New Jersey Individual Health Coverage Program 1997/1998 Final Loss Assessment Updated - December, 2017 Initially Reported Pro-Rata % of Adjusted FINAL 1997/1998 Net Earned Adjusted Net Earned Reimbursable Loss Share Exemptions from Adjusted NEP after NEP after 1997/1998 Loss 11/17/99 Assessment 11/17/99 Assessment 6/23/00 Assessment 6/23/00 Assessment Carrier Names NAIC # Premium (NEP) NEP Adjustment Reason for Adjustment Premium % of Adjusted NEP (unadjusted) Loss Assessment Goal Not Met % Exemptions Exemptions Assessment Payment Received Credits Payment Received 6/23/00 Refunds Paid Credits AEGON Group of Insurance Companies 66281/86231 $ 11,993,631 $ 11,993,631 0.09% $ 25,149 $ 11,993,631 0.28% $ 80,815.51 $ 265,708.69 $ 33,142.04 95287/72052/95720/97705/60054/865 Aetna Inc. 09/95533 $ 3,568,579,471 $ 3,568,579,471 25.82% $ 7,482,715 63.13% 36.87% $ 1,315,735,251 30.59% $ 8,865,690.51 $ 2,897,746.60 $ (6,907.64) Allianz Life Insurance Company of North America 90611 $ 5,692,323 $ 5,692,323 0.04% $ 11,936 $ 5,692,323 0.13% $ 38,356.02 $ 126,108.57 $ 15,729.62 Americaid New Jersey, Inc. 95373 $ 60,512,541 $ (60,512,541) N/A - Medicaid HMO $ - 0.00% $ - $ - 0.00% $ - American General Life Insurance Company of NY 67571 $ 37,865 $ 37,865 0.00% $ 79 $ 37,865 0.00% $ 255.14 $ 838.87 $ 104.63 American Life Insurance Company of New York 60704 $ 3,934 $ 3,934 0.00% $ 8 $ 3,934 0.00% $ 26.51 $ 87.15 $ 10.88 American National Insurance Company 60739 $ 1,256,112 $ 1,256,112 0.01% $ 2,634 $ 1,256,112 0.03% $ 8,463.94 $ 27,828.09 $ 3,471.02 American Preferred Provider Plan $ 2,587,315 $ 2,587,315 0.02% $ 5,425 $ 2,587,315 0.06% $ 17,433.85 $ - $ - American Progressive Life & Health Ins Co of NY 80624 $ 719,294 $ 719,294 0.01% $ 1,508 $ 719,294 0.02% $ 4,846.75 $ 15,935.35 $ 1,987.62 American Republic Insurance Company 60836 $ 402,407 $ 402,407 0.00% $ 844 $ 402,407 0.01% $ 2,711.50 $ 8,914.98 $ 1,111.98 AmeriHealth HMO Inc. 95044/60061 $ 560,425,580 $ 207,827,089 Revised Exhibit K 11/10/99 $ 768,252,669 5.56% $ 1,610,898 90.36% 9.64% $ 74,059,557 1.72% $ 499,028.29 $ 118,951.28 $ (283.56) Anthem Health & Life 67369 $ 53,423,668 $ 53,423,668 0.39% $ 112,021 $ 53,423,668 1.24% $ 359,979.49 $ 1,183,555.91 $ 147,625.78 AtlantiCare Health Plans 95526 $ 5,786,113 $ 5,786,113 0.04% $ 12,133 $ 5,786,113 0.13% $ 38,988.00 $ 128,186.41 $ 15,988.78 Bankers Life and Casualty Company 61263 $ 1,082,089 $ 1,082,089 0.01% $ 2,269 $ 1,082,089 0.03% $ 7,291.33 $ 23,972.76 $ 2,990.14 Bankers Multiple Line Insurance Company 23132 $ 15,901 $ 15,901 0.00% $ 33 $ 15,901 0.00% $ 107.14 $ 352.27 $ 43.94 Banner Life Insurance Company 94250 $ 2,704 $ 2,704 0.00% $ 6 $ 2,704 0.00% $ 18.22 $ 59.90 $ 7.48 BCS Life Insuance Company 80985 $ 1,118 $ 1,118 0.00% $ 2 $ 1,118 0.00% $ 7.53 $ 24.77 $ 3.09 Boston Mutual Life Insurance Co. 61476 $ 3,408,676 $ 3,408,676 0.02% $ 7,147 $ 3,408,676 0.08% $ 22,968.35 $ 75,516.32 $ 9,419.20 Celtic Life Insurance Company 80799 $ 40,052,261 $ 40,052,261 0.29% $ 83,983 $ 40,052,261 0.93% $ 269,880.24 $ 887,323.76 $ 110,676.54 Continental Casualty Company 20443 $ 4,574,705 $ 4,574,705 0.03% $ 9,592 $ 4,574,705 0.11% $ 30,825.29 $ 101,348.70 $ 12,641.29 Colonial Penn Insurance Companies 34789/20796/62065 $ 457,361 $ 457,361 0.00% $ 959 $ 457,361 0.01% $ 3,081.79 $ 10,132.45 $ 1,263.83 Commercial Travelers Mutual Insurance Company 81426 $ 1,734,815 late submission AO 00-07 $ 1,734,815 0.01% $ 3,638 $ 1,734,815 0.04% $ 11,689.53 $ - $ 43,227.17 Connecticut General Life Insurance Company 62308 $ 863,884,120 $ 863,884,120 6.25% $ 1,811,421 19.45% 80.55% $ 695,858,659 16.18% $ 4,688,836.53 $ 1,532,128.37 $ (3,652.28) Conseco Variable Insurance Co. 64017 $ 182 $ 182 0.00% $ 0 $ 182 0.00% $ 1.23 $ 4.03 $ 0.50 CUNA Mutual Insurance Society 62626 $ 4,285,153 $ 4,285,153 0.03% $ 8,985 $ 4,285,153 0.10% $ 28,874.23 $ 94,933.92 $ 11,841.17 Educators Mutual Life Insurance Company 62804 $ 49,031 $ 49,031 0.00% $ 103 $ 49,031 0.00% $ 330.38 $ 1,086.24 $ 135.49 Empire Health Plans Assurance, Inc. 61705 $ 6,593 $ 6,593 0.00% $ 14 $ 6,593 0.00% $ 44.42 $ 146.06 $ 18.22 Employers Health Insurance Company 73288 $ 118,317 $ 118,317 0.00% $ 248 $ 118,317 0.00% $ 797.24 $ 2,621.21 $ 326.95 Equitable Life Assurance Society of the U.S. 62944 $ 13,015,485 $ 13,015,485 0.09% $ 27,291 $ 13,015,485 0.30% $ 87,700.97 $ 288,347.00 $ 35,965.72 Farm Family Life Insurance Company 63126 $ 87,308 $ 87,308 0.00% $ 183 $ 87,308 0.00% $ 588.30 $ 1,934.23 $ 241.26 Fidelity Security Life Insurance Company 71870 $ 6,891,061 $ 6,891,061 0.05% $ 14,449 $ 6,891,061 0.16% $ 46,433.36 $ 152,665.59 $ 19,042.09 First Allmerica Financial Life Insurance Company 84824/69140 $ 4,606,329 $ 4,606,329 0.03% $ 9,659 $ 4,606,329 0.11% $ 31,038.38 $ 102,049.30 $ 12,728.68 Fortis Benefits Insurance Company 70408 $ 3,098,030 $ 2,111,995 NEP Revision 7/19/01 $ 5,210,025 0.04% $ 10,925 $ 5,210,025 0.12% $ 35,106.20 $ - $ - Fortis Insurance Company 69477 $ 11,223,360 $ 11,223,360 0.08% $ 23,534 $ 11,223,360 0.26% $ 75,625.27 $ 248,643.99 $ - $ 31,013.55 Foundation Health Systems 95351/95334/95079 $ 873,927,478 $ 153,345,020 NEP Revision AO 00-06 $ 1,027,272,498 7.43% $ 2,154,019 75.58% 24.42% $ 250,859,944 5.83% $ 1,690,345.09 $ 469,696.47 $ 81,099.88 General American Life Insurance Company 63665 $ 3,990,607 $ 3,990,607 0.03% $ 8,368 $ 3,990,607 0.09% $ 26,889.52 $ 88,408.50 $ 11,027.26 Great-West Life and Annuity Insurance Company 68322 $ 10,038 $ 10,038 0.00% $ 21 $ 10,038 0.00% $ 67.64 $ 222.38 $ 27.74 Guarantee Life Insurance Company 64181 $ 535 $ 535 0.00% $ 1 $ 535 0.00% $ 3.60 $ 11.85 $ 1.48 Guarantee Trust Life Insurance Company 64211 $ 51,376 $ 51,376 0.00% $ 108 $ 51,376 0.00% $ 346.18 $ 1,138.19 $ 141.97 Guardian Life Insurance Company of America 64246 $ 342,741,332 $ 342,741,332 2.48% $ 718,671 0.08% 99.92% $ 342,467,139 7.96% $ 2,307,612.92 $ 754,037.64 $ (1,797.47) Health Plans of America (NJ), Inc. N/A $ 2,033,871 $ 2,033,871 0.01% $ 4,265 $ 2,033,871 0.05% $ 13,704.63 $ 26,781.76 HIP Health Plan of New Jersey 95470 $ 685,211,035 $ 685,211,035 4.96% $ 1,436,773 100.00% 0.00% $ - 0.00% $ - $ - $ - Horizon Healthcare Services, Inc. 55069/95529 $ 3,310,150,929 $ 3,310,150,929 23.95% $ 6,940,834 100.00% 0.00% $ - 0.00% $ - $ - $ - Jefferson Pilot Life America 62057 $ 28,943,417 $ 69,890,743 Exhibit K Adjmt AO 00-03 $ 98,834,160 0.72% $ 207,239 $ 98,834,160 2.30% $ 665,964.58 $ 641,216.78 $ 1,821,478.67 John Alden Life Insurance Company 65080 $ 24,211,334 $ 24,211,334 0.18% $ 50,767 $ 24,211,334 0.56% $ 163,140.87 $ 536,381.50 $ 66,903.26 John Deere Insurance Company 21180 $ 222,087 $ 222,087 0.00% $ 466 $ 222,087 0.01% $ 1,496.47 $ 4,920.15 $ 613.69 John Hancock Mutual Life Insurance Company 65099 $ 24,321,807 $ (10,460,869) Exhibit K Adjmt AO 00-04 $ 13,860,938 0.10% $ 29,064 $ 13,860,938 0.32% $ 93,397.81 $ 538,828.94 $ (193,449.68) Liberty Mutual Insurance Company 65315/23043 $ 14,148 $ 14,148 0.00% $ 30 $ 14,148 0.00% $ 95.33 $ 313.44 $ 39.09 Lincoln National Life Insurance 65676 $ 1,413,050 $ 1,413,050 0.01% $ 2,963 $ 1,413,050 0.03% $ 9,521.42 $ 31,304.92 $ 3,904.69 Loyal American Life Insurance Company 65722 $ 40,032 $ 40,032 0.00% $ 84 $ 40,032 0.00% $ 269.74 $ 886.87 $ 110.63 Managed Healthcare Systems of New Jersey, Inc. 95497 $ 111,057,755 $ (111,057,755) N/A - Medicaid HMO $ - 0.00% $ - $ - 0.00% $ - $ - Manhattan National Life Ins. Co. 67083 $ 9,630,229 $ 9,630,229 0.07% $ 20,193 $ 9,630,229 0.22% $ 64,890.43 $ 213,349.53 $ 26,611.24 Massachusetts Casualty Insurance Company 80896 $ 37,707 $ 37,707 0.00% $ 79 $ 37,707 0.00% $ 254.08 $ 835.37 $ 104.19 Massachusetts Mutual Life Insurance Company 65935 $ 14,051,177 $ 14,051,177 0.10% $ 29,463 $ 14,051,177 0.33% $ 94,679.68 $ 311,291.87 $ 38,827.66 Metropolitan Life Insurance Company 65978 $ 67,922,917 $ 67,922,917 0.49% $ 142,423 $ 67,922,917 1.58% $ 457,678.37 $ 1,504,774.43 $ 187,691.60 Minnesota Life Insurance Company 66168 $ 4,396 $ 4,396 0.00% $ 9 $ 4,396 0.00% $ 29.62 $ 97.39 $ 12.15 MONY Life Insurance Company 66370 $ 76,984 $ 76,984 0.00% $ 161 $ 76,984 0.00% $ 518.73 $ 1,705.52 $ 212.73 Mutual of Omaha Insurance Company 71412 $ 15,272,615 $ 15,272,615 0.11% $ 32,024 $ 15,272,615 0.36% $ 102,909.97 $ 338,351.79 $ 42,202.86 National Benefit Life Insurance Co.