated services) 3.5 Accreditation and Certification (incl $ 271,050 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. 1100 Employers Boulevard DePere, WI 54115 XXX XXX 1,425 83,495 0 XXX XXX 11,361 62,013 0 XXX XXX 54,112 577,919 0 XXX 24,470 106,015 0 XXX XXX XXX XXX 210,277 0 83,495 0 62,013 0 577,919 0 106,015 0 1,039,719 0 329,613 62,029 317,505 0 46,003 77,034 3,605 90 0 20,595 147,326 0 2,255 55,416 157 4 17,994 15,995 1,016 25 363,282 54,002 13,246 124 37,335 15,793 3,319 83 466,869 218,241 21,342 326 0 87,263 794,040 0 109,095 66,151 6,802 169 69 48,802 231,088 0 125,123 42,970 8,441 201 82 48,986 225,803 0 XXX XXX XXX 994 58,826 0 XXX 147,326 0 XXX 7,789 42,819 0 XXX 58,826 0 XXX 40,926 471,580 0 XXX 42,819 0 16,958 73,489 0 XXX 471,580 0 XXX 73,489 0 XXX 794,040 0 XXX 231,088 44,269 225,803 0 73288 9 10 General Administrative Expenses Total Expenses (6 to 9) 17 33 7 0 0 (23,112) (23,055) 0 16,000 (7,054) 0 (56,912) 17 4 0 0 (23,132) (80,023) 0 16,000 (64,023) 0 2,057,841 727,498 147,505 3,693 1,500 3,514,586 6,452,625 0 121,351 6,573,976 0 2,968,618 1,193,117 196,859 4,676 1,710 3,774,481 8,139,462 0 121,351 8,260,813 62,029 1,467,399 520,731 105,444 2,640 1,072 2,525,454 4,622,739 0 76,159 4,698,898 0 2,168,486 848,093 142,028 3,336 1,222 2,710,505 5,873,670 0 76,159 5,949,829 44,269 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 Humana 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 *73288201821627100* SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (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) Humana Insurance Company 2. 1100 Employers Boulevard DePere, WI 54115 (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 2 Small Group Employer 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 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) 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 73288 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 4,700,442 0 0 0 0 0 4,700,442 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 4,700,442 (164,268) 0 0 4,700,442 (164,268) 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 0 113,176 0 7,597 4,743,938 0 0 0 4,743,938 0 0 0 0 0 0 0 0 113,176 0 7,597 4,743,938 0 0 0 4,743,938 XXX XXX XXX XXX XXX 113,176 0 7,597 4,743,938 0 0 0 4,743,938 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 3,955,702 0 10 0 0 0 3,955,702 0 10 XXX XXX XXX 3,955,702 0 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3,955,692 0 0 0 0 0 0 3,955,692 XXX XXX 0 0 0 0 0 3,955,692 0 0 XXX XXX XXX 0 3,955,692 0 0 0 3,955,692 0 0 0 0 0 0 3,955,692 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 0 3 262,434 6,060 0 0 0 0 0 8 0 3 262,434 6,060 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 0 268,505 XXX 0 0.000 268,505 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 6,941 42,990 49,931 0.011 0 0 0 0.000 6,941 42,990 49,931 XXX XXX XXX XXX XXX 0 0 0 0.000 4,700,442 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 8 0 3 262,434 6,060 0 268,505 XXX 0 0 0 6,941 42,990 49,931 XXX XXX XXX 4,700,442 (164,268) SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 9,589 297,889 2,687 (308,199) 0 1,966 0 0 0 0 0 0 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 9,589 297,889 2,687 (308,199) 0 1,966 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 467,844 XXX 467,844 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 0 467,844 0 467,844 XXX 9,589 297,889 2,687 (308,199) 0 1,966 XXX 467,844 0 0 0 OTHER INDICATORS: 216-2.MT 1. Number of certificates/policies 0 0 0 0 0 0 0 0 0 0 2,584 0 2,584 0 2,584 2. Number of Covered Lives 0 0 0 0 0 0 0 0 0 0 2,584 0 2,584 0 2,584 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 31,201 0 31,201 0 31,201 XXX 0 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ X ] If yes, show the amount of premiums and claims included. Premiums $ XXX 0 0 Claims $ 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) 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 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 XXX XXX NONE XXX XXX 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF 1100 Employers Boulevard DePere, WI 54115 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 73288 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.MT 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 4,700,442 0 0 0 0 0 0 0 0 0 4,700,442 0 0 0 0 4,700,442 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4,700,442 0 0 0 0 0 0 0 0 0 4,700,442 0 0 0 0 4,700,442 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3,982,105 455,858 428,872 0 0 0 0 0 0 0 0 0 0 0 53,400 53,547 148 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3,982,105 455,858 428,872 0 0 0 0 0 0 0 0 0 0 0 53,400 53,547 148 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 3,955,692 0 0 0 0 3,955,692 0 0 0 0 0 0 3,955,692 0 0 0 0 3,955,692 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 Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF Montana DURING THE YEAR All Expenses 1 2. 216-4.MT 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. 1100 Employers Boulevard DePere, WI 54115 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 73288 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 Humana 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 Humana 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 *73288201821628100* SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (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) Humana Insurance Company 2. 1100 Employers Boulevard DePere, WI 54115 (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 2 Small Group Employer 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 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) 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 73288 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 4,022,997 0 0 0 0 0 4,022,997 0 0 XXX XXX XXX 4,022,997 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4,022,997 70,429 0 0 4,022,997 70,429 XXX (14,513) 4,022,997 55,916 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 41,703 0 7,068 3,903,796 (22,941) 0 0 3,880,855 0 0 0 0 0 0 0 0 41,703 0 7,068 3,903,796 (22,941) 0 0 3,880,855 (2,176) 0 417 XXX XXX XXX XXX XXX 39,527 0 7,485 3,920,068 (22,941) 0 0 3,897,128 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,589,177 0 0 0 0 0 2,589,177 0 0 XXX XXX XXX 2,589,177 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,589,177 (9,138) 0 XXX XXX XXX 0 2,580,039 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,589,177 (9,138) 0 0 0 0 0 2,580,039 XXX XXX 0 0 0 2,589,177 (9,138) 0 0 0 0 0 2,580,039 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 0.000 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 0 0 0 0 0 0 0 230 0 3 60,619 4,975 0 0 0 0 0 230 0 3 60,619 4,975 0 65,826 XXX 0 0.000 65,826 XXX 9,211 29,425 38,636 0.010 0 0 0 0.000 9,211 29,425 38,636 XXX XXX 0 0 0 0.000 0 XXX XXX XXX XXX XXX XXX XXX XXX 1,819 90 358 459 1,919 2,049 90 361 61,078 6,894 4,645 XXX 70,472 XXX 7,414 7,633 15,047 XXX 16,625 37,058 53,683 XXX SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 14,783 391,677 24,377 (263,741) 0 167,097 0 0 0 0 0 0 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 14,783 391,677 24,377 (263,741) 0 167,097 4,323 746 1,710 56,631 0 63,411 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 1,029,257 XXX 1,011,043 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 1,029,257 0 1,029,257 XXX XXX 19,107 392,424 26,088 (207,111) 0 230,507 962,427 48,616 48,616 0 OTHER INDICATORS: 216-2.NE 1. Number of certificates/policies 0 0 0 0 0 0 0 0 0 0 4,697 0 4,697 245 4,942 2. Number of Covered Lives 0 0 0 0 0 0 0 0 0 0 6,110 0 6,110 245 6,355 3. Number of Groups 0 0 0 0 0 0 0 0 83 0 83 1 84 4. Member Months 0 0 0 0 0 0 0 0 60,591 0 60,591 3,228 63,819 XXX 0 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ X ] If yes, show the amount of premiums and claims included. Premiums $ XXX 0 0 Claims $ 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) 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 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 XXX XXX NONE XXX XXX 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF 1100 Employers Boulevard DePere, WI 54115 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 73288 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.NE 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) 736,232 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 4,028,280 10,865 16,148 (5,283) 0 0 0 0 0 0 4,022,997 0 (13,883) 9,058 0 4,000,056 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4,028,280 10,865 16,148 (5,283) 0 0 0 0 0 0 4,022,997 0 (13,883) 9,058 0 4,000,056 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,596,713 312,206 305,174 42,501 43,286 0 0 0 0 0 0 0 0 0 13,782 13,835 53 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,596,713 312,206 305,174 42,501 43,286 0 0 0 0 0 0 0 0 0 13,782 13,835 53 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,589,177 (669) 1,211 9,681 0 2,580,039 0 0 0 0 0 0 2,589,177 (669) 1,211 9,681 0 2,580,039 0 0 0 190,656 for stand-alone vision policies. 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF Nebraska DURING THE YEAR All Expenses 1 2. 216-4.NE 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. 1100 Employers Boulevard DePere, WI 54115 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 73288 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 Humana 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 Humana 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 *73288201821629100* SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (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) Humana Insurance Company 2. 1100 Employers Boulevard DePere, WI 54115 (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 2 Small Group Employer 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 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) 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 73288 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 742 0 0 3,373,421 0 0 2,266,121 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 12,214,558 0 0 0 0 0 17,854,842 0 0 XXX XXX XXX 742 6,954 3,373,421 351,327 2,266,121 212,196 0 0 0 0 0 0 0 0 0 0 0 0 0 0 12,214,558 99,096 0 0 17,854,842 669,573 XXX 1,058 0 0 (7,270) 0 0 0 (7,270) 164,259 0 1,248 2,856,586 0 0 0 2,856,586 92,372 0 1,162 1,960,390 0 0 0 1,960,390 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 401,465 0 11,933 11,702,063 (57,379) 0 0 11,644,684 0 0 0 0 0 0 0 0 659,155 0 14,343 16,511,770 (57,379) 0 0 16,454,391 XXX XXX XXX XXX XXX 659,154 0 14,344 16,511,774 (57,379) 0 0 16,454,395 (38,446) (2,016) 281 980,870 146,722 33,583 1,049,169 107,285 22,285 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8,011,754 534 0 0 0 0 10,003,347 252,525 56,149 XXX XXX XXX 10,003,347 252,525 56,149 0 0 0 (40,743) 0 0 0 0 0 0 (40,743) 0 0 0 1,094,009 0 0 0 0 0 0 1,094,009 0 0 0 1,134,169 0 0 0 0 0 0 1,134,169 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8,012,288 (10,235) 0 XXX XXX XXX 0 8,002,053 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10,199,723 (10,235) 0 0 0 0 0 10,189,488 XXX XXX 0 0 0 10,199,723 (10,235) 0 0 0 0 0 10,189,488 0 0 0 0 0 5,005 1,993 1,366 6,737 3,149 9,426 3,851 2,413 24,291 4,829 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 5.604 18,251 0.389 44,810 0.601 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 33 33 (0.005) 7,286 6,829 14,114 0.005 12,754 11,216 23,970 0.012 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 0 627 0 16 83,088 14,278 0 0 0 0 0 15,059 5,845 3,794 114,116 22,257 0 98,009 XXX 0 0.000 161,070 XXX 45,681 90,229 135,910 0.012 0 0 0 0.000 65,720 108,307 174,027 XXX XXX 0 0 0 0.000 17,854,842 0 0 (4) (1) 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 15,059 5,845 3,794 114,116 22,257 0 161,070 XXX 0 0 0 65,720 108,307 174,027 XXX XXX XXX 17,854,842 669,570 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 (48) 201 12 0 164 3 Large Group Employer 4,739 79,699 12,786 104,894 0 202,117 4 5 Small Group Employer Individual 8,097 74,458 8,829 159,438 0 250,822 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 45,044 1,128,410 44,715 254,594 0 1,472,762 0 0 0 0 0 0 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 57,880 1,282,518 66,530 518,937 0 1,925,865 0 0 0 19 0 20 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 4,003,940 XXX 4,003,923 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 33,275 1,528,095 506,619 0 0 0 0 0 0 0 1,935,950 0 4,003,940 XXX 57,880 1,282,519 66,531 518,957 0 1,925,886 XXX 4,003,923 0 0 0 OTHER INDICATORS: 216-2.NV 1. Number of certificates/policies 0 0 604 0 0 0 0 0 0 0 13,871 0 14,475 0 14,475 2. Number of Covered Lives 0 0 912 0 0 0 0 0 0 0 19,240 0 20,152 0 20,152 3. Number of Groups 0 9 0 0 0 0 0 0 553 0 562 0 562 4. Member Months 3,883 10,014 0 0 0 0 0 0 246,023 0 259,920 0 259,920 XXX 0 Is run off business reported in Columns 1 through 9 or 12? Yes [ XXX 0 ] No [ X ] 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 1,999,527 0 533,174 (169,017) XXX 0 0 (316,489) 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 234,180 0 0 0 0 XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF 1100 Employers Boulevard DePere, WI 54115 Nevada 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 73288 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.NV Health Premiums Earned: 742 3,373,421 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 742 3,373,421 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 742 3,373,421 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: (6,504) 1,344,331 2.1 Paid claims during the year 1,837 15,805 2.2 Direct claim liability current year 20,414 395,699 2.3 Direct claim liability prior year 0 10,027 2.4 Direct claim reserves current year 0 28,143 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 15,662 (147,688) 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 2,184 18,421 2.12a Healthcare receivables current year (13,478) 166,109 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 (40,743) 1,094,009 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 (40,743) 1,094,009 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 0 (informational only) 4,084,497 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 2,266,121 0 0 0 0 0 0 0 0 0 2,266,121 0 0 0 0 2,266,121 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 12,206,448 38,898 30,788 8,110 0 0 0 0 0 0 12,214,558 0 (56,254) 1,126 0 12,157,179 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 17,846,731 38,898 30,788 8,110 0 0 0 0 0 0 17,854,842 0 (56,254) 1,126 0 17,797,462 1,335,514 287,847 366,892 0 0 0 0 0 0 0 0 0 0 0 122,300 (3,400) (125,700) 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8,184,274 781,845 931,534 0 0 3,543 4,568 0 0 0 0 0 0 0 21,271 21,510 239 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10,857,614 1,087,333 1,714,538 10,027 28,143 3,543 4,568 0 0 0 0 0 0 0 11,545 38,714 27,169 0 0 1,134,169 0 0 0 0 1,134,169 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8,012,288 21,080 (22,421) 8,895 0 8,002,053 0 0 0 0 0 0 10,199,723 21,080 (22,421) 8,895 0 10,189,488 0 0 0 584,884 for stand-alone vision policies. 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF Nevada DURING THE YEAR All Expenses 1 2. Individual Comprehensive Coverage Expenses: (7) for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 1 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 $ 1 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.NV 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: 7,168 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 554 for affiliated services) 2.3 EDP Equipment and Software (incl $ 14 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 5 for affiliated services) 2.5 Accreditation and Certification (incl $ 11,115 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 (79) 49 10 0 0 53 33 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 33 0 1,554 2,622 127 3 0 699 5,005 0 61 1,899 5 0 558 529 36 1 3,497 2,019 220 5 1,601 677 142 4 7,270 7,746 530 12 0 2,693 18,251 0 3,392 2,097 229 6 2 1,560 7,286 0 1,527 2,292 465 11 5 2,528 6,829 0 XXX Large Group Comprehensive Coverage Expenses: 12,704 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 882 for affiliated services) 3.3 EDP Equipment and Software (incl $ 21 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 8 for affiliated services) 3.5 Accreditation and Certification (incl $ 12,173 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. 1100 Employers Boulevard DePere, WI 54115 XXX XXX 28 1,993 0 XXX XXX 244 1,366 0 XXX XXX 997 6,737 0 XXX 726 3,149 0 XXX XXX XXX XXX 5,005 0 1,993 0 1,366 0 6,737 0 3,149 0 18,251 0 7,286 1,514 6,829 0 2,855 5,036 240 6 0 1,289 9,426 0 116 3,672 10 0 938 990 67 2 17,592 3,613 702 8 2,454 1,038 219 5 23,955 14,349 1,239 21 0 5,245 44,810 0 5,815 3,828 437 11 4 2,658 12,754 0 5,828 2,318 476 12 5 2,578 11,216 0 XXX XXX XXX 52 3,851 0 XXX 9,426 0 XXX 415 2,413 0 XXX 3,851 0 XXX 2,375 24,291 0 XXX 2,413 0 1,114 4,829 0 XXX 24,291 0 XXX 4,829 0 XXX 44,810 0 XXX 12,754 2,880 11,216 0 73288 9 10 General Administrative Expenses Total Expenses (6 to 9) 5 2 0 0 0 (45) (37) 0 201 164 0 (74) 51 11 0 0 8 (3) 0 201 198 0 59,497 20,990 4,318 108 44 104,374 189,331 0 12,786 202,117 0 71,685 33,126 5,543 138 51 111,155 221,696 0 12,786 234,482 1,514 91,440 32,397 6,670 167 68 111,252 241,994 0 8,829 250,822 0 127,038 52,892 8,822 211 77 121,734 310,773 0 8,829 319,602 2,880 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 Humana 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 *73288201821630100* SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (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) Humana Insurance Company 2. 1100 Employers Boulevard DePere, WI 54115 (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 2 Small Group Employer 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 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) 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 73288 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 1,852,248 0 0 0 0 0 1,852,248 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 1,852,248 23,652 0 0 1,852,248 23,652 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 38,582 0 3,603 1,786,411 0 0 0 1,786,411 0 0 0 0 0 0 0 0 38,582 0 3,603 1,786,411 0 0 0 1,786,411 XXX XXX XXX XXX XXX 38,582 0 3,603 1,786,411 0 0 0 1,786,411 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,332,616 0 0 0 0 0 1,332,616 0 0 XXX XXX XXX 1,332,616 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,332,616 0 0 XXX XXX XXX 0 1,332,616 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,332,616 0 0 0 0 0 0 1,332,616 XXX XXX 0 0 0 1,332,616 0 0 0 0 0 0 1,332,616 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 0 0 0 0 0 0 0 0 XXX 0 0 0 0.000 (33) 0 4 154,976 2,520 0 0 0 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX (33) 0 4 154,976 2,520 157,467 XXX 0 0.000 157,467 XXX 3,239 18,982 22,221 0.012 0 0 0 0.000 3,239 18,982 22,221 XXX 1,852,248 0 0 0 0 0 0 0 (33) 0 4 154,976 2,520 0 157,467 XXX 0 0 0 3,239 18,982 22,221 XXX XXX XXX 1,852,248 23,652 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 7,837 131,247 7,925 (189,263) 0 (42,254) 0 0 0 0 0 0 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 7,837 131,247 7,925 (189,263) 0 (42,254) 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 316,361 XXX 316,361 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 0 316,361 0 316,361 XXX 7,837 131,247 7,925 (189,263) 0 (42,254) XXX 316,361 0 0 0 OTHER INDICATORS: 216-2.NH 1. Number of certificates/policies 0 0 0 0 0 0 0 0 0 0 1,830 0 1,830 0 1,830 2. Number of Covered Lives 0 0 0 0 0 0 0 0 0 0 2,407 0 2,407 0 2,407 3. Number of Groups 0 0 0 0 0 0 0 0 14 0 14 0 14 4. Member Months 0 0 0 0 0 0 0 0 30,371 0 30,371 0 30,371 XXX 0 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ X ] If yes, show the amount of premiums and claims included. Premiums $ XXX 0 0 Claims $ 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) 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 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 XXX XXX NONE XXX XXX 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF 1100 Employers Boulevard DePere, WI 54115 DURING THE YEAR New Hampshire 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 73288 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.NH 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 1,852,248 0 0 0 0 0 0 0 0 0 1,852,248 0 0 0 0 1,852,248 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,852,248 0 0 0 0 0 0 0 0 0 1,852,248 0 0 0 0 1,852,248 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,260,991 152,505 168,489 0 0 372,281 265,294 0 0 0 0 0 0 0 19,378 19,457 79 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,260,991 152,505 168,489 0 0 372,281 265,294 0 0 0 0 0 0 0 19,378 19,457 79 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,332,616 1 (1) 0 0 1,332,616 0 0 0 0 0 0 1,332,616 1 (1) 0 0 1,332,616 0 0 0 114,904 for stand-alone vision policies. 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF DURING THE YEAR New Hampshire All Expenses 1 2. 216-4.NH 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. 1100 Employers Boulevard DePere, WI 54115 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 73288 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 Humana 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 Humana 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 *73288201821631100* SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (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) Humana Insurance Company 2. 1100 Employers Boulevard DePere, WI 54115 (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 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) 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 73288 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 10,368,815 0 (3,207) 0 0 0 10,368,815 0 (3,207) XXX XXX XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10,365,608 (124,686) 0 0 10,365,608 (124,686) 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 0 208,551 0 16,117 10,265,627 (4,145) 0 0 10,261,482 0 0 0 0 0 0 0 0 208,551 0 16,117 10,265,627 (4,145) 0 0 10,261,482 XXX XXX XXX XXX XXX 208,551 0 16,117 10,265,627 (4,145) 0 0 10,261,482 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6,821,514 117 0 0 0 0 6,821,514 117 0 XXX XXX XXX 6,821,514 117 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6,821,631 0 0 0 0 0 0 6,821,631 XXX XXX 0 0 0 0 0 6,821,631 0 0 XXX XXX XXX 0 6,821,631 0 0 0 6,821,631 0 0 0 0 0 0 6,821,631 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 0 619 0 6 51,813 14,601 0 0 0 0 0 619 0 6 51,813 14,601 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 67,040 XXX 0 0.000 67,040 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 29,705 98,331 128,036 0.012 0 0 0 0.000 29,705 98,331 128,036 XXX XXX XXX XXX XXX 0 0 0 0.000 10,368,815 0 (3,207) 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 619 0 6 51,813 14,601 0 67,040 XXX 0 0 0 29,705 98,331 128,036 XXX XXX XXX 10,365,608 (124,686) SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 44,333 947,984 62,003 1,544,774 0 2,599,094 0 0 0 0 0 0 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 44,333 947,984 62,003 1,544,774 0 2,599,094 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 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 645,681 XXX 645,681 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 0 645,681 0 645,681 XXX 44,333 947,984 62,003 1,544,774 0 2,599,094 XXX 645,681 0 0 0 OTHER INDICATORS: 216-2.NJ 1. Number of certificates/policies 0 0 0 0 0 0 0 0 0 0 14,027 0 14,027 0 14,027 2. Number of Covered Lives 0 0 0 0 0 0 0 0 0 0 16,557 0 16,557 0 16,557 3. Number of Groups 0 0 0 0 0 0 0 0 49 0 49 0 49 4. Member Months 0 0 0 0 0 0 0 0 199,017 0 199,017 0 199,017 XXX 0 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ X ] If yes, show the amount of premiums and claims included. Premiums $ XXX 0 0 Claims $ 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) 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 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 XXX XXX NONE XXX XXX 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF 1100 Employers Boulevard DePere, WI 54115 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 73288 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) 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) 3,515,163 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 10,377,485 95,230 103,900 (8,670) 0 0 0 0 0 0 10,368,815 0 0 4,145 0 10,364,670 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10,377,485 95,230 103,900 (8,670) 0 0 0 0 0 0 10,368,815 0 0 4,145 0 10,364,670 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6,698,391 756,377 612,698 0 0 0 0 0 0 0 0 0 0 0 20,439 20,443 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6,698,391 756,377 612,698 0 0 0 0 0 0 0 0 0 0 0 20,439 20,443 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6,821,631 0 0 0 0 6,821,631 0 0 0 0 0 0 6,821,631 0 0 0 0 6,821,631 0 0 0 550,999 for stand-alone vision policies. 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF New Jersey DURING THE YEAR All Expenses 1 2. 216-4.NJ 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. 1100 Employers Boulevard DePere, WI 54115 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 73288 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 Humana 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 Humana 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 *73288201821632100* SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (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) Humana Insurance Company 2. 1100 Employers Boulevard DePere, WI 54115 (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 2 Small Group Employer 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 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) 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 73288 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 5,132,902 0 0 0 0 0 5,132,902 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 5,132,902 109,205 0 0 5,132,902 109,205 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 0 173,692 0 10,719 4,839,286 (220,289) 0 0 4,618,997 0 0 0 0 0 0 0 0 173,692 0 10,719 4,839,286 (220,289) 0 0 4,618,997 XXX XXX XXX XXX XXX 173,692 0 10,719 4,839,286 (220,289) 0 0 4,618,997 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3,387,926 411 0 0 0 0 3,387,926 411 0 XXX XXX XXX 3,387,926 411 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3,388,336 (106,513) 0 XXX XXX XXX 0 3,281,824 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3,388,336 (106,513) 0 0 0 0 0 3,281,824 XXX XXX 0 0 0 3,388,336 (106,513) 0 0 0 0 0 3,281,824 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 0 0 0 0 0 0 0 242 0 2 54,195 6,639 0 0 0 0 0 242 0 2 54,195 6,639 0 61,078 XXX 0 0.000 61,078 XXX 12,239 43,073 55,313 0.011 0 0 0 0.000 12,239 43,073 55,313 XXX XXX 0 0 0 0.000 5,132,902 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 242 0 2 54,195 6,639 0 61,078 XXX 0 0 0 12,239 43,073 55,313 XXX XXX XXX 5,132,902 109,205 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 20,992 368,353 46,315 (613,444) 0 (177,784) 0 0 0 0 0 0 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 20,992 368,353 46,315 (613,444) 0 (177,784) 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 1,398,566 XXX 1,398,566 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 1,398,566 0 1,398,566 XXX 20,992 368,353 46,315 (613,444) 0 (177,784) XXX 1,398,566 0 0 0 OTHER INDICATORS: 216-2.NM 1. Number of certificates/policies 0 0 0 0 0 0 0 0 0 0 5,107 0 5,107 0 5,107 2. Number of Covered Lives 0 0 0 0 0 0 0 0 0 0 5,678 0 5,678 0 5,678 3. Number of Groups 0 0 0 0 0 0 0 0 14 0 14 0 14 4. Member Months 0 0 0 0 0 0 0 0 76,405 0 76,405 0 76,405 XXX 0 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ X ] If yes, show the amount of premiums and claims included. Premiums $ XXX 0 0 Claims $ 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) 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 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 XXX XXX NONE XXX XXX 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF 1100 Employers Boulevard DePere, WI 54115 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 73288 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.NM 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) 891,652 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5,138,873 26,478 32,450 (5,971) 0 0 0 0 0 0 5,132,902 0 (150,890) 69,399 0 4,912,613 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5,138,873 26,478 32,450 (5,971) 0 0 0 0 0 0 5,132,902 0 (150,890) 69,399 0 4,912,613 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3,441,358 333,866 392,417 0 0 304,740 284,552 0 0 0 0 0 0 0 14,658 14,816 158 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3,441,358 333,866 392,417 0 0 304,740 284,552 0 0 0 0 0 0 0 14,658 14,816 158 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3,388,336 (18) (93,894) 12,600 0 3,281,824 0 0 0 0 0 0 3,388,336 (18) (93,894) 12,600 0 3,281,824 0 0 0 174,839 for stand-alone vision policies. 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF New Mexico DURING THE YEAR All Expenses 1 2. 216-4.NM 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. 1100 Employers Boulevard DePere, WI 54115 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 73288 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 Humana 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 Humana 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 *73288201821634100* SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (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) Humana Insurance Company 2. 1100 Employers Boulevard DePere, WI 54115 (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 2 Small Group Employer 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 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) 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 73288 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 (88) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 24,838,223 0 0 0 0 0 24,838,135 0 0 XXX XXX XXX (88) 7,846 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 24,838,223 248,824 0 0 24,838,135 256,670 XXX 1,196 0 0 (9,131) 0 0 0 (9,131) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 537,542 0 25,163 24,026,694 (921,884) 0 0 23,104,810 0 0 0 0 0 0 0 0 538,738 0 25,163 24,017,564 (921,884) 0 0 23,095,679 XXX XXX XXX XXX XXX 538,738 0 25,163 24,017,565 (921,884) 0 0 23,095,681 (46,463) (1,562) 954 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16,793,593 524 100 0 0 0 16,747,130 (1,039) 1,054 XXX XXX XXX 16,747,130 (1,039) 1,054 0 0 0 (48,980) (98) 0 0 0 0 0 (49,078) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16,794,017 (673,514) 0 XXX XXX XXX 0 16,120,504 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16,745,037 (673,611) 0 0 0 0 0 16,071,426 XXX XXX 0 0 0 16,745,037 (673,611) 0 0 0 0 0 16,071,426 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 5.364 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 (527) (527) 0.058 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 0 0 0 0 0 0 2,571 1 60 233,867 31,023 0 0 0 0 0 2,571 1 60 233,867 31,023 0 267,521 XXX 0 0.000 267,521 XXX 472,814 172,189 645,003 0.027 0 0 0 0.000 472,814 171,662 644,476 XXX XXX 0 0 0 0.000 24,838,135 0 0 (1) 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 2,571 1 60 233,867 31,023 0 267,521 XXX 0 8 8 472,814 171,670 644,484 XXX XXX XXX 24,838,135 256,668 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 (2) 227 1 0 226 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 0 122,009 2,380,668 94,062 1,309,002 0 3,905,741 0 0 0 0 0 0 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 122,009 2,380,666 94,289 1,309,003 0 3,905,967 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 2,206,289 XXX 2,206,274 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 40,248 0 0 0 0 0 0 0 0 0 2,166,041 0 2,206,289 XXX 122,009 2,380,666 94,289 1,309,003 0 3,905,967 XXX 2,206,282 (8) (8) 0 OTHER INDICATORS: 216-2.NC 1. Number of certificates/policies 0 0 0 0 0 0 0 0 0 0 46,050 0 46,050 0 46,050 2. Number of Covered Lives 0 0 0 0 0 0 0 0 0 0 67,464 0 67,464 0 67,464 3. Number of Groups 0 0 0 0 0 0 0 0 1,057 0 1,057 0 1,057 4. Member Months 0 0 0 0 0 0 0 0 766,820 0 766,820 0 766,820 XXX 0 Is run off business reported in Columns 1 through 9 or 12? Yes [ XXX 0 ] No [ X ] 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 XXX 1,168,723 74,416 0 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 74,513 0 0 XXX (1,766,156) 411,462 0 0 0 0 0 XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF 1100 Employers Boulevard DePere, WI 54115 North 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 73288 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.NC Health Premiums Earned: (88) 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 (88) 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 (88) 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 16,986 2.1 Paid claims during the year 1,216 2.2 Direct claim liability current year 63,815 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 1 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 3,366 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) (3,259) 2.12a Healthcare receivables current year (6,626) 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 (48,980) 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 98 2.18 Ceded incurred claims to non-affiliates 0 2.19 Other adjustments due to MLR calculation - Claims (49,078) 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) 12,101,783 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 24,868,497 68,835 99,109 (30,274) 0 0 0 0 0 0 24,838,223 4,949 (885,233) 41,600 0 23,916,339 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 24,868,409 68,835 99,109 (30,274) 0 0 0 0 0 0 24,838,135 4,949 (885,233) 41,600 0 23,916,250 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16,797,712 1,942,490 1,870,881 187,641 198,634 80 2,091 0 0 0 0 0 0 0 62,298 62,485 187 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16,814,698 1,943,706 1,934,696 187,641 198,634 80 2,092 0 0 0 0 0 0 0 65,665 59,226 (6,439) 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16,794,017 (11,449) (621,132) 40,932 0 16,120,504 0 0 0 0 0 0 16,745,037 (11,449) (621,132) 41,030 0 16,071,426 0 0 0 2,270,328 for stand-alone vision policies. 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF North Carolina DURING THE YEAR All Expenses 1 2. 216-4.NC 3. Individual Comprehensive Coverage Expenses: (53) 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. 1100 Employers Boulevard DePere, WI 54115 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 (527) 0 0 0 0 0 (527) 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (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 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 73288 9 10 General Administrative Expenses Total Expenses (6 to 9) 0 0 0 0 0 (2) (1) 0 227 226 0 (527) 0 0 0 0 (2) (528) 0 227 (301) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 Humana 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 Humana 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 *73288201821635100* SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (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) Humana Insurance Company 2. 1100 Employers Boulevard DePere, WI 54115 (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 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) 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 73288 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 1,800,129 0 0 0 0 0 1,800,129 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 1,800,129 93,534 0 0 1,800,129 93,534 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 40,751 0 6,170 1,659,673 (1,621) 0 0 1,658,052 0 0 0 0 0 0 0 0 40,751 0 6,170 1,659,673 (1,621) 0 0 1,658,052 XXX XXX XXX XXX XXX 40,751 0 6,170 1,659,673 (1,621) 0 0 1,658,052 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,228,735 0 0 0 0 0 1,228,735 0 0 XXX XXX XXX 1,228,735 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,228,735 0 0 0 0 0 0 1,228,735 XXX XXX 0 0 0 0 0 1,228,735 0 0 XXX XXX XXX 0 1,228,735 0 0 0 1,228,735 0 0 0 0 0 0 1,228,735 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 0 1 28,355 2,440 0 0 0 0 0 64 0 1 28,355 2,440 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 30,860 XXX 0 0.000 30,860 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 5,400 16,648 22,048 0.013 0 0 0 0.000 5,400 16,648 22,048 XXX XXX XXX XXX XXX 0 0 0 0.000 1,800,129 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 64 0 1 28,355 2,440 0 30,860 XXX 0 0 0 5,400 16,648 22,048 XXX XXX XXX 1,800,129 93,534 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 9,863 162,070 16,887 (525,978) 0 (337,157) 0 0 0 0 0 0 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 9,863 162,070 16,887 (525,978) 0 (337,157) 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 713,567 XXX 713,567 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 0 713,567 0 713,567 XXX 9,863 162,070 16,887 (525,978) 0 (337,157) XXX 713,567 0 0 0 OTHER INDICATORS: 216-2.ND 1. Number of certificates/policies 0 0 0 0 0 0 0 0 0 0 2,135 0 2,135 0 2,135 2. Number of Covered Lives 0 0 0 0 0 0 0 0 0 0 2,623 0 2,623 0 2,623 3. Number of Groups 0 0 0 0 0 0 0 0 8 0 8 0 8 4. Member Months 0 0 0 0 0 0 0 0 30,671 0 30,671 0 30,671 XXX 0 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ X ] If yes, show the amount of premiums and claims included. Premiums $ XXX 0 0 Claims $ 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) 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 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 XXX XXX NONE XXX XXX 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF 1100 Employers Boulevard DePere, WI 54115 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 73288 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) 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) 438,340 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,802,415 9,666 11,952 (2,285) 0 0 0 0 0 0 1,800,129 0 0 1,621 0 1,798,508 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,802,415 9,666 11,952 (2,285) 0 0 0 0 0 0 1,800,129 0 0 1,621 0 1,798,508 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,248,231 136,148 149,060 0 0 0 0 0 0 0 0 0 0 0 6,583 6,599 16 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,248,231 136,148 149,060 0 0 0 0 0 0 0 0 0 0 0 6,583 6,599 16 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,228,735 0 0 0 0 1,228,735 0 0 0 0 0 0 1,228,735 0 0 0 0 1,228,735 0 0 0 72,107 for stand-alone vision policies. 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF North Dakota DURING THE YEAR All Expenses 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) 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. 1100 Employers Boulevard DePere, WI 54115 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 73288 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 Humana 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 Humana 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 *73288201821636100* SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (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) Humana Insurance Company 2. 1100 Employers Boulevard DePere, WI 54115 (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 2 Small Group Employer 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 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) 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 73288 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 0 0 0 14,277,585 0 0 12,837,454 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 160,008,445 0 0 0 0 0 187,123,484 0 0 XXX XXX XXX 187,123,484 0 0 0 13,067 14,277,585 291,219 12,837,454 661,390 0 0 0 0 0 0 0 0 0 0 0 0 0 0 160,008,445 (3,689,999) 0 0 187,123,484 (2,724,323) XXX (278,367) 187,123,484 (3,002,689) 1,992 0 0 (15,059) 0 0 0 (15,059) 197,806 0 8,823 13,779,737 0 0 0 13,779,737 210,822 0 6,919 11,958,322 0 0 0 11,958,322 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,386,872 0 111,375 162,200,198 (166,037) 0 0 162,034,161 0 0 0 0 0 0 0 0 1,797,491 0 127,117 187,923,198 (166,037) 0 0 187,757,161 (41,929) 0 7,747 XXX XXX XXX XXX XXX 1,755,562 0 134,864 188,235,748 (166,037) 0 0 188,069,711 (72,818) (3,391) 17 11,549,365 308,511 85,411 9,723,720 52,150 16,015 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 123,134,306 794 13,684 0 0 0 144,334,574 358,064 115,127 XXX XXX XXX 144,334,574 358,064 115,127 0 0 0 (76,226) 0 0 0 0 0 0 (76,226) 0 0 0 11,772,465 0 99,463 130,925 230,388 0 0 11,772,465 0 0 0 9,759,856 0 0 0 0 0 0 9,759,856 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 144,577,511 5,058 99,463 130,925 230,388 0 0 144,582,569 XXX XXX 0 0 0 0 0 123,121,416 5,058 0 XXX XXX XXX 0 123,126,474 0 0 0 144,577,511 5,058 99,463 130,925 230,388 0 0 144,582,569 0 0 0 0 0 45,218 18,585 10,983 57,125 24,520 50,307 21,170 11,749 58,757 26,657 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 11,287 111 981 2,100,880 205,916 0 0 0 0 0 106,811 39,866 23,713 2,216,761 257,093 37,936 1,548 18,033 13,541 33,799 144,747 41,414 41,746 2,230,303 290,892 0 5.062 156,431 0.866 168,639 0.830 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 2,319,175 XXX 0 0.000 2,644,244 XXX 104,858 XXX 2,749,102 XXX 0 (137) (137) 0.009 57,009 52,150 109,159 0.008 60,797 55,806 116,603 0.010 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 0.000 382,735 999,009 1,381,743 0.009 0 0 0 0.000 500,541 1,106,827 1,607,368 XXX 187,792 157,764 345,556 XXX 688,332 1,264,592 1,952,924 XXX XXX XXX XXX XXX 0 XXX XXX XXX XXX XXX XXX XXX XXX SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 (12) 378 0 0 366 3 Large Group Employer 42,479 145,239 31,397 825,573 0 1,044,688 4 5 Small Group Employer Individual 51,398 (119,056) 38,638 928,525 0 899,504 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 0 401,955 18,670,959 308,945 9,299,338 0 28,681,196 0 0 0 0 0 0 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 495,831 18,697,130 379,358 11,053,435 0 30,625,754 78,399 60,935 45,189 1,125,466 0 1,309,989 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 8,297,225 XXX 10,032,455 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 60,938 696,994 1,013,721 0 0 0 0 0 0 0 6,525,572 0 8,297,225 XXX XXX 574,230 18,758,064 424,547 12,178,901 0 31,935,743 6,849,372 3,183,083 3,183,083 0 OTHER INDICATORS: 216-2.OH 1. Number of certificates/policies 0 10,127 13,277 0 0 0 0 0 0 0 165,418 0 188,822 1,892 190,714 2. Number of Covered Lives 0 18,587 24,579 0 0 0 0 0 0 0 247,327 0 290,493 4,684 295,177 3. Number of Groups 60 4 0 0 0 0 0 0 6,509 0 6,573 16 6,589 4. Member Months 245,154 319,592 0 0 0 0 0 0 2,866,959 0 3,431,697 56,100 3,487,797 XXX (8) Is run off business reported in Columns 1 through 9 or 12? Yes [ XXX 0 ] No [ X ] 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 27,206 XXX 0 0 0 0 7,036 XXX 0 0 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 (259,547) XXX 0 272,061 0 0 0 0 (384,160) XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF 1100 Employers Boulevard DePere, WI 54115 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 73288 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.OH Health Premiums Earned: 0 14,277,585 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) 0 130,925 1.5 Paid rate credits 0 0 1.6 Reserve for rate credits current year 0 230,388 1.7 Reserve for rate credits prior year 0 (230,388) 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 14,277,585 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 0 14,377,047 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: (57,277) 12,354,190 2.1 Paid claims during the year 20 1,220,519 2.2 Direct claim liability current year 14,801 1,678,520 2.3 Direct claim liability prior year 0 631 2.4 Direct claim reserves current year 0 353 2.5 Direct claim reserves prior year 0 0 2.6 Direct contract reserves current year (1) 0 2.7 Direct contract reserves prior year 0 130,925 2.8 Paid rate credits 0 0 2.9 Reserve for rate credits current year 0 230,388 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 4,169 24,539 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 1,316 90,583 2.12a Healthcare receivables current year (2,853) 66,044 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 (76,226) 11,772,465 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 (76,226) 11,871,928 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) 21,338,826 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 12,837,454 0 0 0 0 0 0 0 0 0 12,837,454 0 0 0 0 12,837,454 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 160,030,620 131,134 153,309 (22,175) 0 0 0 0 0 0 160,008,445 411 (134,525) 31,923 0 159,842,408 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 187,145,659 131,134 153,309 (22,175) 130,925 0 230,388 (230,388) 0 0 187,123,484 411 (134,525) 31,923 0 187,056,910 10,337,657 975,013 1,548,669 0 0 0 0 0 0 0 0 0 0 0 4,145 32,791 28,646 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 121,228,419 15,284,510 13,085,422 220,600 237,061 0 (94) 0 0 0 0 0 0 0 289,723 289,976 252 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 143,862,989 17,480,062 16,327,413 221,231 237,414 0 (95) 130,925 0 230,388 0 0 0 0 322,576 414,666 92,090 0 0 9,759,856 0 0 0 0 9,759,856 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 123,121,416 (346,232) (68,576) (419,867) 0 123,126,474 0 0 0 0 0 0 144,577,511 (346,232) (68,576) (419,867) 0 144,682,032 0 0 0 6,240,844 for stand-alone vision policies. 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF Ohio DURING THE YEAR All Expenses 1 Individual Comprehensive Coverage Expenses: (14) 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 $ (1) 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 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: 58,534 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 4,389 for affiliated services) 2.3 EDP Equipment and Software (incl $ 109 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 40 for affiliated services) 2.5 Accreditation and Certification (incl $ 38,094 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 (137) 0 0 0 0 0 (137) 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (137) 0 13,629 24,202 1,183 30 0 6,174 45,218 0 574 17,700 51 1 4,122 4,675 331 8 26,714 19,754 1,857 41 12,461 5,269 1,109 27 57,498 71,601 4,532 107 0 22,692 156,431 0 26,569 15,957 2,177 54 22 12,231 57,009 0 26,340 11,206 2,316 57 23 12,207 52,150 0 XXX Large Group Comprehensive Coverage Expenses: 64,629 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 4,967 for affiliated services) 3.3 EDP Equipment and Software (incl $ 124 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 46 for affiliated services) 3.5 Accreditation and Certification (incl $ 14,436 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. 1100 Employers Boulevard DePere, WI 54115 XXX XXX 259 18,585 0 XXX XXX 1,847 10,983 0 XXX XXX 8,759 57,125 0 XXX 5,653 24,520 0 XXX XXX XXX XXX 45,218 0 18,585 0 10,983 0 57,125 0 24,520 0 156,431 0 57,009 14,302 52,150 0 14,872 27,335 1,313 33 0 6,753 50,307 0 641 20,179 57 1 4,254 5,193 367 9 22,118 25,116 1,895 47 13,543 5,729 1,204 30 55,428 83,553 4,836 120 0 24,702 168,639 0 28,552 16,490 2,479 62 25 13,189 60,797 0 25,221 13,326 2,791 70 28 14,370 55,806 0 XXX XXX XXX 291 21,170 0 XXX 50,307 0 XXX 1,925 11,749 0 XXX 21,170 0 XXX 9,581 58,757 0 XXX 11,749 0 6,152 26,657 0 XXX 58,757 0 XXX 26,657 0 XXX 168,639 0 XXX 60,797 16,196 55,806 0 73288 9 10 General Administrative Expenses Total Expenses (6 to 9) 0 0 0 0 0 (12) (12) 0 378 366 0 (137) 0 0 0 0 (12) (149) 0 378 229 0 474,931 168,462 34,860 873 355 333,808 1,013,291 0 31,397 1,044,688 0 585,339 267,227 43,885 1,092 400 380,938 1,278,881 0 31,397 1,310,278 14,302 537,086 190,717 39,569 991 402 92,101 860,866 0 38,638 899,504 0 646,287 304,085 49,675 1,243 456 144,362 1,146,107 0 38,638 1,184,746 16,196 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 Humana 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 *73288201821637100* SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (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) Humana Insurance Company 2. 1100 Employers Boulevard DePere, WI 54115 (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 2 Small Group Employer 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 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) 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 73288 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 54 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8,596,983 0 0 0 0 0 8,597,037 0 0 XXX XXX XXX 54 3,661 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8,596,983 258,269 0 0 8,597,037 261,930 XXX 558 0 0 (4,164) 0 0 0 (4,164) 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 193,627 0 13,754 8,131,333 (746,861) 0 0 7,384,472 0 0 0 0 0 0 0 0 194,185 0 13,754 8,127,168 (746,861) 0 0 7,380,308 XXX XXX XXX XXX XXX 194,185 0 13,754 8,127,168 (746,861) 0 0 7,380,308 (20,912) (198) 15 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4,802,774 70 68 0 0 0 4,781,862 (128) 83 XXX XXX XXX 4,781,862 (128) 83 0 0 0 (21,126) 0 0 0 0 0 0 (21,126) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4,781,651 281,852 0 0 0 0 0 5,063,503 XXX XXX 0 0 0 0 0 4,802,776 281,852 0 XXX XXX XXX 0 5,084,628 0 0 0 4,781,651 281,852 0 0 0 0 0 5,063,503 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 0 740 0 12 32,069 11,015 0 0 0 0 0 740 0 12 32,069 11,015 0 5.073 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 43,836 XXX 0 0.000 43,836 XXX 0 (12) (12) 0.003 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 42,854 66,589 109,443 0.013 0 0 0 0.000 42,854 66,577 109,431 XXX XXX XXX XXX XXX 0 0 0 0.000 8,597,037 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 740 0 12 32,069 11,015 0 43,836 XXX 0 0 0 42,854 66,577 109,431 XXX XXX XXX 8,597,037 261,930 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 0 106 0 0 106 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 46,597 557,134 22,501 (194,609) 0 431,622 0 0 0 0 0 0 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 46,597 557,134 22,607 (194,609) 0 431,728 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 1,731,810 XXX 1,731,810 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 16,867 0 0 0 0 0 0 0 0 0 1,714,942 0 1,731,810 XXX 46,597 557,134 22,607 (194,609) 0 431,728 XXX 1,731,810 0 0 0 OTHER INDICATORS: 216-2.OK 1. Number of certificates/policies 0 0 0 0 0 0 0 0 0 0 13,834 0 13,834 0 13,834 2. Number of Covered Lives 0 0 0 0 0 0 0 0 0 0 21,133 0 21,133 0 21,133 3. Number of Groups 0 0 0 0 0 0 0 0 283 0 283 0 283 4. Member Months 0 0 0 0 0 0 0 0 267,260 0 267,260 0 267,260 XXX 0 Is run off business reported in Columns 1 through 9 or 12? Yes [ XXX 0 ] No [ X ] 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 54 0 0 XXX 10,852 0 0 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 (35,261) 7,604 0 0 0 0 0 XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF 1100 Employers Boulevard DePere, WI 54115 Oklahoma 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 73288 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.OK Health Premiums Earned: 54 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 54 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 54 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: (19,864) 2.1 Paid claims during the year 10 2.2 Direct claim liability current year 1,235 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 37 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 7 2.12a Healthcare receivables current year (30) 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 (21,126) 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 (21,126) 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) 3,586,724 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 8,597,811 27,301 28,129 (828) 0 0 0 0 0 0 8,596,983 0 (612,615) 134,246 0 7,850,122 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8,597,865 27,301 28,129 (828) 0 0 0 0 0 0 8,597,037 0 (612,615) 134,246 0 7,850,176 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5,243,131 835,532 778,985 0 0 (11,176) 471,950 0 0 0 0 0 0 0 13,776 13,862 86 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5,223,267 835,541 780,219 0 0 (11,176) 471,950 0 0 0 0 0 0 0 13,813 13,869 56 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4,802,776 6,379 (257,730) (533,204) 0 5,084,628 0 0 0 0 0 0 4,781,651 6,379 (257,730) (533,204) 0 5,063,503 0 0 0 580,828 for stand-alone vision policies. 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF Oklahoma DURING THE YEAR All Expenses 1 2. 216-4.OK 3. Individual Comprehensive Coverage Expenses: (1) 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. 1100 Employers Boulevard DePere, WI 54115 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 (12) 0 0 0 0 0 (12) 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (12) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 73288 9 10 General Administrative Expenses Total Expenses (6 to 9) 0 0 0 0 0 0 0 0 106 106 0 (12) 0 0 0 0 0 (12) 0 106 94 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 Humana 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 Humana 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 *73288201821638100* SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (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) Humana Insurance Company 2. 1100 Employers Boulevard DePere, WI 54115 (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 2 Small Group Employer 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 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) 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 73288 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 3,689,418 0 0 0 0 0 3,689,418 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 3,689,418 (734) 0 0 3,689,418 (734) 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 0 485 0 6,569 3,683,098 (3,009) 0 0 3,680,088 0 0 0 0 0 0 0 0 485 0 6,569 3,683,098 (3,009) 0 0 3,680,088 XXX XXX XXX XXX XXX 485 0 6,569 3,683,098 (3,009) 0 0 3,680,088 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,753,397 250 0 0 0 0 2,753,397 250 0 XXX XXX XXX 2,753,397 250 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,753,647 2,198 0 0 0 0 0 2,755,846 XXX XXX 0 0 0 0 0 2,753,647 2,198 0 XXX XXX XXX 0 2,755,846 0 0 0 2,753,647 2,198 0 0 0 0 0 2,755,846 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 0 155 0 19 31,525 4,469 0 0 0 0 0 155 0 19 31,525 4,469 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 36,168 XXX 0 0.000 36,168 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 5,080 34,748 39,827 0.011 0 0 0 0.000 5,080 34,748 39,827 XXX XXX XXX XXX XXX 0 0 0 0.000 3,689,418 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 155 0 19 31,525 4,469 0 36,168 XXX 0 0 0 5,080 34,748 39,827 XXX XXX XXX 3,689,418 (734) SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 10,415 332,842 16,157 (469,506) 0 (110,092) 0 0 0 0 0 0 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 10,415 332,842 16,157 (469,506) 0 (110,092) 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 958,339 XXX 958,339 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 0 958,339 0 958,339 XXX 10,415 332,842 16,157 (469,506) 0 (110,092) XXX 958,339 0 0 0 OTHER INDICATORS: 216-2.OR 1. Number of certificates/policies 0 0 0 0 0 0 0 0 0 0 1,933 0 1,933 0 1,933 2. Number of Covered Lives 0 0 0 0 0 0 0 0 0 0 1,933 0 1,933 0 1,933 3. Number of Groups 0 0 0 0 0 0 0 0 1 0 1 0 1 4. Member Months 0 0 0 0 0 0 0 0 22,624 0 22,624 0 22,624 XXX 0 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ X ] If yes, show the amount of premiums and claims included. Premiums $ XXX 0 0 Claims $ 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) 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 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 XXX XXX NONE XXX XXX 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF 1100 Employers Boulevard DePere, WI 54115 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 73288 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.OR 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 3,689,418 0 0 0 0 0 0 0 0 0 3,689,418 0 0 3,009 0 3,686,409 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3,689,418 0 0 0 0 0 0 0 0 0 3,689,418 0 0 3,009 0 3,686,409 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,814,244 351,115 343,416 42,552 87,038 0 0 0 0 0 0 0 0 0 23,811 24,068 257 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,814,244 351,115 343,416 42,552 87,038 0 0 0 0 0 0 0 0 0 23,811 24,068 257 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 2,753,647 0 0 (2,198) 0 2,755,846 0 0 0 0 0 0 2,753,647 0 0 (2,198) 0 2,755,846 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 Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF Oregon DURING THE YEAR All Expenses 1 2. 216-4.OR 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. 1100 Employers Boulevard DePere, WI 54115 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 73288 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 Humana 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 Humana 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 *73288201821639100* SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (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) Humana Insurance Company 2. 1100 Employers Boulevard DePere, WI 54115 (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 2 Small Group Employer 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 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) 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 73288 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 17,145,946 0 0 0 0 0 17,145,946 0 0 XXX XXX XXX 17,145,946 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 17,145,946 204,025 0 0 17,145,946 204,025 XXX (15,544) 17,145,946 188,481 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 330,703 0 24,514 16,586,704 (54,027) 0 0 16,532,678 0 0 0 0 0 0 0 0 330,703 0 24,514 16,586,704 (54,027) 0 0 16,532,678 (2,319) 0 601 XXX XXX XXX XXX XXX 328,384 0 25,115 16,603,966 (54,027) 0 0 16,549,939 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 10,670,551 3,221 797 0 0 0 10,670,551 3,221 797 XXX XXX XXX 10,670,551 3,221 797 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10,672,975 (35,082) 0 XXX XXX XXX 0 10,637,893 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10,672,975 (35,082) 0 0 0 0 0 10,637,893 XXX XXX 0 0 0 10,672,975 (35,082) 0 0 0 0 0 10,637,893 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 0 0 0 0 0 0 0 1,069 0 31 168,217 22,180 0 0 0 0 0 1,069 0 31 168,217 22,180 0 191,497 XXX 0 0.000 191,497 XXX 66,053 131,397 197,449 0.012 0 0 0 0.000 66,053 131,397 197,449 XXX XXX 0 0 0 0.000 0 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 166 1,069 0 31 168,217 22,346 166 191,663 XXX 0 0 0 66,053 131,397 197,450 XXX XXX XXX SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 73,342 1,270,999 64,323 1,514,393 0 2,923,057 0 0 0 0 0 0 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 73,342 1,270,999 64,323 1,514,393 0 2,923,057 20,290 1,241 10,044 64,603 0 96,178 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 2,582,782 XXX 4,054,052 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 2,582,782 0 2,582,782 XXX XXX 93,632 1,272,240 74,367 1,578,996 0 3,019,235 2,503,699 1,550,353 1,550,353 0 OTHER INDICATORS: 216-2.PA 1. Number of certificates/policies 0 0 0 0 0 0 0 0 0 0 23,959 0 23,959 0 23,959 2. Number of Covered Lives 0 0 0 0 0 0 0 0 0 0 30,536 0 30,536 0 30,536 3. Number of Groups 0 0 0 0 0 0 0 0 247 0 247 1 248 4. Member Months 0 0 0 0 0 0 0 0 384,328 0 384,328 0 384,328 XXX 0 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ X ] If yes, show the amount of premiums and claims included. Premiums $ XXX 0 0 Claims $ 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) 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 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 XXX XXX NONE XXX XXX 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF 1100 Employers Boulevard DePere, WI 54115 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 73288 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.PA 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) 6,855,478 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 17,154,203 139,843 148,100 (8,257) 0 0 0 0 0 0 17,145,946 (103) (51,452) 2,472 0 17,091,920 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 17,154,203 139,843 148,100 (8,257) 0 0 0 0 0 0 17,145,946 (103) (51,452) 2,472 0 17,091,920 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10,740,561 1,155,047 1,163,420 46,100 60,808 0 462 0 0 0 0 0 0 0 44,042 45,469 1,427 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10,740,561 1,155,047 1,163,420 46,100 60,808 0 462 0 0 0 0 0 0 0 44,042 45,469 1,427 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 10,672,975 8,002 (28,155) 14,929 0 10,637,893 0 0 0 0 0 0 10,672,975 8,002 (28,155) 14,929 0 10,637,893 0 0 0 891,891 for stand-alone vision policies. 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF Pennsylvania DURING THE YEAR All Expenses 1 2. 216-4.PA 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. 1100 Employers Boulevard DePere, WI 54115 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 73288 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 Humana 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 Humana 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 *73288201821640100* SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (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) Humana Insurance Company 2. 1100 Employers Boulevard DePere, WI 54115 (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 2 Small Group Employer 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 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) 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 73288 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 2,066,437 0 0 0 0 0 2,066,437 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 2,066,437 (17,253) 0 0 2,066,437 (17,253) 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 39,341 0 3,368 2,040,981 0 0 0 2,040,981 0 0 0 0 0 0 0 0 39,341 0 3,368 2,040,981 0 0 0 2,040,981 XXX XXX XXX XXX XXX 39,341 0 3,368 2,040,981 0 0 0 2,040,981 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,472,603 0 0 0 0 0 1,472,603 0 0 XXX XXX XXX 1,472,603 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,472,603 0 0 0 0 0 0 1,472,603 XXX XXX 0 0 0 0 0 1,472,603 0 0 XXX XXX XXX 0 1,472,603 0 0 0 1,472,603 0 0 0 0 0 0 1,472,603 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 54 0 0 26,150 2,163 0 0 0 0 0 54 0 0 26,150 2,163 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 28,367 XXX 0 0.000 28,367 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 2,309 16,337 18,646 0.009 0 0 0 0.000 2,309 16,337 18,646 XXX XXX XXX XXX XXX 0 0 0 0.000 2,066,437 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 54 0 0 26,150 2,163 0 28,367 XXX 0 0 0 2,309 16,337 18,646 XXX XXX XXX 2,066,437 (17,253) SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 5,579 272,340 10,175 (224,692) 0 63,401 0 0 0 0 0 0 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 5,579 272,340 10,175 (224,692) 0 63,401 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 457,964 XXX 457,964 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 0 457,964 0 457,964 XXX 5,579 272,340 10,175 (224,692) 0 63,401 XXX 457,964 0 0 0 OTHER INDICATORS: 216-2.RI 1. Number of certificates/policies 0 0 0 0 0 0 0 0 0 0 873 0 873 0 873 2. Number of Covered Lives 0 0 0 0 0 0 0 0 0 0 873 0 873 0 873 3. Number of Groups 0 0 0 0 0 0 0 0 1 0 1 0 1 4. Member Months 0 0 0 0 0 0 0 0 10,461 0 10,461 0 10,461 XXX 0 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ X ] If yes, show the amount of premiums and claims included. Premiums $ XXX 0 0 Claims $ 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) 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 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 XXX XXX NONE XXX XXX 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF 1100 Employers Boulevard DePere, WI 54115 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 73288 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.RI 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 2,066,437 0 0 0 0 0 0 0 0 0 2,066,437 0 0 0 0 2,066,437 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,066,437 0 0 0 0 0 0 0 0 0 2,066,437 0 0 0 0 2,066,437 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,467,897 181,755 172,159 0 0 0 0 0 0 0 0 0 0 0 4,890 4,911 20 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,467,897 181,755 172,159 0 0 0 0 0 0 0 0 0 0 0 4,890 4,911 20 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,472,603 0 0 0 0 1,472,603 0 0 0 0 0 0 1,472,603 0 0 0 0 1,472,603 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 Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF Rhode Island DURING THE YEAR All Expenses 1 2. 216-4.RI 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. 1100 Employers Boulevard DePere, WI 54115 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 73288 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 Humana 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 Humana 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 *73288201821641100* SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (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) Humana Insurance Company 2. 1100 Employers Boulevard DePere, WI 54115 (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 2 Small Group Employer 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 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) 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 73288 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 15,182,031 0 0 0 0 0 15,182,031 0 0 XXX XXX XXX 0 4,291 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 15,182,031 296,054 0 0 15,182,031 300,345 XXX 654 0 0 (4,945) 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 296,754 0 22,960 14,566,263 (37,152) 0 0 14,529,111 0 0 0 0 0 0 0 0 297,408 0 22,960 14,561,318 (37,152) 0 0 14,524,166 XXX XXX XXX XXX XXX 297,408 0 22,960 14,561,318 (37,152) 0 0 14,524,166 (24,157) (836) 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 9,782,944 1,014 811 0 0 0 9,758,786 178 818 XXX XXX XXX 9,758,786 178 818 0 0 0 (25,000) 0 0 0 0 0 0 (25,000) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 9,783,146 (64,190) 0 XXX XXX XXX 0 9,718,956 0 0 0 0 0 0 0 0 0 0 0 0 0 0 9,758,147 (64,190) 0 0 0 0 0 9,693,956 XXX XXX 0 0 0 9,758,147 (64,190) 0 0 0 0 0 9,693,956 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5.055 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 (38) (38) 0.008 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 0 0 0 0 0 0 900 0 52 144,968 20,505 0 0 0 0 0 900 0 52 144,968 20,505 0 166,427 XXX 0 0.000 166,427 XXX 50,843 126,107 176,950 0.012 0 0 0 0.000 50,843 126,070 176,913 XXX XXX 0 0 0 0.000 15,182,031 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 900 0 52 144,968 20,505 0 166,427 XXX 0 0 0 50,843 126,070 176,913 XXX XXX XXX 15,182,031 300,345 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 0 124 0 0 124 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 71,074 1,443,981 103,852 (319,664) 0 1,299,243 0 0 0 0 0 0 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 71,074 1,443,981 103,976 (319,664) 0 1,299,367 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 3,187,504 XXX 3,187,504 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 19,968 0 0 0 0 0 0 0 0 0 3,167,536 0 3,187,504 XXX 71,074 1,443,981 103,976 (319,664) 0 1,299,367 XXX 3,187,504 0 0 0 OTHER INDICATORS: 216-2.SC 1. Number of certificates/policies 0 0 0 0 0 0 0 0 0 0 22,311 0 22,311 0 22,311 2. Number of Covered Lives 0 0 0 0 0 0 0 0 0 0 29,942 0 29,942 0 29,942 3. Number of Groups 0 0 0 0 0 0 0 0 341 0 341 0 341 4. Member Months 0 0 0 0 0 0 0 0 359,990 0 359,990 0 359,990 XXX 0 Is run off business reported in Columns 1 through 9 or 12? Yes [ XXX 0 ] No [ X ] 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 XXX 1,880 0 0 XXX 0 0 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 (7,954) 0 0 0 0 0 0 XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF 1100 Employers Boulevard DePere, WI 54115 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 73288 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.SC 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: (18,273) 2.1 Paid claims during the year 71 2.2 Direct claim liability current year 4,282 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 2,517 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) (3,907) 2.12a Healthcare receivables current year (6,423) 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 (25,000) 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 (25,000) 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) 4,889,567 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 15,186,664 51,222 55,856 (4,633) 0 0 0 0 0 0 15,182,031 1,711,936 (2,727,282) (978,193) 0 15,144,879 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 15,186,664 51,222 55,856 (4,633) 0 0 0 0 0 0 15,182,031 1,711,936 (2,727,282) (978,193) 0 15,144,879 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 9,808,560 1,058,164 1,062,160 114,471 90,900 (138) 12 0 0 0 0 0 0 0 44,838 45,401 563 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 9,790,288 1,058,235 1,066,442 114,471 90,900 (138) 12 0 0 0 0 0 0 0 47,355 41,495 (5,861) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 9,783,146 983,810 (738,420) 309,580 0 9,718,956 0 0 0 0 0 0 9,758,147 983,810 (738,420) 309,580 0 9,693,956 0 0 0 997,316 for stand-alone vision policies. 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF South Carolina DURING THE YEAR All Expenses 1 2. 216-4.SC 3. Individual Comprehensive Coverage Expenses: (4) 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. 1100 Employers Boulevard DePere, WI 54115 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 (38) 0 0 0 0 0 (38) 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (38) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 73288 9 10 General Administrative Expenses Total Expenses (6 to 9) 0 0 0 0 0 0 0 0 124 124 0 (38) 0 0 0 0 0 (38) 0 124 86 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 Humana 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 Humana 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 *73288201821642100* SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (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) Humana Insurance Company 2. 1100 Employers Boulevard DePere, WI 54115 (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 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) 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 73288 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 2,869,961 0 0 0 0 0 2,869,961 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 2,869,961 65,573 0 0 2,869,961 65,573 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 74,784 0 6,262 2,723,342 (142,373) 0 0 2,580,969 0 0 0 0 0 0 0 0 74,784 0 6,262 2,723,342 (142,373) 0 0 2,580,969 XXX XXX XXX XXX XXX 74,784 0 6,262 2,723,342 (142,373) 0 0 2,580,969 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,068,432 0 0 0 0 0 2,068,432 0 0 XXX XXX XXX 2,068,432 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,068,432 (26,784) 0 XXX XXX XXX 0 2,041,648 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,068,432 (26,784) 0 0 0 0 0 2,041,648 XXX XXX 0 0 0 2,068,432 (26,784) 0 0 0 0 0 2,041,648 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 0 0 0 0 0 0 0 63 0 1 18,729 3,270 0 0 0 0 0 63 0 1 18,729 3,270 0 22,063 XXX 0 0.000 22,063 XXX 6,033 20,728 26,762 0.010 0 0 0 0.000 6,033 20,728 26,762 XXX XXX 0 0 0 0.000 2,869,961 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 63 0 1 18,729 3,270 0 22,063 XXX 0 0 0 6,033 20,728 26,762 XXX XXX XXX 2,869,961 65,573 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 12,088 181,993 7,531 (516,355) 0 (314,744) 0 0 0 0 0 0 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 12,088 181,993 7,531 (516,355) 0 (314,744) 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 805,241 XXX 805,241 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 0 805,241 0 805,241 XXX 12,088 181,993 7,531 (516,355) 0 (314,744) XXX 805,241 0 0 0 OTHER INDICATORS: 216-2.SD 1. Number of certificates/policies 0 0 0 0 0 0 0 0 0 0 2,735 0 2,735 0 2,735 2. Number of Covered Lives 0 0 0 0 0 0 0 0 0 0 3,563 0 3,563 0 3,563 3. Number of Groups 0 0 0 0 0 0 0 0 24 0 24 0 24 4. Member Months 0 0 0 0 0 0 0 0 48,034 0 48,034 0 48,034 XXX 0 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ X ] If yes, show the amount of premiums and claims included. Premiums $ XXX 0 0 Claims $ 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) 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 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 XXX XXX NONE XXX XXX 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF 1100 Employers Boulevard DePere, WI 54115 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 73288 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) 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) 492,312 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 2,870,247 14,469 14,755 (286) 0 0 0 0 0 0 2,869,961 0 (136,532) 5,841 0 2,727,588 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,870,247 14,469 14,755 (286) 0 0 0 0 0 0 2,869,961 0 (136,532) 5,841 0 2,727,588 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,123,825 264,072 277,906 0 0 4,171 11,857 0 0 0 0 0 0 0 33,874 33,998 124 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,123,825 264,072 277,906 0 0 4,171 11,857 0 0 0 0 0 0 0 33,874 33,998 124 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,068,432 36,968 (64,716) (964) 0 2,041,648 0 0 0 0 0 0 2,068,432 36,968 (64,716) (964) 0 2,041,648 0 0 0 77,333 for stand-alone vision policies. 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF South Dakota DURING THE YEAR All Expenses 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) 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. 1100 Employers Boulevard DePere, WI 54115 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 73288 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 Humana 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 Humana 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 *73288201821643100* SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (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) Humana Insurance Company 2. 1100 Employers Boulevard DePere, WI 54115 (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 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) 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 73288 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 (3,562,447) 0 0 102,165,419 0 0 96,462,054 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 25,873,245 0 0 0 0 0 220,938,270 0 0 XXX XXX XXX 220,938,270 0 0 (3,562,447) 1,729,953 102,165,419 3,301,507 96,462,054 2,982,836 0 0 0 0 0 0 0 0 0 0 0 0 0 0 25,873,245 599,888 0 0 220,938,270 8,614,183 XXX (319,731) 220,938,270 8,294,452 281,688 0 39,683 (5,613,771) 0 0 0 (5,613,771) 1,916,806 0 77,214 96,869,892 (2,055,925) 0 0 94,813,968 1,750,044 0 53,547 91,675,626 0 0 0 91,675,626 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 488,004 0 100,666 24,684,687 (793,150) 0 0 23,891,536 0 0 0 0 0 0 0 0 4,436,542 0 271,110 207,616,434 (2,849,075) 0 0 204,767,359 (48,234) 0 6,730 XXX XXX XXX XXX XXX 4,388,309 0 277,841 207,977,669 (2,849,075) 0 0 205,128,594 (17,651,716) (2,290,273) (142,730) 57,722,796 22,297,667 4,975,968 62,739,357 19,893,938 4,138,864 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 17,089,744 81 68 0 0 0 119,900,181 39,901,413 8,972,170 XXX XXX XXX 119,900,181 39,901,413 8,972,170 0 0 0 (19,799,258) (1,417) (2,694,072) 7,077,098 4,383,026 0 0 (19,800,676) 0 0 0 75,044,495 (2,516,182) 0 0 0 0 0 72,528,313 0 0 0 78,494,431 0 (3,190,625) 1,190,166 0 2,089,619 0 78,583,591 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 17,089,757 (534,368) 0 XXX XXX XXX 0 16,555,389 0 0 0 0 0 0 0 0 0 0 0 0 0 0 150,829,424 (3,051,967) (5,884,697) 8,267,264 4,383,026 2,089,619 0 147,866,617 XXX XXX 0 0 0 150,829,424 (3,051,967) (5,884,697) 8,267,264 4,383,026 2,089,619 0 147,866,617 405,260 158,771 134,223 938,603 194,496 424,537 168,664 127,960 1,304,121 204,932 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,831,354 0.794 2,230,215 0.881 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 617,526 530,935 1,148,461 0.012 700,023 705,555 1,405,578 0.015 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 (33) 0 (4) 0 658 622 3.527 1 (230,934) (230,933) 0.041 XXX XXX XXX 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 1,699 1 115 134,194 37,774 0 0 0 0 0 831,463 327,437 262,295 2,376,919 437,861 22,459 989 8,329 76,860 22,254 853,922 328,425 270,625 2,453,778 460,115 0 173,783 XXX 0 0.000 4,235,974 XXX 130,892 XXX 4,366,865 XXX 0 0 0 0.000 92,422 165,206 257,629 0.010 0 0 0 0.000 1,409,972 1,170,763 2,580,735 XXX 102,614 98,384 200,998 XXX 1,512,586 1,269,147 2,781,733 XXX XXX SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 (77,680) 49,620 286,752 0 258,692 3 Large Group Employer 325,226 4,265,079 280,359 6,641,587 0 11,512,251 4 5 Small Group Employer Individual 436,623 4,139,526 240,385 7,264,357 0 12,080,892 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 0 146,161 2,312,852 173,530 205,318 0 2,837,860 0 0 0 0 0 0 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 908,010 10,639,777 743,894 14,398,014 0 26,689,695 101,030 500,501 31,700 903,513 0 1,536,744 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) 14,158,525 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 23,394,339 XXX 23,787,056 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 7,793,589 (2,624,650) 0 0 0 0 0 0 0 4,066,876 0 23,394,339 XXX XXX 1,009,040 11,140,279 775,593 15,301,527 0 28,226,439 21,886,939 1,900,117 1,900,117 0 OTHER INDICATORS: 216-2.TN 1. Number of certificates/policies 0 10,860 13,593 0 0 0 0 0 0 0 59,312 0 83,765 3,163 86,928 2. Number of Covered Lives 0 18,953 22,767 0 0 0 0 0 0 0 91,753 0 133,473 5,595 139,068 3. Number of Groups 1,678 294 0 0 0 0 0 0 2,778 0 4,750 143 4,893 4. Member Months 1,124 247,654 260,839 0 0 0 0 0 0 972,363 0 1,481,980 35,708 1,517,688 XXX Is run off business reported in Columns 1 through 9 or 12? Yes [ XXX 0 ] No [ X ] 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 (10,087,024) (127,102) XXX 6,067,111 1,078,900 0 0 (947,155) XXX 0 0 0 0 1,847,105 299,322 ACA Receipts and Payments 4. Permanent ACA Risk Adjustment Program 4.0 Premium adjustments receipts/(payments) 2,178,660 5. Transitional ACA Reinsurance Program 5.0 Amounts received for claims 1,080,317 6. Temporary ACA Risk Corridors Program 6.1 Retrospective premium received 6.2 Rate credits or policy experience refunds paid 63,751 0 (962,517) XXX 6,454,264 0 0 72,444 0 XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF 1100 Employers Boulevard DePere, WI 54115 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 73288 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.TN Health Premiums Earned: (3,562,447) 102,165,419 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) 7,013,348 0 1.5 Paid rate credits 0 0 1.6 Reserve for rate credits current year 4,383,026 0 1.7 Reserve for rate credits prior year (4,383,026) 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 (3,562,447) 102,165,419 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 2,055,925 1.14 Ceded premiums earned to non-affiliates 0 0 1.15 Other Adjustments due to MLR calculation - Premiums (6,192,769) 100,109,494 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 5,363,460 77,642,489 2.1 Paid claims during the year 1,645,671 5,963,499 2.2 Direct claim liability current year 31,008,053 7,102,989 2.3 Direct claim liability prior year 0 311,573 2.4 Direct claim reserves current year 0 203,232 2.5 Direct claim reserves prior year 0 0 2.6 Direct contract reserves current year 2,886,247 0 2.7 Direct contract reserves prior year 7,013,348 0 2.8 Paid rate credits 0 0 2.9 Reserve for rate credits current year 4,383,026 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 (4,455,589) 1,566,844 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) (60,680) 1,427,138 2.12a Healthcare receivables current year 4,394,909 (139,706) 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 (19,799,258) 75,044,495 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 1,417 2,516,182 2.18 Ceded incurred claims to non-affiliates 0 0 2.19 Other adjustments due to MLR calculation - Claims (22,430,997) 72,528,313 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) 7,652,490 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 96,462,054 0 0 0 1,578,303 2,089,619 0 2,089,619 0 0 96,462,054 0 0 0 0 92,794,132 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 25,889,230 52,313 68,298 (15,985) 0 0 0 0 0 0 25,873,245 874 (738,743) 55,282 0 25,080,095 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 220,954,256 52,313 68,298 (15,985) 8,591,650 2,089,619 4,383,026 (2,293,407) 0 0 220,938,270 874 (738,743) 2,111,206 0 211,790,952 72,488,530 6,934,230 6,016,844 2,914 1,578 0 0 1,578,303 2,089,619 0 0 0 0 0 (1,419,258) 1,176,394 2,595,652 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16,308,136 2,391,307 1,523,941 35,738 38,350 3,326 2,468 0 0 0 0 0 0 0 83,991 84,203 212 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 171,802,615 16,934,707 45,651,827 350,225 243,160 3,326 2,888,715 8,591,650 2,089,619 4,383,026 0 0 0 0 (4,224,011) 2,627,055 6,851,066 0 0 78,494,431 0 0 0 89,160 74,915,669 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 17,089,757 73,016 (589,013) 18,371 0 16,555,389 0 0 0 0 0 0 150,829,424 73,016 (589,013) 2,535,970 89,160 141,568,374 0 0 0 3,587,429 for stand-alone vision policies. 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF Tennessee DURING THE YEAR All Expenses 1 Individual Comprehensive Coverage Expenses: (12,521) for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 1,629 for affiliated services) 1.3 EDP Equipment and Software (incl $ 41 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 17 for affiliated services) 1.5 Accreditation and Certification (incl $ 967 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 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. (1) (34) 0 0 0 2 (33) 0 XXX XXX XXX 0 (4) 0 0 XXX 0 0 0 XXX 133,015 202,317 10,239 256 0 59,433 405,260 0 Large Group Comprehensive Coverage Expenses: 623,216 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 40,668 for affiliated services) 3.3 EDP Equipment and Software (incl $ 957 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 352 for affiliated services) 3.5 Accreditation and Certification (incl $ 637,831 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 (33) 0 Small Group Comprehensive Coverage Expenses: 553,477 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 37,100 for affiliated services) 2.3 EDP Equipment and Software (incl $ 890 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 325 for affiliated services) 2.5 Accreditation and Certification (incl $ 601,424 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. 1100 Employers Boulevard DePere, WI 54115 XXX 0 (4) 0 XXX 0 0 59,368 45,687 3,365 84 XXX 4,747 158,771 0 XXX XXX 335 105 30 0 0 152 622 0 150 658 0 XXX XXX (58) (25) (5) 0 0 88 1 0 XXX (282,029) 22,300 4,687 117 48 23,943 (230,934) 0 XXX 0 0 658 0 622 0 1 0 (230,934) 0 675,356 141,565 27,354 329 98,801 41,794 8,784 220 977,188 573,913 50,552 909 0 228,792 1,831,354 0 297,596 170,433 16,969 421 172 131,936 617,526 0 286,472 103,970 19,597 464 189 120,243 530,935 0 XXX 25,719 134,223 0 Total (1 to 5) XXX XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 336 142 30 0 0 0 0 (4) 0 10,647 142,548 809 20 XXX 0 0 0 0 (LOCATION) NAIC Company Code 2018 XXX 93,997 938,603 0 XXX 44,896 194,496 0 XXX XXX XXX XXX 405,260 0 158,771 0 134,223 0 938,603 0 194,496 0 1,831,354 0 617,526 110,655 530,935 0 133,786 220,499 10,254 256 0 59,742 424,537 0 6,672 158,601 449 11 54,796 46,608 2,893 71 1,002,241 151,010 36,677 347 104,110 44,039 9,258 231 1,301,605 620,757 59,531 917 0 247,406 2,230,215 0 334,893 195,652 19,974 496 202 148,806 700,023 0 388,249 135,545 26,251 628 255 154,627 705,555 0 XXX XXX XXX 2,932 168,664 0 XXX 424,537 0 XXX 23,592 127,960 0 113,846 1,304,121 0 127,960 0 XXX 1,304,121 0 XXX 168,664 0 XXX 47,294 204,932 0 XXX XXX 204,932 0 XXX 2,230,215 0 XXX 700,023 128,891 705,555 0 73288 9 10 General Administrative Expenses Total Expenses (6 to 9) 156,538 55,069 11,575 290 118 (14,517) 209,072 0 49,620 258,692 0 (125,215) 77,450 16,286 408 166 9,666 (21,240) 0 49,620 28,380 0 3,973,510 1,431,231 283,884 7,108 2,887 5,533,272 11,231,892 0 280,359 11,512,251 0 5,534,766 2,279,548 371,002 8,902 3,248 6,014,242 14,211,707 0 280,359 14,492,066 110,655 4,207,413 1,494,109 300,927 7,532 3,059 5,827,467 11,840,507 0 240,385 12,080,892 0 6,232,160 2,446,063 406,683 9,572 3,516 6,378,306 15,476,300 0 240,385 15,716,685 128,891 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 Humana 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 *73288201821644100* SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (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) Humana Insurance Company 2. 1100 Employers Boulevard DePere, WI 54115 (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 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) 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 73288 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 (18,465,140) 0 0 162,331,408 0 0 123,120,086 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 135,525,728 0 0 0 0 0 402,512,081 0 0 XXX XXX XXX 402,512,081 0 0 (18,465,140) (3,369,155) 162,331,408 7,240,570 123,120,086 4,323,290 0 0 0 0 0 0 0 0 0 0 0 0 0 0 135,525,728 1,244,368 0 0 402,512,081 9,439,072 XXX (555,413) 402,512,081 8,883,659 (459,103) 0 6,744 (14,643,627) 0 0 0 (14,643,627) 3,132,643 0 89,713 151,868,482 0 0 0 151,868,482 2,130,564 0 66,553 116,599,679 0 0 0 116,599,679 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 2,069,127 0 224,424 131,987,810 (17,444,725) 0 0 114,543,085 0 0 0 0 0 0 0 0 6,873,230 0 387,434 385,812,344 (17,444,725) 0 0 368,367,619 (83,353) 0 15,481 XXX XXX XXX XXX XXX 6,789,878 0 402,915 386,435,629 (17,444,725) 0 0 368,990,904 (2,264,075) (156,594) 26,738 99,080,410 14,250,523 2,463,183 94,205,705 8,059,524 1,790,047 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 102,143,812 (1,459) 825 0 0 0 293,165,853 22,151,994 4,280,793 XXX XXX XXX 293,165,853 22,151,994 4,280,793 0 0 0 (2,447,406) (8,782) 0 0 0 0 0 (2,456,188) 0 0 0 110,867,750 0 0 0 0 0 0 110,867,750 0 0 0 100,475,182 0 276,865 0 0 0 0 100,752,047 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 102,141,528 (11,169,703) 0 XXX XXX XXX 0 90,971,824 0 0 0 0 0 0 0 0 0 0 0 0 0 0 311,037,054 (11,178,485) 276,865 0 0 0 0 300,135,434 XXX XXX 0 0 0 311,037,054 (11,178,485) 276,865 0 0 0 0 300,135,434 1 0 0 0 2,185 453,181 171,923 120,739 789,972 254,615 456,337 177,853 118,421 753,269 248,850 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,187 0.167 1,790,431 0.742 1,754,728 0.877 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 1 215,766 215,767 (0.015) 645,240 575,234 1,220,475 0.008 642,597 609,304 1,251,901 0.011 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 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 9,801 6 622 323,950 174,099 0 0 0 0 0 919,321 349,782 239,783 1,867,191 679,749 50,084 2,346 17,526 292,277 51,427 969,405 352,128 257,309 2,159,467 731,177 0 508,479 XXX 0 0.000 4,055,825 XXX 413,661 XXX 4,469,486 XXX 0 0 0 0.000 551,366 609,176 1,160,542 0.009 0 0 0 0.000 1,839,205 2,009,480 3,848,685 XXX 236,210 213,915 450,125 XXX 2,075,415 2,223,395 4,298,809 XXX XXX SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 1,018 (55,792) 1,001,042 0 946,267 3 Large Group Employer 441,319 4,822,827 438,220 8,837,987 0 14,540,353 4 5 Small Group Employer Individual 473,915 2,887,401 316,687 9,071,538 0 12,749,542 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 0 807,866 16,776,815 526,477 1,629,026 0 19,740,184 0 0 0 0 0 0 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 1,723,101 24,488,060 1,225,592 20,539,593 0 47,976,346 207,114 262,166 78,278 2,096,054 0 2,643,613 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) (13,351,660) 23,449,473 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 12,351,329 XXX 14,378,635 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 91,461 0 0 0 0 0 0 0 2,162,055 0 12,351,329 XXX XXX 1,930,215 24,750,227 1,303,870 22,635,647 0 50,619,959 9,467,217 4,911,419 4,911,419 0 OTHER INDICATORS: 216-2.TX 1. Number of certificates/policies 0 43,726 52,543 0 0 0 0 0 0 0 281,768 0 378,037 3,546 381,583 2. Number of Covered Lives 0 71,438 85,438 0 0 0 0 0 0 0 465,752 0 622,628 7,262 629,890 3. Number of Groups 1,390 172 0 0 0 0 0 0 16,753 0 18,315 67 18,382 4. Member Months 1,006,091 1,086,714 0 0 0 0 0 0 5,715,332 0 7,810,097 80,178 7,890,275 XXX 1,960 Is run off business reported in Columns 1 through 9 or 12? Yes [ XXX 0 ] No [ X ] 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 0 313,599 1,955,763 75,959,122 712,837 XXX (67,024,059) 6,684,291 319,974 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 6,693,073 44,357 0 XXX 36,573,032 0 0 50,406 0 (995,086) XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF 1100 Employers Boulevard DePere, WI 54115 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 73288 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.TX Health Premiums Earned: (18,465,140) 162,331,408 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) (44,357) (53,375) 1.5 Paid rate credits 0 0 1.6 Reserve for rate credits current year 0 (53,375) 1.7 Reserve for rate credits prior year 0 53,375 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 (18,465,140) 162,331,408 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 (18,420,783) 162,331,408 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 1,033,975 113,690,195 2.1 Paid claims during the year 529,711 11,194,969 2.2 Direct claim liability current year 3,894,192 15,367,708 2.3 Direct claim liability prior year 0 358,419 2.4 Direct claim reserves current year 0 449,734 2.5 Direct claim reserves prior year 0 0 2.6 Direct contract reserves current year (1) 0 2.7 Direct contract reserves prior year (44,357) (53,375) 2.8 Paid rate credits 0 0 2.9 Reserve for rate credits current year 0 (53,375) 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 72,543 (1,441,610) 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 41,400 984,488 2.12a Healthcare receivables current year (31,143) 2,426,098 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 (2,447,406) 110,867,750 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 8,782 0 2.18 Ceded incurred claims to non-affiliates 0 0 2.19 Other adjustments due to MLR calculation - Claims (2,411,830) 110,867,750 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) 55,494,045 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 123,120,086 0 0 0 863,790 227,196 223,045 4,151 0 0 123,120,086 0 0 0 0 122,252,145 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 135,623,255 169,078 266,605 (97,528) 0 0 7,140 (7,140) 0 0 135,525,728 13,107 (16,264,623) 1,193,209 0 118,088,142 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 402,609,609 169,078 266,605 (97,528) 766,058 227,196 176,809 50,387 0 0 402,512,081 13,107 (16,264,623) 1,193,209 0 384,250,912 101,960,923 10,911,367 11,960,386 172 3,704 0 0 863,790 227,196 223,045 0 0 0 0 1,301,131 618,749 (682,382) 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 98,087,924 14,844,356 11,139,461 237,156 267,344 3,124,205 2,628,022 0 0 7,140 0 0 0 0 110,147 110,601 454 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 314,773,016 37,480,403 42,361,747 595,747 720,782 3,124,205 2,628,022 766,058 227,196 176,809 0 0 0 0 42,212 1,755,239 1,713,027 0 0 100,475,182 0 0 0 276,865 99,884,106 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 102,141,528 (240,776) (8,646,425) 2,282,503 0 90,978,964 0 0 0 0 0 0 311,037,054 (240,776) (8,646,425) 2,291,285 276,865 299,318,989 0 0 0 16,219,370 for stand-alone vision policies. 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF Texas DURING THE YEAR All Expenses 1 Individual Comprehensive Coverage Expenses: 61,385 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 5,418 for affiliated services) 1.3 EDP Equipment and Software (incl $ 136 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 55 for affiliated services) 1.5 Accreditation and Certification (incl $ 29,231 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 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. (4) 0 0 0 0 6 1 0 XXX Small Group Comprehensive Coverage Expenses: 647,982 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 46,826 for affiliated services) 2.3 EDP Equipment and Software (incl $ 1,150 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 423 for affiliated services) 2.5 Accreditation and Certification (incl $ 738,162 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 1 0 0 XXX 0 0 0 XXX Total (1 to 5) 1,109 471 99 2 0 506 2,187 0 XXX 0 0 0 XXX 501 2,185 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 1,114 470 99 2 (LOCATION) NAIC Company Code 2018 XXX (203) (86) (18) 0 0 308 1 0 XXX 47,628 73,382 15,424 386 157 78,788 215,766 0 XXX 1 0 0 0 0 0 0 0 2,185 0 2,187 0 1 0 215,766 0 145,497 229,608 12,141 304 0 65,631 453,181 0 6,536 161,921 527 13 49,112 46,463 3,404 85 492,762 174,318 24,495 403 129,348 54,715 11,505 287 823,255 667,024 52,072 1,091 0 246,988 1,790,431 0 306,390 175,896 22,443 561 228 139,723 645,240 0 282,107 126,351 25,559 624 254 140,338 575,234 0 XXX Large Group Comprehensive Coverage Expenses: 660,240 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 48,077 for affiliated services) 3.3 EDP Equipment and Software (incl $ 1,181 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 438 for affiliated services) 3.5 Accreditation and Certification (incl $ 548,239 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. 1100 Employers Boulevard DePere, WI 54115 XXX XXX 2,927 171,923 0 XXX XXX 21,676 120,739 0 XXX XXX 97,994 789,972 0 XXX 58,760 254,615 0 XXX XXX XXX XXX 453,181 0 171,923 0 120,739 0 789,972 0 254,615 0 1,790,431 0 645,240 147,195 575,234 0 143,802 235,176 12,129 303 0 64,926 456,337 0 6,541 167,842 527 13 47,142 46,913 3,400 84 464,512 176,311 22,637 363 126,439 53,479 11,241 280 788,436 679,722 49,935 1,044 0 235,592 1,754,728 0 302,998 177,473 23,007 574 233 138,313 642,597 0 298,189 134,439 27,477 673 274 148,252 609,304 0 XXX XXX XXX 2,929 177,853 0 XXX 456,337 0 XXX 20,881 118,421 0 XXX 177,853 0 XXX 89,444 753,269 0 XXX 118,421 0 57,410 248,850 0 XXX 753,269 0 XXX 248,850 0 XXX 1,754,728 0 XXX 642,597 150,002 609,304 0 73288 9 10 General Administrative Expenses Total Expenses (6 to 9) 565,321 183,999 38,674 969 394 212,702 1,002,059 0 (55,792) 946,267 0 613,855 257,766 54,178 1,357 552 292,306 1,220,013 0 (55,792) 1,164,221 0 5,068,068 1,798,339 368,183 9,224 3,747 6,854,571 14,102,133 0 438,220 14,540,353 0 6,479,821 2,767,610 468,257 11,499 4,230 7,381,621 17,113,038 0 438,220 17,551,258 147,195 5,212,774 1,866,113 380,350 9,521 3,868 4,960,230 12,432,855 0 316,687 12,749,542 0 6,602,396 2,857,747 480,769 11,811 4,376 5,482,386 15,439,484 0 316,687 15,756,172 150,002 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 Humana 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 *73288201821645100* SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (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) Humana Insurance Company 2. 1100 Employers Boulevard DePere, WI 54115 (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 2 Small Group Employer 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 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) 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 73288 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 6,691 0 0 2,801,994 0 0 4,419,933 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3,279,809 0 0 0 0 0 10,508,428 0 0 XXX XXX XXX 10,508,428 0 0 6,691 84,734 2,801,994 (59,157) 4,419,933 176,357 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3,279,809 35,816 0 0 10,508,428 237,750 XXX (7,081) 10,508,428 230,669 12,895 0 0 (90,939) 0 0 0 (90,939) 110,435 0 2,112 2,748,604 0 0 0 2,748,604 193,312 0 2,829 4,047,436 0 0 0 4,047,436 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 141,104 0 28,225 3,074,664 (727) 0 0 3,073,937 0 0 0 0 0 0 0 0 457,746 0 33,165 9,779,766 (727) 0 0 9,779,039 (1,068) 0 122 XXX XXX XXX XXX XXX 456,678 0 33,287 9,787,794 (727) 0 0 9,787,067 (495,572) (8,018) 2,109 2,220,893 470,014 79,080 3,145,293 425,353 130,896 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,162,228 0 85 0 0 0 7,032,842 887,348 212,170 XXX XXX XXX 7,032,842 887,348 212,170 0 0 0 (505,700) (130) 0 0 0 0 0 (505,829) 0 0 0 2,611,827 0 0 0 0 0 0 2,611,827 0 0 0 3,439,750 0 (167,403) 0 0 184,799 0 3,457,146 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 7,708,020 (130) (167,403) 0 0 184,799 0 7,725,286 XXX XXX 0 0 0 0 0 2,162,143 0 0 XXX XXX XXX 0 2,162,143 0 0 0 7,708,020 (130) (167,403) 0 0 184,799 0 7,725,286 0 0 0 0 0 270 0 14 36,675 5,274 0 0 0 0 0 31,891 12,493 8,916 178,320 21,073 0 42,233 XXX 0 0.000 252,692 XXX 14,870 30,419 45,289 0.015 0 0 0 0.000 65,173 75,921 141,094 XXX 0 0 0 0 0 10,601 4,212 3,030 22,222 5,428 21,020 8,281 5,872 119,423 10,371 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 5.561 45,493 0.967 164,966 0.891 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 (1,560) (1,560) 0.017 16,338 18,730 35,069 0.013 33,964 28,332 62,296 0.015 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 0 XXX XXX XXX XXX XXX XXX XXX XXX 359 18 70 2,120 394 32,249 12,511 8,986 180,440 21,467 2,960 255,653 XXX 2,467 1,629 4,096 67,639 77,550 145,190 XXX XXX XXX SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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) 0 223 2,448 19,567 0 22,238 3 Large Group Employer 9,087 101,974 4,192 180,645 0 295,898 4 5 Small Group Employer Individual 20,383 105,253 12,290 367,400 0 505,325 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 23,154 187,381 (36,940) 142,316 0 315,910 0 0 0 0 0 0 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 52,624 394,831 (18,010) 709,927 0 1,139,371 1,866 12,423 457 19,088 0 33,834 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 520,595 XXX 509,447 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 0 394,212 (239,682) (142,297) 0 0 0 0 0 0 0 508,362 0 520,595 XXX XXX 54,490 407,254 (17,554) 729,015 0 1,173,205 487,733 21,715 21,715 0 OTHER INDICATORS: 216-2.UT 1. Number of certificates/policies 0 202 515 0 0 0 0 0 0 0 5,418 0 6,135 17 6,152 2. Number of Covered Lives 0 427 1,110 0 0 0 0 0 0 0 10,238 0 11,775 29 11,804 3. Number of Groups 48 17 0 0 0 0 0 0 130 0 195 1 196 4. Member Months 0 6,388 12,951 0 0 0 0 0 0 131,388 0 150,727 650 151,377 XXX Is run off business reported in Columns 1 through 9 or 12? Yes [ XXX 0 ] No [ X ] 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 8,460 154,076 2,139,090 (2,051) XXX (2,336,783) 98,622 466,850 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 98,752 0 0 XXX 971,231 0 0 0 0 (450,554) XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF 1100 Employers Boulevard DePere, WI 54115 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 73288 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.UT Health Premiums Earned: 6,691 2,801,994 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 6,691 2,801,994 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 6,691 2,801,994 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: (413,872) 2,653,088 2.1 Paid claims during the year 78,451 (123,551) 2.2 Direct claim liability current year 169,711 86,817 2.3 Direct claim liability prior year 0 2,768 2.4 Direct claim reserves current year 0 4,118 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 568 (170,457) 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 4,791 57,805 2.12a Healthcare receivables current year 4,223 228,262 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 (505,700) 2,611,827 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 130 0 2.18 Ceded incurred claims to non-affiliates 0 0 2.19 Other adjustments due to MLR calculation - Claims (505,829) 2,611,827 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) 946,565 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 4,419,933 0 0 0 0 184,799 0 184,799 0 0 4,419,933 0 0 0 0 4,235,134 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3,280,950 5,042 6,182 (1,140) 0 0 0 0 0 0 3,279,809 (9,124) 8,397 0 0 3,279,082 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10,509,568 5,042 6,182 (1,140) 0 184,799 0 184,799 0 0 10,508,428 (9,124) 8,397 0 0 10,322,902 3,426,839 677,501 679,439 55 103 0 0 0 184,799 0 0 0 0 0 169,902 5,076 (164,827) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,178,522 239,910 249,002 0 0 0 0 0 0 0 0 0 0 0 7,287 7,352 65 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7,844,578 872,310 1,184,969 2,823 4,221 0 0 0 184,799 0 0 0 0 0 7,301 75,024 67,723 0 0 3,439,750 0 0 0 17,396 3,272,347 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,162,143 (53) (9,880) (9,933) 0 2,162,143 0 0 0 0 0 0 7,708,020 (53) (9,880) (9,803) 17,396 7,540,487 0 0 0 416,346 for stand-alone vision policies. 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF Utah DURING THE YEAR All Expenses 1 2. Individual Comprehensive Coverage Expenses: 1,800 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 $ 23 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.UT 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: 14,372 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 998 for affiliated services) 2.3 EDP Equipment and Software (incl $ 24 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 9 for affiliated services) 2.5 Accreditation and Certification (incl $ 15,695 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 (1,559) 0 0 0 0 0 (1,560) 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (1,560) 0 3,316 5,529 263 7 0 1,487 10,601 0 152 3,982 11 0 1,265 1,140 74 2 15,122 4,012 661 9 2,757 1,166 246 6 22,612 15,828 1,255 24 0 5,774 45,493 0 7,579 4,872 481 12 5 3,389 16,338 0 9,743 3,859 771 19 8 4,331 18,730 0 XXX Large Group Comprehensive Coverage Expenses: 35,658 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 2,201 for affiliated services) 3.3 EDP Equipment and Software (incl $ 49 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 18 for affiliated services) 3.5 Accreditation and Certification (incl $ 21,853 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. 1100 Employers Boulevard DePere, WI 54115 XXX XXX 67 4,212 0 XXX XXX 550 3,030 0 XXX XXX 2,417 22,222 0 XXX 1,253 5,428 0 XXX XXX XXX XXX 10,601 0 4,212 0 3,030 0 22,222 0 5,428 0 45,493 0 16,338 3,155 18,730 0 6,581 10,940 530 13 0 2,955 21,020 0 289 7,839 23 1 2,424 2,237 149 4 100,784 6,826 3,247 19 5,269 2,229 468 12 115,348 30,071 4,417 48 0 15,082 164,966 0 15,085 11,074 1,005 25 10 6,765 33,964 0 13,772 6,241 1,244 30 12 7,033 28,332 0 XXX XXX XXX 129 8,281 0 XXX 21,020 0 XXX 1,058 5,872 0 XXX 8,281 0 XXX 8,548 119,423 0 XXX 5,872 0 2,392 10,371 0 XXX 119,423 0 XXX 10,371 0 XXX 164,966 0 XXX 33,964 6,537 28,332 0 73288 9 10 General Administrative Expenses Total Expenses (6 to 9) 19,562 1 0 0 0 226 19,790 0 2,448 22,238 0 18,003 1 0 0 0 226 18,230 0 2,448 20,678 0 103,783 36,737 7,470 187 76 143,453 291,706 0 4,192 295,898 0 143,718 61,296 9,978 241 89 156,946 372,268 0 4,192 376,459 3,155 212,372 75,130 15,343 384 156 189,650 493,035 0 12,290 505,325 0 356,577 122,516 22,010 488 178 218,529 720,297 0 12,290 732,587 6,537 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 Humana 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 *73288201821646100* SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (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) Humana Insurance Company 2. 1100 Employers Boulevard DePere, WI 54115 (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 2 Small Group Employer 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 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) 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 73288 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 3,030,586 0 0 0 0 0 3,030,586 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 3,030,586 (125,616) 0 0 3,030,586 (125,616) 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 43,363 0 1,918 3,110,921 0 0 0 3,110,921 0 0 0 0 0 0 0 0 43,363 0 1,918 3,110,921 0 0 0 3,110,921 XXX XXX XXX XXX XXX 43,363 0 1,918 3,110,921 0 0 0 3,110,921 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,228,656 70 0 0 0 0 2,228,656 70 0 XXX XXX XXX 2,228,656 70 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,228,726 0 0 0 0 0 0 2,228,726 XXX XXX 0 0 0 0 0 2,228,726 0 0 XXX XXX XXX 0 2,228,726 0 0 0 2,228,726 0 0 0 0 0 0 2,228,726 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 2 0 0 5,675 3,842 0 0 0 0 0 2 0 0 5,675 3,842 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 9,519 0 0.000 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 0 0 0 0.000 4,366 29,634 34,000 XXX XXX XXX XXX 0 XXX XXX 0 0 0 0.000 4,366 29,634 34,000 0.011 3,030,586 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 3,030,586 (125,616) 0 0 0 0 0 9,519 2 0 0 5,675 3,842 0 XXX 0 0 0 XXX 9,519 XXX 4,366 29,634 34,000 XXX SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 5,955 351,293 4,880 267,142 0 629,270 0 0 0 0 0 0 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 5,955 351,293 4,880 267,142 0 629,270 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 209,407 XXX 209,407 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 0 209,407 0 209,407 XXX 5,955 351,293 4,880 267,142 0 629,270 XXX 209,407 0 0 0 OTHER INDICATORS: 216-2.VT 1. Number of certificates/policies 0 0 0 0 0 0 0 0 0 0 1,732 0 1,732 0 1,732 2. Number of Covered Lives 0 0 0 0 0 0 0 0 0 0 1,746 0 1,746 0 1,746 3. Number of Groups 0 0 0 0 0 0 0 0 4 0 4 0 4 4. Member Months 0 0 0 0 0 0 0 0 20,285 0 20,285 0 20,285 XXX 0 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ X ] If yes, show the amount of premiums and claims included. Premiums $ XXX 0 0 Claims $ 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) 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 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 XXX XXX NONE XXX XXX 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF 1100 Employers Boulevard DePere, WI 54115 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 73288 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) 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 3,030,586 0 0 0 0 0 0 0 0 0 3,030,586 0 0 0 0 3,030,586 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3,030,586 0 0 0 0 0 0 0 0 0 3,030,586 0 0 0 0 3,030,586 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,216,495 263,681 242,458 0 0 0 0 0 0 0 0 0 0 0 8,993 8,998 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,216,495 263,681 242,458 0 0 0 0 0 0 0 0 0 0 0 8,993 8,998 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,228,726 0 0 0 0 2,228,726 0 0 0 0 0 0 2,228,726 0 0 0 0 2,228,726 0 0 0 4,645 for stand-alone vision policies. 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF Vermont DURING THE YEAR All Expenses 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) 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. 1100 Employers Boulevard DePere, WI 54115 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 73288 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 Humana 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 Humana 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 *73288201821647100* SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (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) Humana Insurance Company 2. 1100 Employers Boulevard DePere, WI 54115 (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 2 Small Group Employer 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 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) 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 73288 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 (2,164) 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 29,892,624 0 0 0 0 0 29,890,460 0 0 XXX XXX XXX (2,164) 13,063 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 29,892,624 141,894 0 0 29,890,460 154,958 XXX 1,997 0 0 (17,224) 0 0 0 (17,224) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 502,360 0 42,009 29,206,360 (1,712,218) 0 0 27,494,142 0 0 0 0 0 0 0 0 504,357 0 42,009 29,189,136 (1,712,218) 0 0 27,476,918 XXX XXX XXX XXX XXX 504,357 0 42,009 29,189,136 (1,712,218) 0 0 27,476,918 (75,700) (4,185) 1,541 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 21,823,754 426 135 0 0 0 21,748,055 (3,759) 1,676 XXX XXX XXX 21,748,055 (3,759) 1,676 0 0 0 (81,426) (148) 0 0 0 0 0 (81,573) 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 21,824,046 (586,536) 0 XXX XXX XXX 0 21,237,509 0 0 0 0 0 0 0 0 0 0 0 0 0 0 21,742,620 (586,684) 0 0 0 0 0 21,155,936 XXX XXX 0 0 0 21,742,620 (586,684) 0 0 0 0 0 21,155,936 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4.727 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 (624) (624) 0.036 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 0 0 0 0 0 0 2,785 1 76 173,362 39,312 0 0 0 0 0 2,785 1 76 173,362 39,312 0 215,535 XXX 0 0.000 215,535 XXX 189,497 245,975 435,471 0.015 0 0 0 0.000 189,497 245,351 434,848 XXX XXX 0 0 0 0.000 29,890,460 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 2,785 1 76 173,362 39,312 0 215,535 XXX 0 0 0 189,497 245,351 434,848 XXX XXX XXX 29,890,460 154,958 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 0 379 (2) 0 377 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 0 146,485 2,350,574 181,256 (565,703) 0 2,112,611 0 0 0 0 0 0 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 146,485 2,350,574 181,635 (565,705) 0 2,112,988 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 3,557,611 XXX 3,557,611 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 64,595 0 0 0 0 0 0 0 0 0 3,493,015 0 3,557,611 XXX 146,485 2,350,574 181,635 (565,705) 0 2,112,988 XXX 3,557,611 0 0 0 OTHER INDICATORS: 216-2.VA 1. Number of certificates/policies 0 0 0 0 0 0 0 0 0 0 45,049 0 45,049 0 45,049 2. Number of Covered Lives 0 0 0 0 0 0 0 0 0 0 71,243 0 71,243 0 71,243 3. Number of Groups 0 0 0 0 0 0 0 0 734 0 734 0 734 4. Member Months 0 0 0 0 0 0 0 0 792,651 0 792,651 0 792,651 XXX 0 Is run off business reported in Columns 1 through 9 or 12? Yes [ XXX 0 ] No [ X ] 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 XXX 24,370 112,357 0 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 112,504 0 0 XXX (329,365) 768,461 0 0 0 0 0 XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF 1100 Employers Boulevard DePere, WI 54115 DURING THE YEAR Virginia 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 73288 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.VA Health Premiums Earned: (2,164) 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 (2,164) 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 (2,164) 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: (15,101) 2.1 Paid claims during the year 930 2.2 Direct claim liability current year 66,302 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 (1) 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 953 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 1,764 2.12a Healthcare receivables current year 811 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 (81,426) 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 148 2.18 Ceded incurred claims to non-affiliates 0 2.19 Other adjustments due to MLR calculation - Claims (81,573) 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) 10,581,070 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 29,910,681 61,204 79,262 (18,058) 0 0 0 0 0 0 29,892,624 9,291 (1,672,656) 48,854 0 28,180,406 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 29,908,518 61,204 79,262 (18,058) 0 0 0 0 0 0 29,890,460 9,291 (1,672,656) 48,854 0 28,178,242 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 21,662,186 2,704,744 2,392,335 294,313 358,796 0 0 0 0 0 0 0 0 0 86,066 86,273 206 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 21,647,084 2,705,674 2,458,637 294,313 358,796 0 (1) 0 0 0 0 0 0 0 87,019 88,037 1,017 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 21,824,046 (217,998) (527,021) (158,482) 0 21,237,509 0 0 0 0 0 0 21,742,620 (217,998) (527,021) (158,335) 0 21,155,936 0 0 0 1,790,888 for stand-alone vision policies. 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF DURING THE YEAR Virginia All Expenses 1 2. 216-4.VA 3. Individual Comprehensive Coverage Expenses: (63) 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. 1100 Employers Boulevard DePere, WI 54115 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 (624) 0 0 0 0 0 (624) 0 XXX 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (624) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 73288 9 10 General Administrative Expenses Total Expenses (6 to 9) (2) 0 0 0 0 0 (2) 0 379 377 0 (625) 0 0 0 0 0 (626) 0 379 (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 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 Humana 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 *73288201821648100* SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (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) Humana Insurance Company 2. 1100 Employers Boulevard DePere, WI 54115 (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 2 Small Group Employer 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 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) 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 73288 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 6,945,265 0 0 0 0 0 6,945,265 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 6,945,265 (107,655) 0 0 6,945,265 (107,655) 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 0 111,823 0 8,725 6,932,372 (2,481) 0 0 6,929,890 0 0 0 0 0 0 0 0 111,823 0 8,725 6,932,372 (2,481) 0 0 6,929,890 XXX XXX XXX XXX XXX 111,823 0 8,725 6,932,372 (2,481) 0 0 6,929,890 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 4,684,284 2 539 0 0 0 4,684,284 2 539 XXX XXX XXX 4,684,284 2 539 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4,683,748 0 0 0 0 0 0 4,683,748 XXX XXX 0 0 0 0 0 4,683,748 0 0 XXX XXX XXX 0 4,683,748 0 0 0 4,683,748 0 0 0 0 0 0 4,683,748 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 244 0 46 172,433 9,723 0 0 0 0 0 244 0 46 172,433 9,723 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 0 182,447 XXX 0 0.000 182,447 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 11,411 75,792 87,203 0.013 0 0 0 0.000 11,411 75,792 87,203 XXX XXX XXX XXX XXX 0 0 0 0.000 6,945,265 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 244 0 46 172,433 9,723 0 182,447 XXX 0 0 0 11,411 75,792 87,203 XXX XXX XXX 6,945,265 (107,655) SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 17,261 792,673 (4,008) (140,700) 0 665,226 0 0 0 0 0 0 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 17,261 792,673 (4,008) (140,700) 0 665,226 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 1,311,267 XXX 1,311,267 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 1,311,267 0 1,311,267 XXX 17,261 792,673 (4,008) (140,700) 0 665,226 XXX 1,311,267 0 0 0 OTHER INDICATORS: 216-2.WA 1. Number of certificates/policies 0 0 0 0 0 0 0 0 0 0 4,297 0 4,297 0 4,297 2. Number of Covered Lives 0 0 0 0 0 0 0 0 0 0 4,297 0 4,297 0 4,297 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 51,129 0 51,129 0 51,129 XXX 0 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ X ] If yes, show the amount of premiums and claims included. Premiums $ XXX 0 0 Claims $ 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) 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 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 XXX XXX NONE XXX XXX 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF 1100 Employers Boulevard DePere, WI 54115 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 73288 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.WA 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 6,945,265 0 0 0 0 0 0 0 0 0 6,945,265 0 0 2,481 0 6,942,783 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6,945,265 0 0 0 0 0 0 0 0 0 6,945,265 0 0 2,481 0 6,942,783 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4,677,381 579,056 555,750 0 0 0 0 0 0 0 0 0 0 0 16,940 17,132 193 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4,677,381 579,056 555,750 0 0 0 0 0 0 0 0 0 0 0 16,940 17,132 193 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 0 0 0 0 0 4,683,748 (4) 4 0 0 4,683,748 0 0 0 0 0 0 4,683,748 (4) 4 0 0 4,683,748 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 Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF Washington DURING THE YEAR All Expenses 1 2. 216-4.WA 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. 1100 Employers Boulevard DePere, WI 54115 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 73288 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 Humana 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 Humana 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 *73288201821649100* SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (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) Humana Insurance Company 2. 1100 Employers Boulevard DePere, WI 54115 (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 2 Small Group Employer 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 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) 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 73288 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 5,784,676 0 0 0 0 0 5,784,676 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 5,784,676 218,042 0 0 5,784,676 218,042 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 0 185,535 0 13,012 5,368,088 (270) 0 0 5,367,818 0 0 0 0 0 0 0 0 185,535 0 13,012 5,368,088 (270) 0 0 5,367,818 XXX XXX XXX XXX XXX 185,535 0 13,012 5,368,088 (270) 0 0 5,367,818 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3,819,564 442 950 0 0 0 3,819,564 442 950 XXX XXX XXX 3,819,564 442 950 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3,819,056 0 0 0 0 0 0 3,819,056 XXX XXX 0 0 0 0 0 3,819,056 0 0 XXX XXX XXX 0 3,819,056 0 0 0 3,819,056 0 0 0 0 0 0 3,819,056 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 0 397 0 4 35,840 7,152 0 0 0 0 0 397 0 4 35,840 7,152 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 43,392 XXX 0 0.000 43,392 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 17,651 45,553 63,204 0.012 0 0 0 0.000 17,651 45,553 63,204 XXX XXX XXX XXX XXX 0 0 0 0.000 5,784,676 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 397 0 4 35,840 7,152 0 43,392 XXX 0 0 0 17,651 45,553 63,204 XXX XXX XXX 5,784,676 218,042 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 27,428 429,005 55,026 (981,856) 0 (470,397) 0 0 0 0 0 0 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 27,428 429,005 55,026 (981,856) 0 (470,397) 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 1,912,562 XXX 1,912,562 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 1,912,562 0 1,912,562 XXX 27,428 429,005 55,026 (981,856) 0 (470,397) XXX 1,912,562 0 0 0 OTHER INDICATORS: 216-2.WV 1. Number of certificates/policies 0 0 0 0 0 0 0 0 0 0 7,043 0 7,043 0 7,043 2. Number of Covered Lives 0 0 0 0 0 0 0 0 0 0 9,564 0 9,564 0 9,564 3. Number of Groups 0 0 0 0 0 0 0 0 47 0 47 0 47 4. Member Months 0 0 0 0 0 0 0 0 102,559 0 102,559 0 102,559 XXX 0 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ X ] If yes, show the amount of premiums and claims included. Premiums $ XXX 0 0 Claims $ 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) 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 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 XXX XXX NONE XXX XXX 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF 1100 Employers Boulevard DePere, WI 54115 DURING THE YEAR West Virginia 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 73288 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.WV 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) 1,376,938 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 5,784,357 16,161 15,842 319 0 0 0 0 0 0 5,784,676 0 (270) 0 0 5,784,406 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5,784,357 16,161 15,842 319 0 0 0 0 0 0 5,784,676 0 (270) 0 0 5,784,406 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3,794,634 425,368 391,780 0 0 0 0 0 0 0 0 0 0 0 9,167 9,395 228 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3,794,634 425,368 391,780 0 0 0 0 0 0 0 0 0 0 0 9,167 9,395 228 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3,819,056 (21) 21 0 0 3,819,056 0 0 0 0 0 0 3,819,056 (21) 21 0 0 3,819,056 0 0 0 253,224 for stand-alone vision policies. 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF DURING THE YEAR West Virginia All Expenses 1 2. 216-4.WV 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. 1100 Employers Boulevard DePere, WI 54115 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 73288 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 Humana 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 Humana 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 *73288201821650100* SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (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) Humana Insurance Company 2. 1100 Employers Boulevard DePere, WI 54115 (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 2 Small Group Employer 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 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) 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 73288 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 2,662 0 0 88,540,430 0 0 170,585,373 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 59,035,555 0 0 22,289,362,735 0 0 22,607,526,754 0 0 XXX XXX XXX 22,607,526,754 0 0 2,662 70,781 88,540,430 1,054,325 170,585,373 3,824,054 0 0 0 0 0 0 0 0 0 0 0 0 0 0 59,035,555 (1,273,839) 22,289,362,735 649,212,852 22,607,526,754 652,888,174 XXX (1,494,421) 22,607,526,754 651,393,753 10,821 0 (24) (78,916) 0 0 0 (78,916) 132,419 0 55,614 87,298,071 0 0 0 87,298,071 (130,331) 0 84,685 166,806,965 0 0 0 166,806,965 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 (227,044) 0 43,148 60,493,289 (59,017) 0 0 60,434,273 34,726,428 0 12,704,509 21,592,718,945 (13,015,259) 0 0 21,579,703,686 34,512,293 0 12,887,932 21,907,238,355 (13,074,276) 0 0 21,894,164,078 (224,853) 0 32,362 XXX XXX XXX XXX XXX 34,287,440 0 12,920,294 21,908,925,267 (13,074,276) 0 0 21,895,850,991 (408,503) (8,546) 4,300 62,548,409 12,566,513 2,641,194 133,831,797 23,032,680 5,097,656 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 56,604,844 126 0 14,777,603,755 7,105,306,238 3,930,809,961 15,030,180,301 7,140,897,011 3,938,553,111 XXX XXX XXX 15,030,180,301 7,140,897,011 3,938,553,111 0 0 0 (421,349) (649) 0 0 0 0 0 (421,998) 0 0 0 72,473,727 0 0 0 0 0 0 72,473,727 0 0 0 151,766,821 0 480,841 0 0 0 0 152,247,662 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 56,604,970 (40,459) 0 XXX XXX XXX 0 56,564,511 797,434 375,945,686 0 18,328,045,718 (11,161,952) (11,017,026) 0 2,296,000 13,313,026 0 18,316,883,766 797,434 375,945,686 0 18,608,469,886 (11,203,061) (10,536,185) 0 2,296,000 13,313,026 0 18,597,747,667 XXX XXX 797,434 375,945,686 0 18,608,469,886 (11,203,061) (10,536,185) 0 2,296,000 13,313,026 0 18,597,747,667 0 0 0 0 0 303,921 121,807 86,387 862,895 155,856 655,606 264,283 184,859 2,033,115 330,475 0 0 0 0 0 0 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 5.339 1,530,866 0.848 3,468,338 0.931 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 460,638 429,440 890,078 0.010 1,006,662 1,018,160 2,024,822 0.012 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 (2,472) (2,472) 0.031 XXX XXX XXX 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 2,507 1 150 262,786 88,968 146,084,611 47,797,543 49,111,350 80,061,693 57,533,734 147,046,645 48,183,634 49,382,746 83,220,489 58,109,034 115,369 5,325 37,352 778,581 121,053 147,162,014 48,188,959 49,420,098 83,999,070 58,230,087 0 354,412 XXX 380,588,931 0.866 385,942,547 XXX 1,057,680 XXX 387,000,228 XXX 0 0 0 0.000 124,600 168,777 293,377 0.005 241,050,527 135,905,212 376,955,739 0.017 242,642,427 137,519,116 380,161,543 XXX 520,091 533,073 1,053,165 XXX 243,162,519 138,052,189 381,214,708 XXX XXX SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 58 1,938 1,269 0 3,265 3 Large Group Employer 272,579 2,567,010 195,154 5,289,861 0 8,324,605 4 5 Small Group Employer Individual 653,280 5,061,350 351,796 11,687,440 0 17,753,866 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 155,683 1,972,789 103,270 5,903,160 0 8,134,902 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 169,515,746 210,654,998 55,915,259 1,407,967,456 0 1,844,053,458 170,597,288 220,256,205 56,567,417 1,430,849,186 0 1,878,270,096 418,347 2,296,064 155,191 4,182,903 0 7,052,504 171,015,634 222,552,268 56,722,608 1,435,032,089 0 1,885,322,600 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) (4,912,929) 661,221,792 652,042,225 XXX 12. Income from fees of uninsured plans XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 10,011,348 13. Net investment and other gain/(loss) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 381,063,826 XXX 14. Federal income taxes (excluding taxes on Line 1.5 above) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 39,880,995 XXX 39,880,995 15. Net gain or (loss) (Lines 11 + 12 + 13 - 14) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 993,225,056 XXX 995,759,967 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 0 342,289 4,078,796 (8,687,723) 0 0 0 0 0 0 0 644,565,788 10,011,348 381,063,826 OTHER INDICATORS: 216-2.WI 1. Number of certificates/policies 0 8,734 23,182 0 0 0 0 0 0 0 71,066 6,606,045 6,709,027 9,646 6,718,673 2. Number of Covered Lives 0 16,540 45,595 0 0 0 0 0 0 0 128,387 6,606,045 6,796,567 17,921 6,814,488 3. Number of Groups 916 312 0 0 0 0 0 0 4,092 715 6,035 393 6,428 4. Member Months 230,265 534,138 0 0 0 0 0 0 1,392,644 79,379,936 81,536,983 189,886 81,726,869 XXX 0 Is run off business reported in Columns 1 through 9 or 12? Yes [ XXX 0 ] No [ X ] 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 2,662 (507,604) XXX (3,184,807) 494,283 0 0 (2,510,062) XXX 0 0 0 0 3,941,530 766,899 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 0 494,933 0 0 (125,701) XXX 2,727,128 0 0 0 0 XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF 1100 Employers Boulevard DePere, WI 54115 Wisconsin 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 73288 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.WI Health Premiums Earned: 2,662 88,540,430 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 2,662 88,540,430 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 2,662 88,540,430 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: (153,662) 73,292,902 2.1 Paid claims during the year 3,877 6,877,456 2.2 Direct claim liability current year 266,465 9,437,028 2.3 Direct claim liability prior year 0 456,119 2.4 Direct claim reserves current year 0 388,954 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 5,099 (1,673,230) 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 341 964,550 2.12a Healthcare receivables current year (4,758) 2,637,780 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 (421,349) 72,473,727 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 649 0 2.18 Ceded incurred claims to non-affiliates 0 0 2.19 Other adjustments due to MLR calculation - Claims (421,998) 72,473,727 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) 11,194,316 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 170,585,373 0 0 0 151,348 0 (284,659) 284,659 0 0 170,585,373 0 0 0 0 170,149,366 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 59,049,054 69,255 82,755 (13,499) 0 0 0 0 0 0 59,035,555 123,447 (124,033) 58,431 0 58,976,538 22,289,362,735 0 0 0 153,730,552 142,906,070 216,255,765 (73,349,695) 0 0 22,289,362,735 0 0 13,015,259 0 22,195,966,619 22,607,540,253 69,255 82,755 (13,499) 153,881,899 142,906,070 215,971,106 (73,065,036) 0 0 22,607,526,754 123,447 (124,033) 13,073,690 0 22,513,635,615 156,483,998 12,991,798 16,298,178 1,379 731 0 0 151,348 0 (284,659) 0 0 0 0 1,847,452 1,574,897 (272,555) 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 53,178,770 7,333,058 3,850,528 109,948 123,898 0 (128) 0 0 0 0 0 0 0 42,509 42,799 290 0 0 17,777,298,391 1,623,713,641 1,435,437,169 0 0 0 0 153,730,552 142,906,070 216,255,765 375,945,686 353,024,512 346,777,961 323,856,788 93,855,687 870,832,247 776,976,561 0 0 18,060,100,400 1,650,919,831 1,465,289,368 567,446 513,582 0 (128) 153,881,899 142,906,070 215,971,106 375,945,686 353,024,512 346,777,961 323,856,788 94,077,517 873,414,834 779,337,317 0 0 151,766,821 0 0 0 480,841 151,811,655 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 56,604,970 (23,022) 1,113,487 1,130,925 0 56,564,511 18,328,045,719 0 0 11,161,952 0 18,236,502,910 18,608,469,887 (23,022) 1,113,487 12,293,526 480,841 18,516,930,805 0 0 0 2,887,369 for stand-alone vision policies. 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF Wisconsin DURING THE YEAR All Expenses 1 Individual Comprehensive Coverage Expenses: (443) for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services (14) 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 $ 412 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 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. (1) 0 0 0 0 2 0 0 XXX Small Group Comprehensive Coverage Expenses: 433,581 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 29,138 for affiliated services) 2.3 EDP Equipment and Software (incl $ 692 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 253 for affiliated services) 2.5 Accreditation and Certification (incl $ 414,833 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) (2) 0 0 0 0 3 1 0 XXX 0 0 0 XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 0 0 0 0 1 0 0 XXX (LOCATION) NAIC Company Code 2018 XXX (67) (28) (6) 0 0 101 0 0 XXX (2,471) (1) 0 0 0 0 (2,472) 0 XXX 0 0 0 0 0 0 0 0 0 0 1 0 0 0 (2,472) 0 94,585 159,214 7,519 188 0 42,414 303,921 0 4,567 114,885 327 8 35,877 32,752 2,115 52 642,574 115,084 24,642 263 79,180 33,493 7,041 175 856,784 455,428 41,644 687 0 176,323 1,530,866 0 216,544 132,798 13,923 346 141 96,886 460,638 0 227,500 86,278 17,096 408 166 97,991 429,440 0 XXX Large Group Comprehensive Coverage Expenses: 971,251 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 64,895 for affiliated services) 3.3 EDP Equipment and Software (incl $ 1,532 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 563 for affiliated services) 3.5 Accreditation and Certification (incl $ 855,420 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. 1100 Employers Boulevard DePere, WI 54115 XXX XXX 2,019 121,807 0 XXX XXX 15,591 86,387 0 XXX XXX 80,331 862,895 0 XXX 35,967 155,856 0 XXX XXX XXX XXX 303,921 0 121,807 0 86,387 0 862,895 0 155,856 0 1,530,866 0 460,638 90,991 429,440 0 203,088 344,800 16,208 405 0 91,105 655,606 0 9,828 249,376 707 18 76,338 70,629 4,560 113 1,552,460 242,047 57,470 562 167,884 71,017 14,927 374 2,009,598 977,869 93,871 1,472 0 385,528 3,468,338 0 472,042 291,118 30,937 770 314 211,482 1,006,662 0 538,332 205,552 41,070 987 402 231,818 1,018,160 0 3,468,338 0 XXX 1,006,662 200,835 XXX 1,018,160 0 XXX XXX XXX 4,355 264,283 0 XXX 655,606 0 XXX 33,218 184,859 0 180,577 2,033,115 0 184,859 0 XXX 2,033,115 0 XXX 264,283 0 XXX 76,274 330,475 0 XXX XXX 330,475 0 73288 9 10 General Administrative Expenses Total Expenses (6 to 9) (1,887) (659) (139) (3) (1) 4,017 1,327 0 1,938 3,265 0 (4,427) (688) (145) (4) (1) 4,120 (1,145) 0 1,938 793 0 3,034,986 1,090,918 218,717 5,477 2,224 3,777,128 8,129,450 0 195,154 8,324,605 0 4,335,815 1,765,421 291,380 6,919 2,531 4,148,328 10,550,394 0 195,154 10,745,548 90,991 6,692,538 2,484,075 483,076 12,095 4,912 7,725,374 17,402,070 0 351,796 17,753,866 0 9,712,510 3,958,614 648,954 15,324 5,627 8,554,202 22,895,230 0 351,796 23,247,026 200,835 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 Humana 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 *73288201821651100* SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (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) Humana Insurance Company 2. 1100 Employers Boulevard DePere, WI 54115 (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 2 Small Group Employer 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 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) 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 73288 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 3,245,097 0 0 0 0 0 3,245,097 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 3,245,097 (97,505) 0 0 3,245,097 (97,505) 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 3,129 0 2,131 3,337,341 (3,135) 0 0 3,334,206 0 0 0 0 0 0 0 0 3,129 0 2,131 3,337,341 (3,135) 0 0 3,334,206 XXX XXX XXX XXX XXX 3,129 0 2,131 3,337,341 (3,135) 0 0 3,334,206 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,451,695 70 0 0 0 0 2,451,695 70 0 XXX XXX XXX 2,451,695 70 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,451,765 0 0 0 0 0 0 2,451,765 XXX XXX 0 0 0 0 0 2,451,765 0 0 XXX XXX XXX 0 2,451,765 0 0 0 2,451,765 0 0 0 0 0 0 2,451,765 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 35 0 1 33,567 4,317 0 0 0 0 0 35 0 1 33,567 4,317 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 37,919 XXX 0 0.000 37,919 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 5,941 30,695 36,636 0.011 0 0 0 0.000 5,941 30,695 36,636 XXX XXX XXX XXX XXX 0 0 0 0.000 3,245,097 0 0 0 0 0 0 0 XXX XXX XXX XXX XXX XXX XXX XXX 0 0 0 0 0 35 0 1 33,567 4,317 0 37,919 XXX 0 0 0 5,941 30,695 36,636 XXX XXX XXX 3,245,097 (97,505) SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 5,889 218,351 6,473 296,791 0 527,503 0 0 0 0 0 0 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 5,889 218,351 6,473 296,791 0 527,503 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 280,383 XXX 280,383 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 0 280,383 0 280,383 XXX 5,889 218,351 6,473 296,791 0 527,503 XXX 280,383 0 0 0 OTHER INDICATORS: 216-2.WY 1. Number of certificates/policies 0 0 0 0 0 0 0 0 0 0 2,600 0 2,600 0 2,600 2. Number of Covered Lives 0 0 0 0 0 0 0 0 0 0 2,835 0 2,835 0 2,835 3. Number of Groups 0 0 0 0 0 0 0 0 1 0 1 0 1 4. Member Months 0 0 0 0 0 0 0 0 33,254 0 33,254 0 33,254 XXX 0 Is run off business reported in Columns 1 through 9 or 12? Yes [ ] No [ X ] If yes, show the amount of premiums and claims included. Premiums $ XXX 0 0 Claims $ 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) 3. Temporary ACA Risk Corridors Program 3.1 Accrued retrospective premium 3.2 Reserve for rate credits or policy experience refunds 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 XXX XXX NONE XXX XXX 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF 1100 Employers Boulevard DePere, WI 54115 DURING THE YEAR Wyoming 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 73288 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.WY 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) 252,642 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 3,247,038 6,263 8,204 (1,941) 0 0 0 0 0 0 3,245,097 0 0 3,135 0 3,241,961 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3,247,038 6,263 8,204 (1,941) 0 0 0 0 0 0 3,245,097 0 0 3,135 0 3,241,961 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,433,794 275,777 257,387 0 0 0 0 0 0 0 0 0 0 0 419 441 22 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,433,794 275,777 257,387 0 0 0 0 0 0 0 0 0 0 0 419 441 22 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,451,765 0 0 0 0 2,451,765 0 0 0 0 0 0 2,451,765 0 0 0 0 2,451,765 0 0 0 65,979 for stand-alone vision policies. 0 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF DURING THE YEAR Wyoming All Expenses 1 2. 216-4.WY 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. 1100 Employers Boulevard DePere, WI 54115 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 73288 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 Humana 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 Humana 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 *73288201821659100* SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 1 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (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) Humana Insurance Company 2. 1100 Employers Boulevard DePere, WI 54115 (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 Individual 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 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) 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 73288 13 14 15 Subtotal (Cols. 1 through 12) Uninsured Plans Total 13 + 14 (22,137,377) 0 0 823,678,609 0 0 678,194,368 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,188,880,285 0 (41,056) 22,289,362,735 0 0 24,957,978,619 0 (41,056) XXX XXX XXX 24,957,978,619 0 (41,056) (22,137,377) (700,094) 823,678,609 27,147,129 678,194,368 19,190,967 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,188,839,229 (395,618) 22,289,362,735 649,212,852 24,957,937,563 694,455,236 XXX (13,695,091) 24,957,937,563 680,760,145 (34,669) 0 66,329 (21,468,944) 0 0 0 (21,468,944) 12,282,038 0 514,253 783,735,189 (2,055,925) 0 0 781,679,264 7,060,430 0 352,749 651,590,222 0 0 0 651,590,222 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 15,679,122 0 1,732,446 1,171,823,279 (30,362,550) 0 0 1,141,460,730 34,726,428 0 12,704,509 21,592,718,945 (13,015,259) 0 0 21,579,703,686 69,713,348 0 15,370,287 24,178,398,692 (45,433,734) 0 0 24,132,964,958 (2,063,919) 0 345,344 XXX XXX XXX XXX XXX 67,649,430 0 15,715,632 24,193,812,357 (45,433,734) 0 0 24,148,378,623 (26,787,467) (3,261,085) (110,832) 526,563,243 108,689,905 22,499,293 509,574,932 88,419,079 19,479,900 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 881,308,230 10,894 19,557 14,777,603,755 7,105,306,238 3,930,809,961 16,668,262,692 7,299,165,031 3,972,697,879 XXX XXX XXX 16,668,262,692 7,299,165,031 3,972,697,879 0 (262,477) 0 (30,200,197) (151,577) (2,446,421) 8,164,201 5,717,780 0 0 (30,351,774) 0 0 0 612,753,855 (2,516,182) (2,279,187) 2,017,801 1,894,101 2,155,487 0 610,237,673 0 0 0 578,514,110 0 (1,669,909) 1,698,607 1,278,093 3,438,395 0 580,703,110 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 0 797,434 375,945,686 0 18,328,045,718 (11,161,952) (11,017,026) 0 2,296,000 13,313,026 0 18,316,883,766 797,434 375,683,209 0 20,370,413,053 (30,499,118) (17,412,544) 11,880,610 11,185,974 18,906,908 0 20,342,102,934 XXX XXX 0 0 0 0 0 881,299,567 (16,669,408) 0 XXX XXX XXX 0 864,630,159 797,434 375,683,209 0 20,370,413,053 (30,499,118) (17,412,544) 11,880,610 11,185,974 18,906,908 0 20,342,102,934 (37) 2 (3) (239,492) 3,427 2,783,162 1,104,168 791,257 6,394,162 1,441,021 2,664,704 1,067,169 741,533 7,100,038 1,358,600 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 85,057 151 5,331 7,798,865 1,599,168 146,084,611 47,797,543 49,111,350 80,061,693 57,533,734 151,617,497 49,969,034 50,649,467 101,115,265 61,935,950 1,385,246 63,751 451,082 3,240,663 1,395,367 153,002,743 50,032,785 51,100,549 104,355,929 63,331,317 (236,103) 1.418 12,513,770 0.798 12,932,043 0.908 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 9,488,572 XXX 380,588,931 0.866 415,287,213 XXX 6,536,109 XXX 421,823,322 XXX 40 (98,391) (98,350) 0.005 4,209,899 3,716,546 7,926,445 0.010 4,102,731 3,887,086 7,989,817 0.012 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 5,098,835 7,215,122 12,313,956 0.011 241,050,527 135,905,212 376,955,739 0.017 254,462,032 150,625,574 405,087,607 XXX 6,308,076 6,362,841 12,670,918 XXX 260,770,109 156,988,416 417,758,524 XXX XXX XXX XXX XXX 0 XXX XXX XXX XXX XXX XXX XXX XXX SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 (107,534) 30,073 1,624,703 0 1,547,262 3 Large Group Employer 4 5 Small Group Employer Individual 2,468,848 25,183,809 2,085,750 49,038,194 0 78,776,601 2,630,441 19,738,262 1,544,337 48,166,412 0 72,079,452 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 5,804,640 101,166,405 4,330,932 92,281,593 0 203,583,569 169,515,746 210,654,998 55,915,259 1,407,967,456 0 1,844,053,458 180,419,693 356,635,940 63,906,350 1,599,078,359 0 2,200,040,343 3,937,262 9,979,711 1,677,249 47,598,059 0 63,192,281 184,356,955 366,615,651 65,583,599 1,646,676,418 0 2,263,232,623 11. Underwriting Gain/(Loss) (Lines 1.12 - 5.7 - 6.6 - 8.3 - 10.5) 72,224,775 (22,114,199) 51,444,473 661,221,792 770,446,861 XXX 12. Income from fees of uninsured plans XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 95,392,908 13. Net investment and other gain/(loss) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 381,063,826 XXX 14. Federal income taxes (excluding taxes on Line 1.5 above) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 39,880,995 XXX 39,880,995 15. Net gain or (loss) (Lines 11 + 12 + 13 - 14) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 1,111,629,692 XXX 1,140,036,958 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 7,670,021 0 0 0 0 0 0 0 703,461,219 95,392,908 381,063,826 OTHER INDICATORS: 216-2.GT 1. Number of certificates/policies 1 171,167 167,960 0 0 0 0 0 0 0 2,030,104 6,606,045 8,975,277 100,630 9,075,907 2. Number of Covered Lives 1 290,379 286,321 0 0 0 0 0 0 0 3,262,798 6,606,045 10,445,544 197,250 10,642,794 3. Number of Groups 9,048 1,334 0 0 0 0 0 0 88,614 715 99,711 1,779 101,490 4. Member Months 5,477 3,880,594 3,541,817 0 0 0 0 0 0 37,824,278 79,379,936 124,632,102 2,278,287 126,910,389 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 8,004,014 2,493,207 67,972,750 (18,013,516) 4,771,087 XXX (50,284,914) 10,972,182 (5,638,736) 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 10,986,597 158,361 0 XXX 66,246,198 0 0 179,955 0 (2,389,284) XXX 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 2 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF 1100 Employers Boulevard DePere, WI 54115 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 73288 12 Medicare Advantage Part C and Medicare Part D Stand-Alone Subject to ACA 13 Total (a) 1. 216-3.GT Health Premiums Earned: (22,204,391) 823,678,609 1.1 Direct premiums written 67,013 0 1.2 Unearned premium prior year 0 0 1.3 Unearned premium current year 67,013 0 1.4 Change in unearned premium (Lines 1.2 - 1.3) 8,005,840 1,964,426 1.5 Paid rate credits 0 2,155,487 1.6 Reserve for rate credits current year 5,717,780 1,840,726 1.7 Reserve for rate credits prior year (5,717,780) 314,761 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 (22,137,377) 823,678,609 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 2,055,925 1.14 Ceded premiums earned to non-affiliates 0 0 1.15 Other Adjustments due to MLR calculation - Premiums (24,425,438) 819,343,497 1.16 Net premiums earned (Lines 1.11 - 1.5 - 1.8 + 1.12 + 1.13 - 1.14 + 1.15) 2. Direct Claims Incurred: 16,335,448 620,511,406 2.1 Paid claims during the year 2,035,351 43,852,490 2.2 Direct claim liability current year 52,714,335 56,124,155 2.3 Direct claim liability prior year 0 2,099,048 2.4 Direct claim reserves current year 0 1,912,038 2.5 Direct claim reserves prior year 0 0 2.6 Direct contract reserves current year 3,396,557 0 2.7 Direct contract reserves prior year 8,005,840 1,964,426 2.8 Paid rate credits 0 2,155,487 2.9 Reserve for rate credits current year 5,717,780 1,840,726 2.10 Reserve for rate credits prior year (262,477) 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 381,363 0 2.11b Accrued medical incentive pools and bonuses current year 643,840 0 2.11c Accrued medical incentive pools and bonuses prior year (5,514,314) (2,047,918) 2.12 Net healthcare receivables (Lines 2.12a - 2.12b) 10,075 7,514,961 2.12a Healthcare receivables current year 5,524,389 9,562,879 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 (30,200,197) 612,753,855 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 151,577 2,516,182 2.18 Ceded incurred claims to non-affiliates 0 0 2.19 Other adjustments due to MLR calculation - Claims (32,639,834) 607,958,486 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) 405,167,766 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 678,194,368 0 0 0 4,592,011 3,665,591 692,299 2,973,292 0 0 678,194,368 0 0 0 0 670,629,064 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,189,314,868 2,370,037 2,804,620 (434,583) 0 0 7,094 (7,094) 0 0 1,188,880,285 1,779,926 (30,477,834) 1,664,642 0 1,158,524,829 22,289,362,735 0 0 0 153,730,552 142,906,070 216,255,765 (73,349,695) 0 0 22,289,362,735 0 0 13,015,259 0 22,195,966,619 24,958,346,189 2,437,050 2,804,620 (367,570) 168,292,829 148,727,148 224,513,664 (75,786,516) 0 0 24,957,978,619 1,779,926 (30,477,834) 16,735,826 0 24,820,038,572 577,231,444 71,001,871 75,430,586 433,952 485,962 0 0 4,592,011 3,665,591 692,299 0 0 0 0 1,801,913 5,702,298 3,900,384 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 856,742,654 109,870,880 84,830,291 3,286,703 3,787,589 15,405,599 13,501,448 0 0 7,094 0 0 0 0 1,879,848 1,885,561 5,714 0 0 17,777,298,391 1,623,713,641 1,435,437,169 0 0 0 0 153,730,552 142,906,070 216,255,765 375,945,686 353,024,512 346,777,961 323,856,788 93,855,687 870,832,247 776,976,561 0 0 19,848,119,344 1,850,474,232 1,704,536,536 5,819,703 6,185,589 15,405,599 16,898,005 168,292,829 148,727,148 224,513,664 375,683,209 353,024,512 347,159,324 324,500,628 89,975,216 885,945,143 795,969,927 0 0 578,514,110 0 0 0 2,189,000 573,137,807 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 0 881,299,567 616,373 (13,893,027) 3,392,754 0 864,637,253 18,328,045,719 0 0 11,161,952 0 18,236,502,910 20,370,413,054 616,373 (13,893,027) 17,222,465 2,189,000 20,249,596,622 0 0 0 109,331,338 for stand-alone vision policies. 0 0 0 0 0 0 0 0 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 REPORT FOR: 1. CORPORATION NAIC Group Code 0119 (To Be Filed by April 1 - Not for Rebate Purposes) 2. Humana Insurance Company BUSINESS IN THE STATE OF Grand Total DURING THE YEAR All Expenses 1 Individual Comprehensive Coverage Expenses: 45,547 for affiliated services) 1.1 Salaries (including $ 1.2 Outsourced Services 7,410 for affiliated services) 1.3 EDP Equipment and Software (incl $ 183 for affiliated services) 1.4 Other Equipment (excl. EDP) (incl $ 86 for affiliated services) 1.5 Accreditation and Certification (incl $ 29,639 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: 3,854,739 for affiliated services) 2.1 Salaries (including $ 2.2 Outsourced Services 266,316 for affiliated services) 2.3 EDP Equipment and Software (incl $ 6,428 for affiliated services) 2.4 Other Equipment (excl. EDP) (incl $ 2,348 for affiliated services) 2.5 Accreditation and Certification (incl $ 3,944,932 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: 3,854,868 for affiliated services) 3.1 Salaries (including $ 3.2 Outsourced Services 263,360 for affiliated services) 3.3 EDP Equipment and Software (incl $ 6,295 for affiliated services) 3.4 Other Equipment (excl. EDP) (incl $ 2,312 for affiliated services) 3.5 Accreditation and Certification (incl $ 3,399,797 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. 1100 Employers Boulevard DePere, WI 54115 (1) (49) 0 0 0 13 (37) 0 XXX 0 2 0 0 XXX XXX 0 2 0 XXX (37) 0 875,087 1,442,959 70,385 1,760 0 392,971 2,783,162 0 XXX XXX 328,662 298,403 20,264 502 XXX 20,126 1,104,168 0 XXX 1,104,168 0 828,383 1,395,883 66,759 1,667 0 372,012 2,664,704 0 39,360 1,007,375 2,906 71 XXX XXX 1,067,169 0 XXX (239,492) 0 4,449,096 1,074,677 189,400 2,498 XXX XXX XXX 40 7 (98,391) 0 732,064 309,660 65,103 1,626 6,430,134 4,161,013 348,571 6,470 0 1,567,581 12,513,770 0 1,940,318 1,264,957 127,911 3,186 1,297 872,231 4,209,899 0 1,954,033 754,974 149,109 3,588 1,461 853,381 3,716,546 0 12,513,770 0 XXX 4,209,899 837,307 XXX 3,716,546 0 7,055,397 3,999,015 353,991 6,042 0 1,517,598 12,932,043 0 1,891,272 1,229,786 126,927 3,159 1,284 850,304 4,102,731 0 2,030,141 796,725 158,995 3,835 1,561 895,828 3,887,086 0 12,932,043 0 XXX 4,102,731 825,236 XXX 3,887,086 0 XXX 791,257 0 XXX 6,394,162 0 XXX 1,441,021 0 304,573 284,866 18,766 465 5,192,836 1,018,927 204,188 2,308 690,245 291,965 61,372 1,531 XXX XXX 132,863 741,533 0 681,779 7,100,038 0 313,487 1,358,600 0 741,533 0 XXX 7,100,038 0 XXX 1,358,600 0 XXX XXX (362,411) 115,228 24,219 607 247 123,720 (98,391) 0 (236,103) 0 332,568 1,441,021 0 XXX (348) (134) (31) (1) 0 554 40 0 3,427 0 678,491 6,394,162 0 XXX 17,456 1,067,169 0 (119,923) (50,784) (10,663) (268) 0 (54,465) (236,103) 0 784 3,427 0 143,426 791,257 0 XXX Total (1 to 5) XXX XXX Claims Adjustment Expenses 7 8 Other Claims Cost Adjustment Containment Expenses Expenses 6 1,747 738 155 3 (55,262) (239,492) 0 (3) 0 45,224 1,035,315 3,419 83 XXX (121,672) (51,469) (10,818) (271) 0 (3) 0 2 0 XXX 2,783,162 0 XXX 2,664,704 0 2 (6) 0 0 (LOCATION) NAIC Company Code 2018 XXX 73288 9 10 General Administrative Expenses Total Expenses (6 to 9) 938,152 289,767 60,578 1,497 618 226,578 1,517,189 0 30,073 1,547,262 0 455,470 354,077 74,103 1,835 865 296,387 1,182,736 0 30,073 1,212,809 7 28,222,909 10,202,482 2,037,565 51,041 20,726 36,156,130 76,690,851 0 2,085,750 78,776,601 0 38,547,394 16,383,426 2,663,156 64,283 23,483 39,449,323 97,131,066 0 2,085,750 99,216,816 837,307 27,571,866 10,165,132 1,993,692 49,919 20,271 30,734,236 70,535,115 0 1,544,337 72,079,452 0 38,548,675 16,190,659 2,633,604 62,955 23,116 33,997,966 91,456,975 0 1,544,337 93,001,311 825,236 SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 Humana Insurance Company SUPPLEMENTAL HEALTH CARE EXHIBIT - PART 3 (Continued) All Expenses 1 Improve Health Outcomes 7. 8. 216-6.GT 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 *73288201828500100* SUPPLEMENTAL INVESTMENT RISKS INTERROGATORIES For The Year Ended December 31, 2018 (To Be Filed by April 1) Of The Humana Insurance Company ADDRESS (City, State and Zip Code) Louisville , KY 40202 0119 NAIC Group Code NAIC Company Code 73288 39-1263473 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. $ 1 2 3 Issuer Description of Exposure Amount 7,233,381,293 4 Percentage of Total Admitted Assets 2.01 MET TRANSPRTN AUTH NY REVENUE BONDS $ 58,580,371 0.8 % 2.02 CD COMMERCIAL MORTGAGE TRUST BONDS $ 58,306,521 0.8 % 2.03 JPMORGAN CHASE & CO BONDS $ 53,406,348 0.7 % 2.04 APPLE INC BONDS $ 47,965,502 0.7 % 2.05 JP MORGAN CHASE BONDS $ 45,278,744 0.6 % 2.06 MARYLAND ST BONDS $ 40,559,910 0.6 % 2.07 NEW YORK ST DORM AUTH BONDS 2.08 GOLDMAN SACHS GROUP INC $ 39,915,350 0.6 % BONDS $ 39,247,216 0.5 % 2.09 NEW YORK ST DORM AUTH SALES BONDS $ 38,255,687 0.5 % 2.10 BANK OF AMERICA CORP BONDS $ 36,831,207 0.5 % 3. 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 $ 3,392,278,627 46.9 % 3.07 P/RP-1 $ 0 0.0 % 3.02 NAIC-2 $ 351,917,387 4.9 % 3.08 P/RP-2 $ 0 0.0 % 3.03 NAIC-3 $ 131,242,517 1.8 % 3.09 P/RP-3 $ 0 0.0 % 3.04 NAIC-4 $ 4,803,550 0.1 % 3.10 P/RP-4 $ 0 0.0 % 3.05 NAIC-5 $ 0 0.0 % 3.11 P/RP-5 $ 0 0.0 % $ 0 0.0 % $ 0 0.0 % 3.06 NAIC-6 4. 4.01 3.12 P/RP-6 Assets held in foreign investments: Yes [ X ] No [ Are assets held in foreign investments less than 2.5% of the reporting entity’s total admitted assets? ] 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 $ 27,306,379 0.4 % 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 Humana 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 0 0 0 $ $ $ 0.0 % 0.0 % 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: Country 2: Countries designated NAIC - 2: $ $ 0 0 0.0 % 0.0 % 6.03 6.04 Country 1: Country 2: Countries designated NAIC - 3 or below: $ $ 0 0 0.0 % 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 2 NAIC Designation 10.01 10.02 10.03 10.04 10.05 10.06 10.07 10.08 10.09 10.10 3 $ $ $ $ $ $ $ $ $ $ 285.1 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 0.0 0.0 0.0 % % % % % % % % % % SUPPLEMENT FOR THE YEAR 2018 OF THE Humana 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 [ X ] No [ 13.01 Are assets held in equity interests less than 2.5% of the reporting entity’s total admitted assets? ] If response to 13.01 above is yes, responses are not required for the remainder of Interrogatory 13. 1 Issuer 2 $ $ $ $ $ $ $ $ $ $ 13.02 13.03 13.04 13.05 13.06 13.07 13.08 13.09 13.10 13.11 285.2 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 Humana 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 Humana 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 Humana 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 *73288201829001100* 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 Humana Insurance Company 73288 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 113,350 0 457,596,701 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 113,350 0 457,596,701 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 0 442,724,213 442,724,213 0 0 0 0 14,872,488 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 113,350 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) Medicare - Federal Exemption from Assessment Federal Employee Health Benefits Plan 0 0 0 0 0 0 0 0 0 0 442,041,176 683,037 0 0 0 0 Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 0 0 0 0 0 442,724,213 0 0 290.AL *73288201830001100* 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 Humana Insurance Company 73288 DIRECT BUSINESS IN THE STATE OF: Alabama 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 113,350 0 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. 4. 3 14,872,488 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 0 113,350 0 14,872,488 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 *73288201829002100* 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 Humana Insurance Company 73288 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 22,473 0 11,193,390 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 22,473 0 11,193,390 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) 22,473 0 0 0 0 9,356,766 9,356,766 0 0 0 0 1,836,624 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) Medicare - Federal Exemption from Assessment 0 0 0 0 0 0 0 0 9,356,766 0 0 0 Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 0 0 0 0 0 9,356,766 0 0 290.AK *73288201830002100* 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 Humana Insurance Company 73288 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 22,473 0 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. 4. 3 1,836,624 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 22,473 0 1,836,624 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 *73288201829003100* 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 Humana Insurance Company 73288 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 1,147,118 0 304,482,532 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,147,118 0 304,482,532 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 0 249,879,433 249,879,433 0 0 0 0 54,603,099 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 1,147,118 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 0 243,326,603 4,741,693 1,811,137 0 249,879,433 0 0 0 0 0 0 0 Medicare - Federal Exemption from Assessment Stop-Loss Premium Federal Employee Health Benefits Plan Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.AZ *73288201830003100* 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 Humana Insurance Company 73288 DIRECT BUSINESS IN THE STATE OF: Arizona 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 1,147,118 0 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. 4. 3 54,603,099 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 1,147,118 0 54,603,099 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 *73288201829004100* 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 Humana Insurance Company 73288 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 20,352 0 165,965,197 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 20,352 0 165,965,197 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 0 157,288,236 157,288,236 0 0 0 0 8,676,961 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 20,352 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) Medicare - Federal Exemption from Assessment Federal Employee Health Benefits Plan 0 0 0 0 0 0 0 0 0 0 157,042,562 245,674 0 0 0 0 Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 0 0 0 0 0 157,288,236 0 0 290.AR *73288201830004100* 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 Humana Insurance Company 73288 DIRECT BUSINESS IN THE STATE OF: Arkansas 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 20,352 0 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. 4. 3 8,676,961 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 20,352 0 8,676,961 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 *73288201829005100* 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 Humana Insurance Company 73288 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 3,305,181 0 421,918,988 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3,305,181 0 421,918,988 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 0 337,221,840 337,221,840 0 0 0 0 84,697,148 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 3,305,181 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) Medicare - Federal Exemption from Assessment 0 0 0 0 0 0 0 0 337,221,840 0 0 0 Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 0 0 0 0 0 337,221,840 0 0 290.CA *73288201830005100* 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 Humana Insurance Company 73288 DIRECT BUSINESS IN THE STATE OF: California 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 3,305,181 0 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. 4. 3 84,697,148 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 3,305,181 0 84,697,148 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 *73288201829006100* 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 Humana Insurance Company 73288 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 972,909 0 347,545,338 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 0 972,909 0 347,545,338 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 0 312,039,351 312,039,351 0 0 0 0 35,505,987 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 972,909 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) Medicare - Federal Exemption from Assessment Stop-Loss Premium 0 0 0 0 0 0 0 0 0 0 284,709,252 27,330,099 0 0 0 0 Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 0 0 0 0 0 312,039,351 0 0 290.CO *73288201830006100* 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 Humana Insurance Company 73288 DIRECT BUSINESS IN THE STATE OF: Colorado 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 972,909 0 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. 4. 3 35,505,987 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 0 972,909 0 35,505,987 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.CO *73288201829007100* 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 Humana Insurance Company 73288 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 30,296 0 41,645,852 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 30,296 0 41,645,852 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) 30,296 0 0 0 0 36,855,603 36,855,603 0 0 0 0 4,790,249 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) Medicare - Federal Exemption from Assessment 0 0 0 0 0 0 0 0 36,855,603 0 0 0 Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 0 0 0 0 0 36,855,603 0 0 290.CT *73288201830007100* 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 Humana Insurance Company 73288 DIRECT BUSINESS IN THE STATE OF: Connecticut 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 30,296 0 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. 4. 3 4,790,249 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 30,296 0 4,790,249 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 *73288201829008100* 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 Humana Insurance Company 73288 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 0 0 31,223,227 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 31,223,227 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) 0 0 0 0 0 26,680,034 26,680,034 0 0 0 0 4,543,193 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) Medicare - Federal Exemption from Assessment 0 0 0 0 0 0 0 0 26,680,034 0 0 0 Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 0 0 0 0 0 26,680,034 0 0 290.DE *73288201830008100* 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 Humana Insurance Company 73288 DIRECT BUSINESS IN THE STATE OF: Delaware 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 0 0 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. 4. 3 4,543,193 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 0 0 4,543,193 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 *73288201829009100* 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 Humana Insurance Company 73288 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 37,080 0 6,266,958 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 0 0 0 0 0 0 0 0 0 37,080 0 6,266,958 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) 37,080 0 0 0 0 4,528,991 4,528,991 0 0 0 0 1,737,967 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) Medicare - Federal Exemption from Assessment Federal Employee Health Benefits Plan 0 0 0 0 0 0 0 0 0 0 3,794,003 734,988 0 0 0 0 Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 0 0 0 0 0 4,528,991 0 0 290.DC *73288201830009100* 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 Humana Insurance Company 73288 DIRECT BUSINESS IN THE STATE OF: District of Columbia 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 37,080 0 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. 4. 3 1,737,967 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 37,080 0 1,737,967 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 *73288201829010100* 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 Humana Insurance Company 73288 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 4,550,619 0 1,868,135,773 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 4,550,619 0 1,868,135,773 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) 4,550,619 0 0 0 0 1,747,843,489 1,747,843,489 0 0 0 0 120,292,284 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 1,743,350,991 289,668 4,202,830 0 1,747,843,489 0 0 0 0 0 0 0 Medicare - Federal Exemption from Assessment Stop-Loss Premium Federal Employee Health Benefits Plan Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.FL *73288201830010100* 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 Humana Insurance Company 73288 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 4,550,619 0 120,292,284 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 4,550,619 0 120,292,284 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 *73288201829011100* 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 Humana Insurance Company 73288 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 5,507,620 0 1,018,619,683 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5,507,620 0 1,018,619,683 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 0 821,651,107 821,651,107 0 0 0 0 196,968,576 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 5,507,620 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 0 777,061,754 42,244,670 2,344,683 0 821,651,107 0 0 0 0 0 0 0 Medicare - Federal Exemption from Assessment Stop-Loss Premium Federal Employee Health Benefits Plan Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.GA *73288201829012100* 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 Humana Insurance Company 73288 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 0 0 101,580,025 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 101,580,025 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) 0 0 0 0 0 99,392,953 99,392,953 0 0 0 0 2,187,072 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) Medicare - Federal Exemption from Assessment 0 0 0 0 0 0 0 0 99,392,953 0 0 0 Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 0 0 0 0 0 99,392,953 0 0 290.HI *73288201830012100* 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 Humana Insurance Company 73288 DIRECT BUSINESS IN THE STATE OF: Hawaii 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 0 0 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. 4. 3 2,187,072 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 0 0 2,187,072 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 *73288201829013100* 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 Humana Insurance Company 73288 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 0 0 60,225,565 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 60,225,565 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) 0 0 0 0 0 57,621,068 57,621,068 0 0 0 0 2,604,497 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) Medicare - Federal Exemption from Assessment 0 0 0 0 0 0 0 0 57,621,068 0 0 0 Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 0 0 0 0 0 57,621,068 0 0 290.ID *73288201830013100* 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 Humana Insurance Company 73288 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 0 0 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. 4. 3 2,604,497 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 0 0 2,604,497 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 *73288201829014100* 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 Humana Insurance Company 73288 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 2,827,596 0 831,536,854 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,827,596 0 831,536,854 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 0 597,407,167 597,407,167 0 0 0 0 234,129,687 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 2,827,596 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 0 592,889,481 3,337,116 1,180,570 0 597,407,167 0 0 0 0 0 0 0 Medicare - Federal Exemption from Assessment Stop-Loss Premium Federal Employee Health Benefits Plan Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.IL *73288201830014100* 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 Humana Insurance Company 73288 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 2,827,596 0 234,129,687 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 2,827,596 0 234,129,687 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 *73288201829015100* 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 Humana Insurance Company 73288 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 1,786,985 0 947,335,515 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,786,985 0 947,335,515 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 0 864,042,632 864,042,632 0 0 0 0 83,292,883 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 1,786,985 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) Medicare - Federal Exemption from Assessment Stop-Loss Premium 0 0 0 0 0 0 0 0 0 0 855,625,523 8,417,109 0 0 0 0 Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 0 0 0 0 0 864,042,632 0 0 290.IN *73288201830015100* 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 Humana Insurance Company 73288 DIRECT BUSINESS IN THE STATE OF: Indiana 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 1,786,985 0 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. 4. 3 83,292,883 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 1,786,985 0 83,292,883 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 *73288201829016100* 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 Humana Insurance Company 73288 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 13,248 0 210,274,170 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 13,248 0 210,274,170 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 0 207,556,018 207,556,018 0 0 0 0 2,718,152 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 13,248 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) Medicare - Federal Exemption from Assessment 0 0 0 0 0 0 0 0 207,556,018 0 0 0 Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 0 0 0 0 0 207,556,018 0 0 290.IA *73288201830016100* 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 Humana Insurance Company 73288 DIRECT BUSINESS IN THE STATE OF: Iowa 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 13,248 0 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. 4. 3 2,718,152 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 13,248 0 2,718,152 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 *73288201829017100* 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 Humana Insurance Company 73288 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 666,979 0 325,962,730 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 666,979 0 325,962,730 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 0 179,347,955 179,347,955 0 0 0 0 146,614,775 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 666,979 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 0 165,052,358 13,798,556 497,041 0 179,347,955 0 0 0 0 0 0 0 Medicare - Federal Exemption from Assessment Stop-Loss Premium Federal Employee Health Benefits Plan Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.KS *73288201830017100* 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 Humana Insurance Company 73288 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 666,979 0 146,614,775 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 0 666,979 0 146,614,775 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 *73288201829018100* 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 Humana Insurance Company 73288 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 7,190,071 0 1,779,790,851 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7,190,071 0 1,779,790,851 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) 7,190,071 0 0 0 0 1,779,210,317 1,779,210,317 0 0 0 0 580,534 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) Medicare - Federal Exemption from Assessment Stop-Loss Premium 0 0 0 0 0 0 0 0 0 0 1,778,799,159 411,158 0 0 0 0 Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 0 0 0 0 0 1,779,210,317 0 0 290.KY *73288201830018100* 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 Humana Insurance Company 73288 DIRECT BUSINESS IN THE STATE OF: Kentucky 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 7,190,071 0 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. 4. 3 580,534 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 7,190,071 0 580,534 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 *73288201829019100* 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 Humana Insurance Company 73288 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 1,472,279 0 370,619,632 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,472,279 0 370,619,632 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 0 367,922,015 367,922,015 0 0 0 0 2,697,617 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 1,472,279 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 0 365,482,098 1,725,164 714,753 0 367,922,015 0 0 0 0 0 0 0 Medicare - Federal Exemption from Assessment Stop-Loss Premium Federal Employee Health Benefits Plan Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.LA *73288201830019100* 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 Humana Insurance Company 73288 DIRECT BUSINESS IN THE STATE OF: Louisiana 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 1,472,279 0 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. 4. 3 2,697,617 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 1,472,279 0 2,697,617 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 *73288201829020100* 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 Humana Insurance Company 73288 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 1,423 0 10,566,018 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,423 0 10,566,018 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) 1,423 0 0 0 0 9,765,750 9,765,750 0 0 0 0 800,268 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) Medicare - Federal Exemption from Assessment 0 0 0 0 0 0 0 0 9,765,750 0 0 0 Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 0 0 0 0 0 9,765,750 0 0 290.ME *73288201830020100* 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 Humana Insurance Company 73288 DIRECT BUSINESS IN THE STATE OF: Maine 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 1,423 0 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. 4. 3 800,268 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 1,423 0 800,268 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.ME *73288201829021100* 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 Humana Insurance Company 73288 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 281,350 0 87,690,791 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 281,350 0 87,690,791 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) 281,350 0 0 0 0 74,489,135 74,489,135 0 0 0 0 13,201,656 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) Medicare - Federal Exemption from Assessment Federal Employee Health Benefits Plan 0 0 0 0 0 0 0 0 0 0 69,841,163 4,647,972 0 0 0 0 Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 0 0 0 0 0 74,489,135 0 0 290.MD *73288201830021100* 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 Humana Insurance Company 73288 DIRECT BUSINESS IN THE STATE OF: Maryland 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 281,350 0 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. 4. 3 13,201,656 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 0 281,350 0 13,201,656 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 *73288201829022100* 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 Humana Insurance Company 73288 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 40,478 0 85,799,153 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 40,478 0 85,799,153 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) 40,478 0 0 0 0 74,122,339 74,122,339 0 0 0 0 11,676,814 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) Medicare - Federal Exemption from Assessment 0 0 0 0 0 0 0 0 74,122,339 0 0 0 Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 0 0 0 0 0 74,122,339 0 0 290.MA *73288201830022100* 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 Humana Insurance Company 73288 DIRECT BUSINESS IN THE STATE OF: Massachusetts 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 40,478 0 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. 4. 3 11,676,814 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 40,478 0 11,676,814 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 *73288201829023100* 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 Humana Insurance Company 73288 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 739,158 0 866,501,129 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 739,158 0 866,501,129 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 0 834,644,742 834,644,742 0 0 0 0 31,856,387 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 739,158 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) Medicare - Federal Exemption from Assessment 0 0 0 0 0 0 0 0 834,644,742 0 0 0 Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 0 0 0 0 0 834,644,742 0 0 290.MI *73288201830023100* 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 Humana Insurance Company 73288 DIRECT BUSINESS IN THE STATE OF: Michigan 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 739,158 0 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. 4. 3 31,856,387 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 0 739,158 0 31,856,387 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 *73288201829024100* 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 Humana Insurance Company 73288 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 58,302 0 471,064,867 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 58,302 0 471,064,867 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 0 468,782,697 468,782,697 0 0 0 0 2,282,170 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 58,302 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) Medicare - Federal Exemption from Assessment 0 0 0 0 0 0 0 0 468,782,697 0 0 0 Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 0 0 0 0 0 468,782,697 0 0 290.MN *73288201830024100* 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 Humana Insurance Company 73288 DIRECT BUSINESS IN THE STATE OF: Minnesota 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 58,302 0 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. 4. 3 2,282,170 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 58,302 0 2,282,170 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 *73288201829025100* 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 Humana Insurance Company 73288 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 245,017 0 534,704,563 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 245,017 0 534,704,563 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 0 497,363,846 497,363,846 0 0 0 0 37,340,717 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 245,017 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 0 495,424,634 1,515,279 423,933 0 497,363,846 0 0 0 0 0 0 0 Medicare - Federal Exemption from Assessment Stop-Loss Premium Federal Employee Health Benefits Plan Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.MS *73288201830025100* 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 Humana Insurance Company 73288 DIRECT BUSINESS IN THE STATE OF: Mississippi 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 245,017 0 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. 4. 3 37,340,717 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 0 245,017 0 37,340,717 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 *73288201829026100* 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 Humana Insurance Company 73288 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 1,366,507 0 411,297,150 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,366,507 0 411,297,150 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 0 290,013,624 290,013,624 0 0 0 0 121,283,526 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 1,366,507 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 0 278,057,243 10,655,811 1,300,570 0 290,013,624 0 0 0 0 0 0 0 Medicare - Federal Exemption from Assessment Stop-Loss Premium Federal Employee Health Benefits Plan Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.MO *73288201830026100* 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 Humana Insurance Company 73288 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 1,366,507 0 121,283,526 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 1,366,507 0 121,283,526 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 *73288201829027100* 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 Humana Insurance Company 73288 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 0 0 60,056,226 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 60,056,226 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) 0 0 0 0 0 55,355,783 55,355,783 0 0 0 0 4,700,443 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) Medicare - Federal Exemption from Assessment 0 0 0 0 0 0 0 0 55,355,783 0 0 0 Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 0 0 0 0 0 55,355,783 0 0 290.MT *73288201830027100* 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 Humana Insurance Company 73288 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 0 0 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. 4. 3 4,700,443 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 0 0 4,700,443 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 *73288201829028100* 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 Humana Insurance Company 73288 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 33,730 0 107,160,809 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 33,730 0 107,160,809 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 0 103,132,529 103,132,529 0 0 0 0 4,028,280 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 33,730 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) Medicare - Federal Exemption from Assessment 0 0 0 0 0 0 0 0 103,132,529 0 0 0 Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 0 0 0 0 0 103,132,529 0 0 290.NE *73288201830028100* 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 Humana Insurance Company 73288 DIRECT BUSINESS IN THE STATE OF: Nebraska 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 33,730 0 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. 4. 3 4,028,280 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 33,730 0 4,028,280 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 *73288201829029100* 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 Humana Insurance Company 73288 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 302,495 0 160,578,702 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 302,495 0 160,578,702 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 0 142,731,971 142,731,971 0 0 0 0 17,846,731 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 302,495 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) Medicare - Federal Exemption from Assessment 0 0 0 0 0 0 0 0 142,731,971 0 0 0 Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 0 0 0 0 0 142,731,971 0 0 290.NV *73288201830029100* 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 Humana Insurance Company 73288 DIRECT BUSINESS IN THE STATE OF: Nevada 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 302,495 0 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. 4. 3 17,846,731 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 0 302,495 0 17,846,731 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 *73288201829030100* 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 Humana Insurance Company 73288 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 11,282 0 27,006,527 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 11,282 0 27,006,527 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) 11,282 0 0 0 0 25,154,279 25,154,279 0 0 0 0 1,852,248 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) Medicare - Federal Exemption from Assessment 0 0 0 0 0 0 0 0 25,154,279 0 0 0 Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 0 0 0 0 0 25,154,279 0 0 290.NH *73288201830030100* 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 Humana Insurance Company 73288 DIRECT BUSINESS IN THE STATE OF: New Hampshire 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 11,282 0 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. 4. 3 1,852,248 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 11,282 0 1,852,248 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 *73288201829031100* 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 Humana Insurance Company 73288 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 28,928 0 107,555,667 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 28,928 0 107,555,667 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) 28,928 0 0 0 0 97,178,182 97,178,182 0 0 0 0 10,377,485 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) Medicare - Federal Exemption from Assessment 0 0 0 0 0 0 0 0 97,178,182 0 0 0 Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 0 0 0 0 0 97,178,182 0 0 290.NJ *73288201830031100* 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 Humana Insurance Company 73288 DIRECT BUSINESS IN THE STATE OF: New Jersey 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 28,928 0 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. 4. 3 10,377,485 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 28,928 0 10,377,485 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.NJ *73288201829032100* 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 Humana Insurance Company 73288 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 38,593 0 144,551,451 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 38,593 0 144,551,451 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 0 139,412,577 139,412,577 0 0 0 0 5,138,874 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 38,593 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) Medicare - Federal Exemption from Assessment 0 0 0 0 0 0 0 0 139,412,577 0 0 0 Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 0 0 0 0 0 139,412,577 0 0 290.NM *73288201830032100* 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 Humana Insurance Company 73288 DIRECT BUSINESS IN THE STATE OF: New Mexico 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 38,593 0 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. 4. 3 5,138,874 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 38,593 0 5,138,874 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 *73288201829034100* 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 Humana Insurance Company 73288 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 637,041 0 925,315,562 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 0 637,041 0 925,315,562 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 0 901,652,898 901,652,898 0 0 0 0 23,662,664 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 637,041 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) Medicare - Federal Exemption from Assessment Federal Employee Health Benefits Plan 0 0 0 0 0 0 0 0 0 0 900,447,153 1,205,745 0 0 0 0 Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 0 0 0 0 0 901,652,898 0 0 290.NC *73288201829035100* 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 Humana Insurance Company 73288 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 18,157 0 44,229,586 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 18,157 0 44,229,586 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) 18,157 0 0 0 0 42,427,172 42,427,172 0 0 0 0 1,802,414 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) Medicare - Federal Exemption from Assessment 0 0 0 0 0 0 0 0 42,427,172 0 0 0 Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 0 0 0 0 0 42,427,172 0 0 290.ND *73288201830035100* 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 Humana Insurance Company 73288 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 18,157 0 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. 4. 3 1,802,414 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 18,157 0 1,802,414 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 *73288201829036100* 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 Humana Insurance Company 73288 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 3,265,476 0 1,344,457,064 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3,265,476 0 1,344,457,064 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) 3,265,476 0 0 0 0 1,190,580,818 1,190,580,818 0 0 0 0 153,876,246 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 1,157,442,331 31,484,985 1,653,502 0 1,190,580,818 0 0 0 0 0 0 0 Medicare - Federal Exemption from Assessment Stop-Loss Premium Federal Employee Health Benefits Plan Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.OH *73288201830036100* 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 Humana Insurance Company 73288 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 3,265,476 0 153,876,246 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 3,265,476 0 153,876,246 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 *73288201829037100* 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 Humana Insurance Company 73288 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 365,295 0 407,999,906 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 365,295 0 407,999,906 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 0 400,413,792 400,413,792 0 0 0 0 7,586,114 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 365,295 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) Medicare - Federal Exemption from Assessment Federal Employee Health Benefits Plan 0 0 0 0 0 0 0 0 0 0 399,402,041 1,011,751 0 0 0 0 Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 0 0 0 0 0 400,413,792 0 0 290.OK *73288201830037100* 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 Humana Insurance Company 73288 DIRECT BUSINESS IN THE STATE OF: Oklahoma 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 365,295 0 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. 4. 3 7,586,114 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 0 365,295 0 7,586,114 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 *73288201829038100* 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 Humana Insurance Company 73288 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 1,491 0 56,973,463 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,491 0 56,973,463 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) 1,491 0 0 0 0 53,284,045 53,284,045 0 0 0 0 3,689,418 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) Medicare - Federal Exemption from Assessment 0 0 0 0 0 0 0 0 53,284,045 0 0 0 Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 0 0 0 0 0 53,284,045 0 0 290.OR *73288201830038100* 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 Humana Insurance Company 73288 DIRECT BUSINESS IN THE STATE OF: Oregon 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 1,491 0 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. 4. 3 3,689,418 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 1,491 0 3,689,418 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 *73288201829039100* 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 Humana Insurance Company 73288 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 141,015 0 304,620,278 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 141,015 0 304,620,278 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 0 287,474,263 287,474,263 0 0 0 0 17,146,015 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 141,015 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) Medicare - Federal Exemption from Assessment Federal Employee Health Benefits Plan 0 0 0 0 0 0 0 0 0 0 287,466,076 8,187 0 0 0 0 Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 0 0 0 0 0 287,474,263 0 0 290.PA *73288201829040100* 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 Humana Insurance Company 73288 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 0 0 10,976,039 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 10,976,039 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) 0 0 0 0 0 8,909,602 8,909,602 0 0 0 0 2,066,437 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) Medicare - Federal Exemption from Assessment 0 0 0 0 0 0 0 0 8,909,602 0 0 0 Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 0 0 0 0 0 8,909,602 0 0 290.RI *73288201830040100* 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 Humana Insurance Company 73288 DIRECT BUSINESS IN THE STATE OF: Rhode Island 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 0 0 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. 4. 3 2,066,437 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 0 0 2,066,437 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 *73288201829041100* 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 Humana Insurance Company 73288 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 155,009 0 568,137,156 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 155,009 0 568,137,156 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) 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 0 553,449,699 553,449,699 0 0 0 0 14,687,457 0 0 0 0 0 0 0 0 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) Medicare - Federal Exemption from Assessment Federal Employee Health Benefits Plan 0 0 0 0 0 0 0 0 0 0 552,950,492 499,207 0 0 0 0 Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 0 0 0 0 0 553,449,699 0 0 Current Year DETAILS OF WRITE-INS 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 155,009 290.SC *73288201830041100* 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 Humana Insurance Company 73288 DIRECT BUSINESS IN THE STATE OF: South Carolina 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 155,009 0 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. 4. 3 14,687,457 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 0 155,009 0 14,687,457 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 *73288201829042100* 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 Humana Insurance Company 73288 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 36,528 0 90,662,707 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 36,528 0 90,662,707 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) 36,528 0 0 0 0 87,792,459 87,792,459 0 0 0 0 2,870,248 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) Medicare - Federal Exemption from Assessment 0 0 0 0 0 0 0 0 87,792,459 0 0 0 Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 0 0 0 0 0 87,792,459 0 0 290.SD *73288201830042100* 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 Humana Insurance Company 73288 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 36,528 0 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. 4. 3 2,870,248 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 36,528 0 2,870,248 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 *73288201829043100* 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 Humana Insurance Company 73288 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 1,210,994 0 564,389,073 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,210,994 0 564,389,073 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 0 356,300,796 356,300,796 0 0 0 0 208,088,277 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 1,210,994 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 0 352,026,468 4,266,917 7,411 0 356,300,796 0 0 0 0 0 0 0 Medicare - Federal Exemption from Assessment Stop-Loss Premium Federal Employee Health Benefits Plan Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.TN *73288201830043100* 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 Humana Insurance Company 73288 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 1,210,994 0 208,088,277 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 1,210,994 0 208,088,277 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 *73288201829044100* 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 Humana Insurance Company 73288 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 7,806,689 0 5,020,915,420 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7,806,689 0 5,020,915,420 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) 7,806,689 0 0 0 0 4,652,272,440 4,652,272,440 0 0 0 0 368,642,980 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 4,619,122,257 31,749,630 1,400,553 0 4,652,272,440 0 0 0 0 0 0 0 Medicare - Federal Exemption from Assessment Stop-Loss Premium Federal Employee Health Benefits Plan Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.TX *73288201830044100* 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 Humana Insurance Company 73288 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 7,806,689 0 368,642,980 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 7,806,689 0 368,642,980 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 *73288201829045100* 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 Humana Insurance Company 73288 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 313,967 0 58,439,738 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 313,967 0 58,439,738 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) 313,967 0 0 0 0 47,995,720 47,995,720 0 0 0 0 10,444,018 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) Medicare - Federal Exemption from Assessment Stop-Loss Premium 0 0 0 0 0 0 0 0 0 0 47,930,169 65,551 0 0 0 0 Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 0 0 0 0 0 47,995,720 0 0 290.UT *73288201830045100* 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 Humana Insurance Company 73288 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 313,967 0 10,444,018 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 0 313,967 0 10,444,018 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 *73288201829046100* 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 Humana Insurance Company 73288 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 0 0 13,410,274 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 13,410,274 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) 0 0 0 0 0 10,379,688 10,379,688 0 0 0 0 3,030,586 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) Medicare - Federal Exemption from Assessment 0 0 0 0 0 0 0 0 10,379,688 0 0 0 Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 0 0 0 0 0 10,379,688 0 0 290.VT *73288201830046100* 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 Humana Insurance Company 73288 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 0 0 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. 4. 3 3,030,586 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 0 0 3,030,586 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 *73288201829047100* 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 Humana Insurance Company 73288 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 598,235 0 972,214,400 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 0 598,235 0 972,214,400 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 0 946,916,279 946,916,279 0 0 0 0 25,298,121 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 598,235 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) Medicare - Federal Exemption from Assessment Federal Employee Health Benefits Plan 0 0 0 0 0 0 0 0 0 0 942,305,882 4,610,397 0 0 0 0 Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 0 0 0 0 0 946,916,279 0 0 290.VA *73288201830047100* 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 Humana Insurance Company 73288 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 598,235 0 25,298,121 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 0 598,235 0 25,298,121 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 *73288201829048100* 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 Humana Insurance Company 73288 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 0 0 166,191,930 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 0 166,191,930 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 0 159,246,665 159,246,665 0 0 0 0 6,945,265 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 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) Medicare - Federal Exemption from Assessment 0 0 0 0 0 0 0 0 159,246,665 0 0 0 Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 0 0 0 0 0 159,246,665 0 0 290.WA *73288201830048100* 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 Humana Insurance Company 73288 DIRECT BUSINESS IN THE STATE OF: Washington 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 0 0 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. 4. 3 6,945,265 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 0 0 6,945,265 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 *73288201829049100* 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 Humana Insurance Company 73288 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 59,519 0 1,024,549,346 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 59,519 0 1,024,549,346 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) 59,519 0 0 0 0 1,019,030,233 1,019,030,233 0 0 0 0 5,519,113 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) Medicare - Federal Exemption from Assessment Federal Employee Health Benefits Plan 0 0 0 0 0 0 0 0 0 0 1,018,764,989 265,244 0 0 0 0 Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 0 0 0 0 0 1,019,030,233 0 0 290.WV *73288201830049100* 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 Humana Insurance Company 73288 DIRECT BUSINESS IN THE STATE OF: West Virginia 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 59,519 0 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. 4. 3 5,519,113 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 59,519 0 5,519,113 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 *73288201829050100* 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 Humana Insurance Company 73288 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 2,357,644 0 907,854,363 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,357,644 0 907,854,363 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 0 590,112,852 590,112,852 0 0 0 0 317,741,511 0 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 2,357,644 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) Medicare - Federal Exemption from Assessment 0 0 0 0 0 0 0 0 590,112,852 0 0 0 Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 0 0 0 0 0 590,112,852 0 0 290.WI *73288201830050100* 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 Humana Insurance Company 73288 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 2,357,644 0 317,741,511 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 2,357,644 0 317,741,511 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 *73288201829051100* 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 Humana Insurance Company 73288 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 0 0 15,772,471 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 0 0 15,772,471 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) 0 0 0 0 0 12,525,434 12,525,434 0 0 0 0 3,247,037 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) Medicare - Federal Exemption from Assessment 0 0 0 0 0 0 0 0 12,525,434 0 0 0 Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 0 0 0 0 0 12,525,434 0 0 290.WY *73288201830051100* 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 Humana Insurance Company 73288 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 0 0 AMOUNTS REQUIRED TO DETERMINE THIS STATE’S ASSESSMENT BASE 1. 4. 3 3,247,037 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 0 0 3,247,037 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 *73288201829059100* 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 Humana Insurance Company 73288 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 49,778,480 0 24,873,560,810 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 49,778,480 0 24,873,560,810 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) 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 22,431,481,497 22,431,481,497 0 0 0 0 2,442,079,313 0 0 0 0 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 29,449,185 22,219,998,906 182,033,406 0 22,431,481,497 0 0 0 0 0 0 0 Current Year DETAILS OF WRITE-INS 0 0 0 MODEL ACT BASE (Line 5 minus Line 10) 49,778,480 Federal Employee Health Benefits Plan Medicare - Federal Exemption from Assessment Stop-Loss Premium Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 0901 thru 0903 plus 0998)(Line 9 above) 290.GT SUPPLEMENT FOR THE YEAR 2018 OF THE Humana Insurance Company Life Supplement - Analysis of Annuity Operations by Lines of Business NONE Life Supplement - Analysis of Annuity Operations by Lines of Business Overflow Page NONE Life Supplement - Analysis of Increase in Annuity Reserves During the Year NONE LS214, LS214-1, LS215