Disease Management Industry Report by cpd60066

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									                                                                   2009 Colorado Annual Health Cost Report




         Company Name:
         NAIC Code:
         Name of person completing this form:
         Address 1:
         Address 2:
         City:
         State:
         ZIP:
         Telephone:
         E-Mail:


All health carriers in Colorado are required to submit this report. An insurer must only complete the pages of this report that are applicable to
their business.

         This page is required for all health carriers. Please answer the following questions:


    1 For what types of insurance products did you have Colorado written health premium in 2009?

                                Type                                                                   Mark 'X' if applicable
         Comprehensive Major Medical
         Health Maintenance Organization
         Dental
         Vision
         Accidental Death & Dismemberment
         Disability Income
         Long-term Care
         Credit Health
         Other/Limited Benefit plans
         (including specified or dread disease, hospital indemnity, etc.)

    2 Is your business not-for-profit? (Y / N)
      If so, are you a Fraternal organization? (Y / N)




    3 Were you a Third Party Administrator (TPA) for any other insurer during
      2009 OR did another insurer act as a TPA for your business? (Y / N)
      If so, please list them.




    4    Please provide the Total Executive Compensation paid in 2009.
   4a    Executive Salaries
   4b    Bonuses
   4c    All Other Compensation (including Stock Options)
   4d    If N/A, please list parent company that compensation is reported under.
         (This can be found on the Supplemental Compensation Exhibit that
         accompanies the Annual Financial Statement.)

Please provide the amount of each item listed below that is attributable to the Colorado health portion of your

   5a    Dividends Paid to Stockholders
   5b    Paid Lobbying Expenditures (include both internal and external)
   5c    Advertising and Marketing Expenditures
   5d    Non-executive Staff Salaries
   5e    Payments to Legal Counsel
   5f    Charitable Contributions

   5g    Losses on Investments or Investment Income
   5h    Net Income
    5i   The Amount of Surplus
    5j   The Amount of Capital
   5k    Total Adjusted Capital
    5l   Authorized Control Level Risk-Based Capital

  5m State Taxes, Licenses and Fees
   5n Federal Taxes

         Comments:
    6
on of your business.
                                                                                                                    2009 Colorado Annual Health Cost Report
                                                                                                                    COMPREHENSIVE MAJOR MEDICAL



         Company Name:                                                                                              0
         NAIC Code:                                                                                                 0
         Name of person completing this form:                                                                       0
         Address 1:                                                                                                 0
         Address 2:                                                                                                 0
         City:                                                                                                      0
         State:                                                                                                     0
         ZIP:                                                                                                       0
         Telephone:                                                                                                 0
         E-Mail:                                                                                                    0

         Since you indicated that you had no Comprehensive Major Medical business written in Colorado in 2009, you are NOT REQUIRED to complete this page of the report.

                                                                                                                     Large Group Small Group (1
Line #                                                    Question                                                    (> 50 ees)   - 50 ees)            Individual         Total       Comments

  1      Number of Colorado covered lives as of 1/1/2009                                                                                                                           -
  2      Number of Colorado covered lives as of 12/31/2009                                                                                                                         -
  3      Number of Colorado individual subscribers/certificateholders/policyholders as of 1/1/2009
  4      Number of Colorado individual subscribers/certificateholders/policyholders as of 12/31/2009
  5      Number of Colorado group/policies as of 1/1/2009                                                                                                                          -
  6      Number of Colorado group/policies as of 12/31/2009                                                                                                                        -
  7      Number of Member Months in 2009

  8      Colorado Direct Written Premium in 2009                                                                                                                                   -
  9      Colorado Direct Earned Premium in 2009                                                                                                                                    -
 10      Net Ceded Colorado Reinsurance Premiums in 2009                                                                                                                           -

 11      Dividends Paid to Colorado Policyholders in 2009                                                                                                                          -
         Total Reserves on hand as of 12/31/2009 (including active life reserves, claims reserves and premium
 12      deficiency reserves)                                                                                                                                                      -

 13      Net Colorado Reinsurance Recoveries in 2009                                                                                                                               -
 14      The Cost of providing or arranging healthcare services                                                                                                                    -
 15      Change in Contract Reserves

         Expenditures for disease or case management programs or patient education and other cost containment or
 16
         quality improvement expenses
 17      Producer Commissions
 18      Administrative Expenses

 19      Provision for Profit and Contingencies
 20      Cumulative Rate Change in 2009

 21      Medical trend due solely to provider price changes
 22      Medical trend due solely to utilization changes
 23      Medical trend due solely to medical cost-shifting
 24      Medical trend due solely to new medical procedures and technology
 25      Total Medical Trend
 26      Prescription drug trend due solely to pharmaceutical price changes
 27      Prescription drug trend due solely to utilization changes
 28      Prescription drug trend due solely to cost-shifting
 29      Presciption drug trend due solely to introductions of new brand name and generic drugs
 30      Total Prescription Drug Trend
                                                                                           2009 Colorado Annual Health Cost Report
                                                                                           HMO



         Company Name:                                                                     0
         NAIC Code:                                                                        0
         Name of person completing this form:                                              0
         Address 1:                                                                        0
         Address 2:                                                                        0
         City:                                                                             0
         State:                                                                            0
         ZIP:                                                                              0
         Telephone:                                                                        0
         E-Mail:                                                                           0

         Since you indicated that you had no HMO business written in Colorado in 2009, you are NOT REQUIRED to complete this page of the report.

                                                                                           Large Group (> Small Group (1
Line #
                                           Question                                            50 ees)      - 50 ees)      Individual              Total       Comments

  1      Number of Colorado covered lives as of 1/1/2009                                                                                                   -
  2      Number of Colorado covered lives as of 12/31/2009                                                                                                 -
         Number of Colorado individual subscribers/certificateholders/policyholders
  3
         as of 1/1/2009
         Number of Colorado individual subscribers/certificateholders/policyholders
  4
         as of 12/31/2009
  5      Number of Colorado group/policies as of 1/1/2009                                                                                                  -
  6      Number of Colorado group/policies as of 12/31/2009                                                                                                -
  7      Number of Member Months in 2009

  8      Colorado Direct Written Premium in 2009                                                                                                           -
  9      Colorado Direct Earned Premium in 2009                                                                                                            -
 10      Net Ceded Colorado Reinsurance Premiums in 2009                                                                                                   -

 11      Dividends Paid to Colorado Policyholders in 2009                                                                                                  -
         Total Reserves on hand as of 12/31/2009 (including active life reserves, claims
 12      reserves and premium deficiency reserves)                                                                                                         -

 13      Net Colorado Reinsurance Recoveries in 2009                                                                                                       -
 14      The Cost of providing or arranging healthcare services                                                                                            -
 15      Change in Contract Reserves

         Expenditures for disease or case management programs or patient education
 16
         and other cost containment or quality improvement expenses
 17      Producer Commissions
 18      Administrative Expenses

 19      Provision for Profit and Contingencies
 20      Cumulative Rate Change in 2009

 21      Medical trend due solely to provider price changes
 22      Medical trend due solely to utilization changes
 23      Medical trend due solely to medical cost-shifting
 24      Medical trend due solely to new medical procedures and technology
 25      Total Medical Trend
 26      Prescription drug trend due solely to pharmaceutical price changes
 27      Prescription drug trend due solely to utilization changes
 28      Prescription drug trend due solely to cost-shifting
         Presciption drug trend due solely to introductions of new brand name and
 29
         generic drugs
 30      Total Prescription Drug Trend
                                                                                                           2009 Colorado Annual Health Cost Report
                                                                                                           DENTAL



         Company Name:                                                                                     0
         NAIC Code:                                                                                        0
         Name of person completing this form:                                                              0
         Address 1:                                                                                        0
         Address 2:                                                                                        0
         City:                                                                                             0
         State:                                                                                            0
         ZIP:                                                                                              0
         Telephone:                                                                                        0
         E-Mail:                                                                                           0

         Since you indicated that you had no Dental business written in Colorado in 2009, you are NOT REQUIRED to complete this page of the report.



Line #                                                                                                     Large Group Small Group (1 -
                                                     Question                                               (> 50 ees)    50 ees)                Individual   Total       Comments

  1      Number of Colorado covered lives as of 1/1/2009                                                                                                              -
  2      Number of Colorado covered lives as of 12/31/2009                                                                                                            -
  3      Number of Colorado individual subscribers/certificateholders/policyholders as of 1/1/2009
  4      Number of Colorado individual subscribers/certificateholders/policyholders as of 12/31/2009
  5      Number of Colorado group/policies as of 1/1/2009                                                                                                             -
  6      Number of Colorado group/policies as of 12/31/2009                                                                                                           -
  7      Number of Member Months in 2009

 8       Colorado Direct Written Premium in 2009                                                                                                                      -
 9       Colorado Direct Earned Premium in 2009                                                                                                                       -
 10      Net Ceded Colorado Reinsurance Premiums in 2009                                                                                                              -

 11      Dividends Paid to Colorado Policyholders in 2009                                                                                                             -
         Total Reserves on hand as of 12/31/2009 (including active life reserves, claims reserves and
 12      premium deficiency reserves)                                                                                                                                 -

 13      Net Colorado Reinsurance Recoveries in 2009                                                                                                                  -
 14      The Cost of providing or arranging healthcare services                                                                                                       -
 15      Change in Contract Reserves

         Expenditures for disease or case management programs or patient education and other cost
 16
         containment or quality improvement expenses
 17      Producer Commissions
 18      Administrative Expenses

 19      Provision for Profit and Contingencies
 20      Cumulative Rate Change in 2009

 21      Medical trend due solely to provider price changes
 22      Medical trend due solely to utilization changes
 23      Medical trend due solely to medical cost-shifting
 24      Medical trend due solely to new medical procedures and technology
 25      Total Medical Trend
 26      Prescription drug trend due solely to pharmaceutical price changes
 27      Prescription drug trend due solely to utilization changes
 28      Prescription drug trend due solely to cost-shifting
 29      Presciption drug trend due solely to introductions of new brand name and generic drugs
 30      Total Prescription Drug Trend
                                                                                                           2009 Colorado Annual Health Cost Report
                                                                                                          VISION



         Company Name:                                                                                    0
         NAIC Code:                                                                                       0
         Name of person completing this form:                                                             0
         Address 1:                                                                                       0
         Address 2:                                                                                       0
         City:                                                                                            0
         State:                                                                                           0
         ZIP:                                                                                             0
         Telephone:                                                                                       0
         E-Mail:                                                                                          0

         Since you indicated that you had no Vision business written in Colorado in 2009, you are NOT REQUIRED to complete this page of the report.



Line #                                                                                                     Large Group     Small Group
                                                     Question                                               (> 50 ees)      (1 - 50 ees)    Individual   Total       Comments

  1      Number of Colorado covered lives as of 1/1/2009                                                                                                         -
  2      Number of Colorado covered lives as of 12/31/2009                                                                                                       -
  3      Number of Colorado individual subscribers/certificateholders/policyholders as of 1/1/2009
  4      Number of Colorado individual subscribers/certificateholders/policyholders as of 12/31/2009
  5      Number of Colorado group/policies as of 1/1/2009                                                                                                        -
  6      Number of Colorado group/policies as of 12/31/2009                                                                                                      -
  7      Number of Member Months in 2009

  8      Colorado Direct Written Premium in 2009                                                                                                                 -
  9      Colorado Direct Earned Premium in 2009                                                                                                                  -
 10      Net Ceded Colorado Reinsurance Premiums in 2009                                                                                                         -

 11      Dividends Paid to Colorado Policyholders in 2009                                                                                                        -
         Total Reserves on hand as of 12/31/2009 (including active life reserves, claims reserves and
 12      premium deficiency reserves)                                                                                                                            -

 13      Net Colorado Reinsurance Recoveries in 2009                                                                                                             -
 14      The Cost of providing or arranging healthcare services                                                                                                  -
 15      Change in Contract Reserves

         Expenditures for disease or case management programs or patient education and other cost
 16
         containment or quality improvement expenses
 17      Producer Commissions
 18      Administrative Expenses

 19      Provision for Profit and Contingencies
 20      Cumulative Rate Change in 2009

 21      Total Medical Trend
                                                                                            2009 Colorado Annual Health Cost Report
                                                                                            LIMITED BENEFIT PLANS



         Company Name:                                                                      0
         NAIC Code:                                                                         0
         Name of person completing this form:                                               0
         Address 1:                                                                         0
         Address 2:                                                                         0
         City:                                                                              0
         State:                                                                             0
         ZIP:                                                                               0
         Telephone:                                                                         0
         E-Mail:                                                                            0

         Since you indicated that you had no Other/Limited Benefit Plan business written in Colorado in 2009, you are NOT REQUIRED to complete this page of the report.

                                                                                            Large Group (> Small Group
Line #                                       Question                                           50 ees)     (1 - 50 ees)     Individual       Total                       Comments

  1      Number of Colorado covered lives as of 1/1/2009                                                                                              -
  2      Number of Colorado covered lives as of 12/31/2009                                                                                            -
         Number of Colorado individual subscribers/certificateholders/policyholders as of
  3
         1/1/2009
         Number of Colorado individual subscribers/certificateholders/policyholders as of
  4
         12/31/2009
  5      Number of Colorado group/policies as of 1/1/2009                                                                                             -
  6      Number of Colorado group/policies as of 12/31/2009                                                                                           -
  7      Number of Member Months in 2009

  8      Colorado Direct Written Premium in 2009                                                                                                      -
  9      Colorado Direct Earned Premium in 2009                                                                                                       -
 10      Net Ceded Colorado Reinsurance Premiums in 2009                                                                                              -

 11      Dividends Paid to Colorado Policyholders in 2009                                                                                             -
         Total Reserves on hand as of 12/31/2009 (including active life reserves, claims
 12      reserves and premium deficiency reserves)                                                                                                    -

 13      Net Colorado Reinsurance Recoveries in 2009                                                                                                  -
 14      The Cost of providing or arranging healthcare services                                                                                       -
 15      Change in Contract Reserves

         Expenditures for disease or case management programs or patient education
 16
         and other cost containment or quality improvement expenses
 17      Producer Commissions
 18      Administrative Expenses

 19      Provision for Profit and Contingencies
 20      Cumulative Rate Change in 2009

 21      Total Medical Trend
                                                                                    2009 Colorado Annual Health Cost Report
                                                                                    Accident Only or Accidental Death and Dismemberment



         Company Name:                                                              0
         NAIC Code:                                                                 0
         Name of person completing this form:                                       0
         Address 1:                                                                 0
         Address 2:                                                                 0
         City:                                                                      0
         State:                                                                     0
         ZIP:                                                                       0
         Telephone:                                                                 0
         E-Mail:                                                                    0

         Since you indicated that you had no AD&D business written in Colorado in 2009, you are NOT REQUIRED to complete this page of the report.

                                                                                    Large Group Small Group (1 -
Line #
                                          Question                                   (> 50 ees)    50 ees)       Individual           Total         Comments

  1      Number of Colorado covered lives as of 1/1/2009                                                                                      -
  2      Number of Colorado covered lives as of 12/31/2009                                                                                    -
         Number of Colorado individual
  3
         subscribers/certificateholders/policyholders as of 1/1/2009
         Number of Colorado individual
  4
         subscribers/certificateholders/policyholders as of 12/31/2009
  5      Number of Colorado group/policies as of 1/1/2009                                                                                     -
  6      Number of Colorado group/policies as of 12/31/2009                                                                                   -
  7      Number of Member Months in 2009

  8      Colorado Direct Written Premium in 2009                                                                                              -
  9      Colorado Direct Earned Premium in 2009                                                                                               -
 10      Net Ceded Colorado Reinsurance Premiums in 2009                                                                                      -

 11      Dividends Paid to Colorado Policyholders in 2009                                                                                     -
         Total Reserves on hand as of 12/31/2009 (including active life reserves,
 12      claims reserves and premium deficiency reserves)                                                                                     -

 13      Net Colorado Reinsurance Recoveries in 2009                                                                                          -
 14      The Cost of providing or arranging healthcare services                                                                               -
 15      Change in Contract Reserves


 16      Expenditures for disease or case management programs or patient
         education and other cost containment or quality improvement expenses
 17      Producer Commissions
 18      Administrative Expenses

 19      Provision for Profit and Contingencies
 20      Cumulative Rate Change in 2009

 21      Total Medical Trend
                                                                                                                2009 Colorado Annual Health Cost Report
                                                                                                                DISABILITY INCOME



         Company Name:                                                                                          0
         NAIC Code:                                                                                             0
         Name of person completing this form:                                                                   0
         Address 1:                                                                                             0
         Address 2:                                                                                             0
         City:                                                                                                  0
         State:                                                                                                 0
         ZIP:                                                                                                   0
         Telephone:                                                                                             0
         E-Mail:                                                                                                0

         Since you indicated that you had no Disability Income business written in Colorado in 2009, you are NOT REQUIRED to complete this page of the report.



Line #                                                                                                          Large Group Small Group
                                                      Question                                                   (> 50 ees)  (1 - 50 ees)    Individual          Total       Comments

  1      Number of Colorado covered lives as of 1/1/2009                                                                                                                 -
  2      Number of Colorado covered lives as of 12/31/2009                                                                                                               -
  3      Number of Colorado individual subscribers/certificateholders/policyholders as of 1/1/2009
  4      Number of Colorado individual subscribers/certificateholders/policyholders as of 12/31/2009
  5      Number of Colorado group/policies as of 1/1/2009                                                                                                                -
  6      Number of Colorado group/policies as of 12/31/2009                                                                                                              -
  7      Number of Member Months in 2009

  8      Colorado Direct Written Premium in 2009                                                                                                                         -
  9      Colorado Direct Earned Premium in 2009                                                                                                                          -
  10     Net Ceded Colorado Reinsurance Premiums in 2009                                                                                                                 -

  11     Dividends Paid to Colorado Policyholders in 2009                                                                                                                -
         Total Reserves on hand as of 12/31/2009 (including active life reserves, claims reserves and premium
  12     deficiency reserves)                                                                                                                                            -

  13     Net Colorado Reinsurance Recoveries in 2009                                                                                                                     -
  14     The Cost of providing or arranging healthcare services                                                                                                          -
  15     Change in Contract Reserves

         Expenditures for disease or case management programs or patient education and other cost
  16
         containment or quality improvement expenses
  17     Producer Commissions
  18     Administrative Expenses

  19     Provision for Profit and Contingencies
  20     Cumulative Rate Change in 2009

  21     Total Medical Trend
                                                                                                           2009 Colorado Annual Health Cost Report
                                                                                                           LONG TERM CARE



         Company Name:                                                                                     0
         NAIC Code:                                                                                        0
         Name of person completing this form:                                                              0
         Address 1:                                                                                        0
         Address 2:                                                                                        0
         City:                                                                                             0
         State:                                                                                            0
         ZIP:                                                                                              0
         Telephone:                                                                                        0
         E-Mail:                                                                                           0

         Since you indicated that you had no Long-term Care business written in Colorado in 2009, you are NOT REQUIRED to complete this page of the report.

                                                                                                           Large Group (> Small Group
Line #
                                                      Question                                                 50 ees)     (1 - 50 ees)         Individual    Total       Comments

  1      Number of Colorado covered lives as of 1/1/2009                                                                                                              -
  2      Number of Colorado covered lives as of 12/31/2009                                                                                                            -
  3      Number of Colorado individual subscribers/certificateholders/policyholders as of 1/1/2009
  4      Number of Colorado individual subscribers/certificateholders/policyholders as of 12/31/2009
  5      Number of Colorado group/policies as of 1/1/2009                                                                                                             -
  6      Number of Colorado group/policies as of 12/31/2009                                                                                                           -
  7      Number of Member Months in 2009

  8      Colorado Direct Written Premium in 2009                                                                                                                      -
  9      Colorado Direct Earned Premium in 2009                                                                                                                       -
 10      Net Ceded Colorado Reinsurance Premiums in 2009                                                                                                              -

 11      Dividends Paid to Colorado Policyholders in 2009                                                                                                             -
         Total Reserves on hand as of 12/31/2009 (including active life reserves, claims reserves and
 12      premium deficiency reserves)                                                                                                                                 -

 13      Net Colorado Reinsurance Recoveries in 2009                                                                                                                  -
 14      The Cost of providing or arranging healthcare services                                                                                                       -
 15      Change in Contract Reserves

         Expenditures for disease or case management programs or patient education and other cost
 16
         containment or quality improvement expenses
 17      Producer Commissions
 18      Administrative Expenses

 19      Provision for Profit and Contingencies
 20      Cumulative Rate Change in 2009

 21      Total Medical Trend
                                                                                                                                2009 Colorado Annual Health Cost Report
                                                                                                                                CREDIT HEALTH



         Company Name:                                                                                                          0
         NAIC Code:                                                                                                             0
         Name of person completing this form:                                                                                   0
         Address 1:                                                                                                             0
         Address 2:                                                                                                             0
         City:                                                                                                                  0
         State:                                                                                                                 0
         ZIP:                                                                                                                   0
         Telephone:                                                                                                             0
         E-Mail:                                                                                                                0

         Since you indicated that you had no Credit Health business written in Colorado in 2009, you are NOT REQUIRED to complete this page of the report.

                                                                                                                                Large Group (> Small Group
Line #
                                                                  Question                                                          50 ees)     (1 - 50 ees)   Individual   Total       Comments

  1      Number of Colorado covered lives as of 1/1/2009                                                                                                                            -
  2      Number of Colorado covered lives as of 12/31/2009                                                                                                                          -
  3      Number of Colorado individual subscribers/certificateholders/policyholders as of 1/1/2009
  4      Number of Colorado individual subscribers/certificateholders/policyholders as of 12/31/2009
  5      Number of Colorado group/policies as of 1/1/2009                                                                                                                           -
  6      Number of Colorado group/policies as of 12/31/2009                                                                                                                         -
  7      Number of Member Months in 2009

  8      Colorado Direct Written Premium in 2009                                                                                                                                    -
  9      Colorado Direct Earned Premium in 2009                                                                                                                                     -
 10      Net Ceded Colorado Reinsurance Premiums in 2009                                                                                                                            -

 11      Dividends Paid to Colorado Policyholders in 2009                                                                                                                           -
         Total Reserves on hand as of 12/31/2009 (including active life reserves, claims reserves and premium deficiency
 12      reserves)                                                                                                                                                                  -

 13      Net Colorado Reinsurance Recoveries in 2009                                                                                                                                -
 14      The Cost of providing or arranging healthcare services                                                                                                                     -
 15      Change in Contract Reserves

         Expenditures for disease or case management programs or patient education and other cost containment or quality
 16
         improvement expenses
 17      Producer Commissions
 18      Administrative Expenses

 19      Provision for Profit and Contingencies
 20      Cumulative Rate Change in 2009

 21      Total Medical Trend
                                                                                             2009 Colorado Wellness and Prevention Programs
                                                                                             (C.R.S. 10-16-136)



     Company Name:                                                                           0
     NAIC Code:                                                                              0
     Name of person completing this form:                                                    0
     Address 1:                                                                              0
     Address 2:                                                                              0
     City:                                                                                   0
     State:                                                                                  0
     ZIP:                                                                                    0
     Telephone:                                                                              0
     E-Mail:                                                                                 0



     This page is required for all health carriers. Please answer the following questions:


 1
     What types of wellness and prevention programs did you offer in Colorado in 2009?
                                                                                                                    Mark 'X' if applicable
     Health Screenings
     Mental health and substance abuse screenings and prevention
     Internet, telephonic, live coaching, or consulation-based wellness programs
     Education and Training about dietary habits, including nutritional counseling
     Online and in-person seminars or podcasts on health and wellness topics, wellness
        handouts, a wellness library, videos, or newsletters and a wellness intranet site
     Wellness programs geared specifically for children, teens, or special populations
     Stress management programs
     Employee assistance programs for employees and their families
     Disease Management
     Diabetes care programs
     Tobacco cessation programs
     Prescription drug or carrier-approved nonprescription dietary supplement use that
        aids in overall health and wellness or prevents disease
     Patient-centered medical home programs
     Nurse-on-call programs
     Onsite or external health club or fitness center membership or facilities
     Other (Please list)




 2 List types and nature of incentives or rewards your company provides for participation.
                                                                                                                    Mark 'X' if applicable
     Premium discounts
     Rebates
     Modifications to co-payments
     Modifications to deductibles
     Modifications to coinsurance premiums
     Product discounts or rebates
     Other (please list)




 3 The total number of small groups participating in programs offered by your company.
3a The total dollar amount of discounts provided to these small groups.

 4 The total number of individuals insured through an individual health coverage plan
     that are participating in programs offered by your company.
4a The total dollar amount of discounts provided to these individuals.
   2009 COLORADO GENERAL HEALTH INFORMATION




   Company Name:                                       0
   NAIC Code:                                          0
   Name of person completing this form:                0
   Address 1:                                          0
   Address 2:                                          0
   City:                                               0
   State:                                              0
   ZIP:                                                0
   Telephone:                                          0
   E-Mail:                                             0

                                                                    Association Business Only
                                                             Large Group
                                                           (> 50 members)
1A Earned Premiums
1B Incurred Losses
1C Number of Colorado covered lives as of 1/1/2009
   Number of Colorado covered lives as of 12/31/2009
1D Number of Colorado subscribers as of 1/1/2009
   Number of Colorado subscribers as of 12/31/2009
1E Number of Colorado policies as of 1/1/2009
   Number of Colorado policies as of 12/31/2009

                                                            Stop Loss
2A   Stop Loss Premiums
2B   Employer Group Count
2C   Covered Members
2D   Total Covered Lives

                                                                                      TPA
 3 Were you a TPA for any self-funded plans during 2009? (Y / N)
   (If so, please answer questions 4a, 4b and 4c.)

3a How many covered lives were there at 12/31/2009?
3b How many certificate/policy-holders were there at 12/31/2009?
3c How many group policies were there at 12/31/2009?

 4 Did you provide excess loss insurance (stop loss reinsurance) to any carriers or
   employers with a self-funded plan during 2009? (Y / N)
sociation Business Only
            Small Group
          (1 - 50 members)   Individual
                                                                                                                        2009 Colorado Annual Health Cost Report (C.R.S. 10-16-111)

Many of the questions asked in the Health Cost Report correspond to items on the annual financial statement filed for 2009 (referred to as 'blanks' below). To aid your completion of this report we have included the corresponding lines in
the annual statement for each question, by statement type, if applicable. Please note that we require Colorado health specific responses for most questions, so the data in the annual statement may not equal the response provided for
each question. This guide is designed to provide guidance regarding what we are looking for when you are gathering your responses. In addition, if the data requested is not available on a state-specific health basis or by line of business,
you may provide a response using the allocation method recommended in the instructions. If necessary, you may use a more appropriate allocation method and describe this method in the comment section.




                                        Question                                                    Health                                                        Life                                                       P&C                                                 Fraternal
                                                                                       Supplemental Compensation Exhibit                          Supplemental Compensation Exhibit                           Supplemental Compensation Exhibit                       Supplemental Compensation Exhibit
        4 Please provide the Total Executive Compensation paid in 2009.

                                                                                       Supplemental Compensation Exhibit                          Supplemental Compensation Exhibit                           Supplemental Compensation Exhibit                       Supplemental Compensation Exhibit
       4a Executive Salaries

                                                                                       Supplemental Compensation Exhibit                          Supplemental Compensation Exhibit                           Supplemental Compensation Exhibit                       Supplemental Compensation Exhibit
       4b All Other Compensation (including Stock Options)

                                                                                       Supplemental Compensation Exhibit                          Supplemental Compensation Exhibit                           Supplemental Compensation Exhibit                       Supplemental Compensation Exhibit
       4c Bonuses

             Please provide the amount of each item listed below that is attributable to the Colorado health portion of your business.
                                                                                                                             Expenses on Basic Information Tab
       5a                                                                                       p. 5, line 46, col. 1                                       p. 4, line 52, col. 1                                       p. 4, line 35, col. 1                                     Not applicable
             Dividends Paid to Stockholders

       5b                                                                                       No direct reference                                         No direct reference                                         No direct reference                                     No direct reference
             Paid Lobbying Expenditures (include both internal and external)

       5c                                                                                   p. 14, line 8, col. 2 + col. 3                Exh. 2, line 5.2 + line 7.1 + line 7.2 + line 7.3, col. 3            p. 11, line 3 + line 4, col. 1 + col. 2        Exh. 2, line 5.2 + line 7.1 + line 7.2 + line 7.3, col. 3
             Advertising and Marketing Expenditures

       5d                                                                                   p. 14, line 2, col. 2 + col. 3                                 Exh. 2, line 2, col. 3                                      p. 11, line 8.1, col. 4                                 Exh. 2, line 2, col. 3
             Non-executive Staff Salaries

       5e                                                                                   p. 14, line 4, col. 2 + col. 3                                Exh. 2, line 4.1, col. 3                                p. 11, line 18, col. 1 + col. 2                             Exh. 2, line 4.1, col. 3
             Payments to Legal Counsel

        5f                                                                                      No direct reference                                         No direct reference                                         No direct reference                                     Exh. 2, footnote (a)
             Charitable Contributions

                                                                                                                    Financial and Taxes on Basic Information Tab
       5g                                                                                       p. 4, line 27, col. 2                                  p. 4, line 3 + line 34, col. 1                                   p. 4, line 11, col. 1                              p. 4, line 3 + line 30, col. 1
             Losses on Investments or Investment Income

       5h                                                                                       p. 4, line 32, col. 2                                       p. 4, line 35, col. 1                                       p. 4, line 20, col. 1                                   p. 4, line 31. col. 1
             Net Income

        5i                                                                                      p. 28, line 3, col. 1                                      p. 22, line 28, col. 1                                      No direct reference                                     p. 21, line 15, col. 1
             The Amount of Surplus

        5j                                                                                  p. 28, line 4 - line 3, col. 1                                 p. 22, line 27, col. 1                                      No direct reference                                        Not applicable
             The Amount of Capital

                                                                                               p. 28, line 14, col. 1                                      p. 22, line 30, col. 1                                      p. 17, line 28, col. 1                                  p. 21, line 17, col. 1
       5k Total Adjusted Capital

                                                                                               p. 28, line 15, col. 1                                      p. 22, line 31, col. 1                                      p. 17, line 29, col. 1                                  p. 21, line 18, col. 1
        5l Authorized Control Level Risk-Based Capital

                                                                                                 Company records                                             Company records                                            Company records                                         Company records
      5m State Taxes, Licenses and Fees

       5n                                                                                       p. 4, line 31, col. 2                                       p. 4, line 32, col. 1                                       p. 4, line 19, col. 1                                     Not applicable
             Federal Taxes

                                                                                                      Expenses and Information by Line of Business and Group Size

        8 Colorado Direct Written Premium in 2009

                                                                               A&H Policy Experience Exhibit, all Direct A&H, col. 1      A&H Policy Experience Exhibit, all Direct A&H, col. 1       A&H Policy Experience Exhibit, all Direct A&H, col. 1   A&H Policy Experience Exhibit, all Direct A&H, col. 1
        9 Colorado Direct Earned Premium in 2009

                                                                                                p. 8, col. 3 - col. 2                               Sch. H, Part 4; line B.2 - line A.2                         Sch. H, Part 4; line B.2 - line A.2                     Sch. H, Part 4; line B.2 - line A.2
       10 Net Ceded Colorado Reinsurance Premiums in 2009

                                                                                                 p. 6, line 8, col. 1                                     Sch. H, Part 1; line 13                                     Sch. H, Part 1; line 13                                 Sch. H, Part 1; line 13
       11 Dividends Paid to Colorado Policyholders

          Total Reserves on hand as of 12/31/2009 (including active life                p. 10, line 4.1 + p. 13, lines (6+12)                 Sch. H, Part 2; line A.4 + line B.3 + line C.1              Sch. H, Part 2; line A.4 + line B.3 + line C.1          Sch. H, Part 2; line A.4 + line B.3 + line C.1
       12 reserves, claims reserves and premium deficiency reserves)

                                                                                             p. 9, line 12.3 - line 12.2                            Sch. H, Part 4; line B.3 - line A.3                         Sch. H, Part 4; line B.3 - line A.3                     Sch. H, Part 4; line B.3 - line A.3
       13 Net Colorado Reinsurance Recoveries in 2009

                                                                               A&H Policy Experience Exhibit, all Direct A&H, col. 2      A&H Policy Experience Exhibit, all Direct A&H, col. 2       A&H Policy Experience Exhibit, all Direct A&H, col. 2   A&H Policy Experience Exhibit, all Direct A&H, col. 2
       14 The Cost of providing or arranging healthcare services

                                                                               A&H Policy Experience Exhibit, all Direct A&H, col. 3      A&H Policy Experience Exhibit, all Direct A&H, col. 3       A&H Policy Experience Exhibit, all Direct A&H, col. 3   A&H Policy Experience Exhibit, all Direct A&H, col. 3
       15 Change in Contract Reserves
          Expenditures for disease or case management programs or
          patient education and other cost containment or quality                              p. 14, line 26, col. 1                                     Exh. 2, line 10, col. 2                                               N/A                                           Exh. 2, line 10, col. 2
       16 improvement expenses

                                                                                            p. 14, line 3, col. 2 + col. 3                          Exh. 1, part 2, line 31, cols. 8-10                           p. 11, line 2.8, col. 1 + col. 2                         Exh.1, part 2, line 31, col. 4
       17 Insurance Producer Commissions

                                                                                                p. 7, (lines 19+20)                                     Sch. H, Part 1, lines (4+8)                                Sch. H, Part 1, lines (4+8)                              Sch. H, Part 1, lines (4+8)
       18 Total Colorado Administrative Expenses

                                                                                    Should be provided by the pricing actuary                  Should be provided by the pricing actuary                   Should be provided by the pricing actuary               Should be provided by the pricing actuary
       19 Provision for Profit and Contingencies

                                                                                    Should be provided by the pricing actuary                  Should be provided by the pricing actuary                   Should be provided by the pricing actuary               Should be provided by the pricing actuary
       20 Cumulative Rate Change in 2009

                                                                                                                                                 Trend
                                                                                    Should be provided by the pricing actuary                  Should be provided by the pricing actuary                   Should be provided by the pricing actuary               Should be provided by the pricing actuary
       21 Medical trend due solely to provider price changes

                                                                                    Should be provided by the pricing actuary                  Should be provided by the pricing actuary                   Should be provided by the pricing actuary               Should be provided by the pricing actuary
       22 Medical trend due solely to utilization changes

                                                                                    Should be provided by the pricing actuary                  Should be provided by the pricing actuary                   Should be provided by the pricing actuary               Should be provided by the pricing actuary
       23 Medical trend due solely to medical cost-shifting
          Medical trend due solely to new medical procedures and
                                                                                    Should be provided by the pricing actuary                  Should be provided by the pricing actuary                   Should be provided by the pricing actuary               Should be provided by the pricing actuary
       24 technology

                                                                                    Should be provided by the pricing actuary                  Should be provided by the pricing actuary                   Should be provided by the pricing actuary               Should be provided by the pricing actuary
       25 Total Medical Trend
          Prescription drug trend due solely to pharmaceutical price
                                                                                    Should be provided by the pricing actuary                  Should be provided by the pricing actuary                   Should be provided by the pricing actuary               Should be provided by the pricing actuary
       26 changes

                                                                                    Should be provided by the pricing actuary                  Should be provided by the pricing actuary                   Should be provided by the pricing actuary               Should be provided by the pricing actuary
       27 Prescription drug trend due solely to utilization changes

                                                                                    Should be provided by the pricing actuary                  Should be provided by the pricing actuary                   Should be provided by the pricing actuary               Should be provided by the pricing actuary
       28 Prescription drug trend due solely to cost-shifting
          Presciption drug trend due solely to introductions of new brand
                                                                                    Should be provided by the pricing actuary                  Should be provided by the pricing actuary                   Should be provided by the pricing actuary               Should be provided by the pricing actuary
       29 name and generic drugs

                                                                                    Should be provided by the pricing actuary                  Should be provided by the pricing actuary                   Should be provided by the pricing actuary               Should be provided by the pricing actuary
       30 Total Prescription Drug Trend

								
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