QUARTERLY STATEMENT - Tennessee
QUARTERLY STATEMENTOF THEAMERIGROUP Tennessee, Inc.ofNashvillein the state ofTennessee2020TO THEInsurance DepartmentOF THE STATE OFTennesseeFOR THE YEAR ENDEDJUNE 30, 2020HEALTH2020
STATE OF TENNESSEEDEPARTMENT OF COMMERCE AND INSURANCEFinancial Affairs Section / Analytical Unit 0576500 James Robertson Parkway, 10th FloorNashville, Tennessee 37243-1132(615) 741-1670HEALTH ENTITIESCOMPANY NAME: AMERIGROUP Tennessee, Inc.NAIC Company Code: 12941Telephone: 757-518-3638Contact: Bette Lou GronsethREQUIRED FILINGS IN THE STATE OF:TENNESSEE(1)(2)(3)ChecklistLine #REQUIRED FILINGS FOR THE ABOVE STATE11.1 21112131415161718 19202122II. NAIC SUPPLEMENTSAccident & Health Policy Experience ExhibitActuarial OpinionLife Supplemental Data due March 1Life Supplemental Data due April 1Life Supp Statement non-guaranteed elements –Exh 5, Int. #3Life Supp Statement on par/non-par policies – Exh5 Int. 1&2Life, Health & Annuity Guaranty Assessment BaseReconciliation ExhibitLife, Health & Annuity Guaranty Assessment BaseReconciliation Exhibit Adjustment FormLong-Term Care Experience Reporting FormsManagement Discussion & AnalysisMedicare Part D Coverage SupplementStateNAICState2EO2EOJuratOnly –Note Lxxx2EO22222(5)DUE DATE(6)FORMSOURCE**(7)APPLICABLENOTES3/1NAICA-C, E-P3/1NAICA, Bxxx5/15, 8/15,11/15NAICA, B, E-O, AICNAICVA, B, E-G, xxx2861626364656667III. ELECTRONIC FILINGREQUIREMENTSAnnual Statement Electronic FilingMarch .PDF FilingRisk-Based Capital Electronic FilingRisk-Based Capital .PDF FilingSupplemental Electronic FilingSupplemental .PDF FilingQuarterly Statement Electronic Filing111111168Quarterly .PDF Filing169June .PDF Filing127 Printed Investment Schedule detail (Pages E01E29)Quarterly Financial Statement (8 ½” x 14”)(4)NUMBER OF COPIES*DomesticForeignMedicare Supplement Insurance ExperienceExhibitRisk-Based Capital ReportSchedule SISSupplemental Compensation ExhibitSupplemental Health Care Exhibit (Parts 1, 2 and3)Supplemental Health Care Exhibit’s AllocationReportSupplemental Investment Risk Interrogatories23242526 I. NAIC FINANCIAL STATEMENTSAnnual Statement (8 ½”X14”)Filings Made During the Year 20204/14/14/13/1, 5/15,8/15, 11/15NAICNAICCompanyA, NAIC3/13/13/13/14/14/15/15, 8/15,11/155/15, **ALL HMOs licensed in Tennessee must follow the “Domestic” column filing requirements. 2019 National Association of Insurance Commissioners1HealthTennessee Department of Commerce and Insurance, Authorization #335563 (October 15, 2019), this public document is electronic only and was promulgated at a cost of 0.00 per copy.
(1)(2)(3)ChecklistLine #REQUIRED FILINGS FOR THE ABOVE STATE8182838485868788899091DUE ompanyA, BA, BA, BA, BN/AN/ACompanyA, B1N/AN/AWithin 5Days8/1CompanyA, B1N/AN/ACompanyA, B1EOxxxWithin 10days ofCPADiscovery3/1CompanyA, B1EOxxx3/1CompanyA, B1EOxxx3/1CompanyA, B1N/AN/ACompanyA, B1020000xxxCompanyStateA, BStateNAICState1111EOEON/AEO1Management’s Report of Internal Control OverFinancial ReportingNotification of Adverse Financial ConditionRelief from the five-year rotation requirement forlead audit partnerRelief from the one-year cooling off period forindependent CPARelief from the Requirements for AuditCommitteesRequest for Exemption to File Management’sReport of Internal Control Over FinancialReportingIV. AUDIT/INTERNAL CONTROLRELATED REPORTSAccountant’s Letter of QualificationsAudited Financial ReportsAudited Financial Reports Exemption AffidavitCommunication of Internal Control Related MattersNoted in AuditIndependent CPA (change)104105V. STATE REQUIRED FILINGSCorporate Governance Annual Disclosure***Filings Checklist (with Column 1 completed)Form B-Holding Company Registration Statementand Form C-Summary of RegistrationForm F-Enterprise Risk Report ****ORSA *****22106Premium Tax110110210300xxxN/A0100107108State Filing FeesSigned Jurat12109Certificate of Compliance for Life, A&HAdvertisingCertificate of ComplianceCertificate of Deposit2000000 110111(7)APPLICABLENOTES(6)FORMSOURCE**(4)NUMBER OF 30Case-byCase3/1, 6/1,8/20, 12/13/13/1, 5/15,8/15, 11/15 Domestics;3/1 ForeignsA, B, UCompanyCompanyA, B, UCompanyA, C, D, TStateStateA, C, DA, B, F-I, L, Q13/1NAICStateR003/13/1StateStateBB*If XXX appears in this column, this state does not require this filing, if hard copy is filed with the state of domicile and if the data is filed electronicallywith the NAIC. If N/A appears in this column, the filing is required with the domiciliary state. EO (electronic only filing).**If Form Source is NAIC, the form should be obtained from the appropriate vendor.***For those states that have adopted the NAIC Corporate Governance Annual Disclosure Model Act, an annual disclosure is required of all insurersor insurance groups by June 1. The Corporate Governance Annual Disclosure is a state filing only and should not be submitted by the company to theNAIC. Note however that this filing is intended to be submitted to the lead state if filed at the insurance group level. For more information on leadstates, see the following NAIC URL: http://www.naic.org/public lead state report.htm.****For those states that have adopted the NAIC updated Holding Company Model Act, a Form F filing is required annually by holding companygroups. Consistent with the Form B filing requirements, the Form F is a state filing only and should not be submitted by the company to the NAIC.Note however that this filing is intended to be submitted to the lead state. For more information on lead states, see the following NAIC URL:http://www.naic.org/public lead state report.htm*****For those states that have adopted the NAIC Risk Management and Own Risk and Solvency Assessment Model Act, a summary report isrequired annually by insurers and insurance groups above a specified premium threshold. The ORSA Summary Report is a state filing only and shouldnot be submitted by the company to the NAIC. Note however that this filing is intended to be submitted to the lead state if filed at the insurance grouplevel. For more information on lead states, see the following NAIC URL: http://www.naic.org/public lead state report.htm 2019 National Association of Insurance Commissioners2Health
ANOTES AND INSTRUCTIONS (A-K APPLY TO ALLFILINGS)Required Filings Contact Person:Domestic Hospital, Medical, Dental, & Indemnity Corp., HMO, Visionand Dental Contact Person:Hui Wattanaskolpant, (615) 253-2958Hui.Wattanaskolpant@tn.govAnnual Fees, Tax, & Penalty Questions:Kim Blaylock, (615) 532-7567Kim.Blaylock@tn.govBMailing Address:State of TennesseeDepartment of Commerce and InsuranceFinancial Affairs Section / Analytical Unit 0576500 James Robertson Parkway, 10TH FloorNashville, Tennessee 37243-1132(615) 741-1670CMailing Address for Filing Fees:TCA 56-32-119 provides for a 195.00 445.00 HMO AnnualStatement filing fee.This fee is included on the premium tax returnand should be submitted through OPTins.TCA 56-29-119 provides for a 515.00 Annual Statement filing fee forHospital and Medical Service Corporation.TCA 56-30-117 provides for a 50 Dental Service Plan AnnualStatement filing fee and 56-31-116 provides for a 15 Vision ServicePlan Annual Statement filing fee.Please DO NOT enclose this fee with Annual Statement.DMailing Address for Premium Tax Payments:EDelivery Instructions:OPTins is mandatory with electronic tax filings.Click Here to Participate.E1. Premium tax delivery instructionsA tax return with payment must be submitted via OPTins on or beforeMarch 1st to be considered a timely filing. Please note the statues do notallow a waiver of a late payment of penalty.E2. Annual statement delivery instructionsAn Annual Statement filing must be postmarked on or before March 1st tobe considered a timely filing. The document will be considered a promptfiling provided such document bears a postmark, or comparable marking,no later than the due date and is transmitted by the United States PostalService, FedEx, United Parcel Services, or other carrier recognized by theCommissioner.FLate Filings:Timely filings must be received on or before March 1st.Tennessee DOES NOT recognize filing extensions for AnnualStatements.An example of an incomplete filing is one that does not adhere to therequirements in one or more of the following sections: G, H, L, M, O,P.Late or incomplete filings are assessed a 100.00 per day late or incomplete filing penalty,pursuant to TCA §56-1-502.See Note E above regarding proper postmarksIn addition, electronic filings must be made with the NAIC by March1 to be considered timely per Tenn. R. & Reg. Ch. 0780-01-37-.08.GHOriginal Signatures:Please use blue ink.Signature/Notarization/Certification: 2019 National Association of Insurance CommissionersORIGINAL JURAT, NOTARY, ANDACTUARY SIGNATURES ARE REQUIREDTennessee requires original signatures, includingan original notary signature.3Health
IAmended Filings:JKLExceptions from normal filings:Bar Codes (State or NAIC):Signed Jurat:MNONE Filings:NOFilings new, discontinued or modified materially since last year:Size, printing standards, numbering, & binding:PActuarial Opinion:The Actuarial Opinion or Domiciliary State exemption letter must beon or attached to page 1 of the Annual Statement.QQuarterly Financial Statement (8 ½” x 14”)RCertificate of Compliance A&H advertisingSExemptionsTLate payment of Premium TaxesAll delinquencies shall bear interest of ten percent (10%) per annumfrom the date the amount was due and paid, pursuant to TCA 56-4216UHolding Company Registration StatementVA&H Policy Experience ExhibitTennessee’s Holding Company Registration Deadline is April 30thThe A&H Policy Experience Exhibit must be mailed under separatecover 2019 National Association of Insurance Commissioners4An explanation of the amendment is required.The amended financial statement filingrequires a jurat page with original signaturesand notary.NONENAIC Bar Code InstructionsTCA §56-1-501 requires the financial statementbe subscribed and sworn to by the President andSecretary, or in their absence, two (2) principalofficers. If the statement is signed by anyoneother than the President and Secretary, anaffidavit must be included and stated that suchperson is a principal officer elected by the boardof directors.NAIC Annual Statement Instructions. Blankexhibits or schedules without the word “NONE”will result in an interpretation that an incompletefiling was submitted, and will be subject to filingpenalties, pursuant to Note “F” above.NoneThe NAIC Annual Statement Instructionsprovide guidance on printing standards,statement layout, and required binding. AnnualStatements are properly bound if they are stapledin the CENTER seam or professionally bound byadhesive.The opinion must bear an original signature,and must be completed by a Qualified Actuary.If an Actuarial Opinion does not contain anoriginal signature, the filing will be subject to thepenalties noted in Note “F”Foreign: File with NAIC onlyDomestic & HMOs: Required to fileAn affidavit from the company regardingcompliance with the rule is acceptable. Pursuantto Tenn. Comp. R. & Regs., Ch. 0780-1-8-.17 Annual Statements—Not Allowed. Audited Statements— Must file by June 1Actuarial Opinion—Must file by December 1Premium taxes will be assessed in addition to theamount of taxes; five percent (5%) for the firstmonth or fractional part thereof, additional fivepercent (5%) for the second month or fractionalpart thereof, and penalty thereafter at one half ofone percent (0.5%) per month.Foreign companies & foreign HMOs are NOTrequired to file if domiciliary state laws aresubstantially similar to Tennessee’s Title 56,Chapter 11.State of TennesseeDepartment of Commerce & Insurance10th Floor, Actuarial Section500 James Robertson ParkwayNashville, TN 37243-1130ATTN: Brian HoffmeisterHealth
General InstructionsFor Companies to Use ChecklistPlease Note:This state’s instructions for companies to file with the NAIC are included in this Checklist. The NAICwill not be sending its own checklist this year.Electronic Filing is intended to be filing(s) submitted to the NAIC via the NAIC Internet Filing Sitewhich eliminates the need for a company to submit diskettes or CD-ROM to the NAIC. Companies arenot required to file hard copy filings with the NAIC.Column (1)ChecklistCompanies may use the checklist to submit to a state, if the state requests it. Companies should copy the checklist and place an“x” in this column when submitting information to the state.Column (2)Line #Line # refers to a standard filing number used for easy reference. This line number may change from year to year.Column (3)Required FilingsName of item or form to be filed.The Annual Statement Electronic Filing includes the annual statement data and all supplements due March 1, per the AnnualStatement Instructions. This includes all detail investment schedules and other supplements for which the Annual StatementInstructions exempt printed detail.The March.PDF Filing is the .pdf file for annual statement data, detail for investment schedules and supplements due March 1.The Risk-Based Capital Electronic Filing includes all risk-based capital data.The Risk-Based Capital.PDF Filing is the .pdf file for risk-based capital data.The Supplemental Electronic Filing includes all supplements due April 1, per the Annual Statement Instructions.The Supplemental.PDF Filing is the .pdf file for all supplemental schedules and exhibits due April 1.The Quarterly Electronic Filing includes the complete quarterly filing and the PDF files for all quarterly data.The Quarterly.PDF Filing is the .pdf file for quarterly statement data.The June.PDF Filing is the .pdf file for the Audited Financial Statements and Accountants Letter of Qualifications.Column (4)Number of CopiesIndicates the number of copies that each foreign or domestic company is required to file for each type of form. The Blanks (EX)Task Force modified the 1999 Annual Statement Instructions to waive paper filings of certain NAIC supplements and certaininvestment schedule detail, if such investment schedule data is available to the states via the NAIC database. The checklistsreflect this action taken by the Blanks (EX) Task Force. XXX appears in the “Number of Copies” “Foreign” column for theappropriate schedules and exhibits. Some states have chosen to waive printed quarterly and annual statements from theirforeign insurers and have chosen to rely upon the NAIC database for these filings. This waiver could includesupplemental annual statement filings. The XXX in this column might signify that the state has waived the paper filing ofthe annual statement and all supplements., 2019 National Association of Insurance Commissioners5Health
Column (5)Due DateIndicates the date on which the company must file the form.Column (6)Form SourceThis column contains one of three words: “NAIC,” “State,” or “Company,” If this column contains “NAIC,” the company mustobtain the forms from the appropriate vendor. If this column contains “State,” the state will provide the forms with the filinginstructions (generally, on the state web site). If this column contains “Company,” the company, or its representative (e.g., itsCPA firm), is expected to provide the form based upon the appropriate state instructions or the NAIC Annual StatementInstructions.Column (7)Applicable NotesThis column contains references to the Notes to the Instructions that apply to each item listed on the checklist. The companyshould carefully read these notes before submitting a filing.w:\qa\blanks\checklists\2018 filings made in 2019\2 hlthcklist 2018 filingsmade2019.docx 2019 National Association of Insurance Commissioners6Health
Amerigroup Tennessee, Inc.Statement of Actuarial OpinionTable of Key Indicators:This Opinion ification SectionoPrescribed WordingOnlyxPrescribed Wording with Additional WordingoRevised WordingScope SectionxPrescribed WordingOnlyoPrescribed Wording with Additional WordingoRevised WordingReliance SectionoPrescribed WordingOnlyoPrescribed Wording with Additional WordingxRevised WordingOpinion SectionoPrescribed WordingOnlyoPrescribed Wording with Additional WordingxRevised WordingRelevant Commentsx Revised Wordingo The Actuarial Memorandum includes “Deviation from Standard” wording regarding conformity with an Actuarial Standard ofPracticeIdentificationI, Kecia Rockoff, Director & Actuary III, am an employee of Anthem Inc., and a member of the American Academy of Actuaries. I wasappointed on November 01, 2017 in accordance with the requirements of the annual statement instructions for Amerigroup Tennessee, Inc.,a subsidiary of Anthem, Inc. I meet the Academy qualification standards for rendering the opinion.ScopeI have examined the assumptions and methods used in determining loss reserves, actuarial liabilities and related items listed below, as shownin the quarterly statement of the organization as prepared for filing with state regulatory officials, as of June 30, 2020:A.B.C.D.Claims unpaid (Page 3, Line 1)Accrued medical incentive pool and bonus payments (Page 3, Line 2)Unpaid claims adjustment expenses (Page 3, Line 3)Aggregate health policy reserves (Page 3, Line 4) including unearnedpremium reserves, premium deficiency reserves and additional policyreserves from the Underwriting and Investment Exhibit – Part 2DE. Aggregate life policy reserves (Page 3, Line 5)F. Property/casualty unearned premium reserves (Page 3, Line 6)G. Aggregate health claim reserves (Page 3, Line 7) 158,960,155 7,432,733 3,616,732 42,573,885 0 0 0
H. Any other loss reserves, actuarial liabilities, or related items presentedas liabilities in the quarterly statementI. Specified actuarial items presented as assets in the quarterly statement1. Actuarial Portion of Rx Rebate Receivables (part of Page 2; Lin e 24, Column 1)2. Actuarial Portion of AR CMS - Medicare Final Sweep (part of Page 2; Line 15.3)3. Actuarial Portion of AR CMS - Medicare MidYear Sweep (part of Page 2; Line 15.3)Not Applicable 532,974 3,067,617 2,346,967RelianceIn forming my opinion on Unearned Premium Reserves (part of Aggregate Health Policy Reserves) and Legal Claim Reserves (part ofUnpaid Claims), I relied upon data prepared by Vincent Scher, Staff VP Investment Programs & Treasurer, and Michelle M. RothenbergWilliams, Managing Associate General Counsel Senior, Anthem Inc. as certified in the attached statements. I evaluated that data forreasonableness and consistency.In other respects, my examination included such review of the actuarial assumptions and actuarial methods and of the underlying basicliability records and such tests of the actuarial calculations as I considered necessary. I also reconciled the underlying basic liability recordsto the Underwriting and Investment Exhibit, Analysis of Claims Unpaid of the company’s current quarterly statement.OpinionIn my opinion, the amounts carried in the balance sheet on account of the items identified above:A. Are in accordance with accepted actuarial standards consistently a pplied and are fairly stated in accordance with sound actuarialprinciples;B. Are based on actuarial assumptions relevant to contract provisions and appropriate to the purpose for which the statement wasprepared;C. Meet the requirements of the Insurance Laws and regulations of th e state of Tennessee, and are at least as great as the minimumaggregate amounts required by the state in which this statement is filed;D. Make a good and sufficient provision for all unpaid claims and oth er actuarial liabilities of the organization under the terms of itscontracts and agreements;E. Are computed on th
COMPANY NAME: NAIC Company Code: Contact: Telephone: REQUIRED FILINGS IN THE STATE OF: TENNESSEE Filings Made During the Year 2020 . this state does not require this filing, if hard copy is filed with the state of domicile and if the data is filed electronically with the NAIC. If N/A ap
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